EFFECT OF THROMBOPROPHYLAXIS WITH ENOXAPARIN ON INFLAMMATION MARKERS
Keywords:
thromboprophylaxis, enoxaparin, elective abdominal surgery, mediators of inflammationAbstract
The object of our study is to study the effect of different pre-surgical start periods of thromboprophylaxis with enoxaparin Flenox on levels of pro- and antiinflammatory cytokines. Materials and methods: 80 subjects were prospectively grouped by drug products and thromboprophylaxis regimens. In group 1, UFH (5000 units) was administered 2 hrs before surgery and by 5000 units twice a day for 7 days after surgery. In group 2 (n=30), enoxaparin (Flenox 0.2 mL) 2500 IU was administered 2 hrs before surgery and 2500 UI once a day for 7 days after surgery. In group 3 patients, thromboprophylaxis included administration of enoxaparin (Flenox 0. 2 mL) 2500 IU 8 hrs before surgery and 2500 IU once a day for 7 days after surgery. The levels of IL-1α, TNF-α, IL-6, IL-10 were examined before surgery (stage 1), on the 1st day after surgery (stage 2) and on the 5th day after surgery (stage 3). Results and discussions. In the course thromboprophylaxis with UFH, activation of pro-inflammatory cytokines reduced and was accompanied by inhibition of antiinflammatory cytokines on the 5th day after surgery. Administration of enoxaparin 2 hrs before surgery did not significantly change the inflammatory response to surgical aggression. Therefore, activity of inflammatory response is possibly reduced as a result of reduction of IL-1α by 80 %, and IL-10 — by 23 %. Conclusions. UFH has a short and unstable anti-inflammatory effect. Enoxaparin Flenox administered 2 hrs before surgery ensured normalization of the level of antiinflammatory IL-10 and significant increase in pro-inflammatory cytokines from the first day after surgery, the prevalence of which gave evidence of significant inflammatory process. Enoxaparin Flenox administered 8 hrs before surgery ensured significant reduction of the level of pro-inflammatory cytokines, which, despite some reduction of the level of anti-inflammatory IL-10, gave evidence in favour of strong anti-inflammatory effect of such period of start of thromboprophylaxis.
References
Симбирцев А. С. Роль цитокинов в регуляции физиологических функций иммунной системы / А. С. Симбирцев // Физиология и патология иммунной системы. – 2004. – № 10. – С. 3–9.
Белобородов В. Б. Иммунопатология тяжелого сепсиса и возможности ее коррекции / В. Б. Белобородов // Вестник интенсивной терапии. – 2010. – № 4. – С. 3–8
Макацария А. Д. Тромбогеморрагические осложнения в акушерско-гинекологической практике : рук. для врачей / А. Д. Макацария. – М. : ООО «Медицинское информационное агентство», 2011. – 1056 с.
Гайтон А. К. Медицинская физиология / А. К. Гайтон, Дж. Э. Холл : пер. c англ. ; под ред. В. И. Кобрина. – М. : Логосфера, 2008. – С. 509–521.
Wiley-Blackwell, Inc. Used with permission from Arend WP, Physiology of cytokine pathways in rheumatoid arthritis, J. Arthritis Care and Research, Blackwell Publishing Ltd. 2007.
Verhamme P. Hemostasis and inflammation: two of a kind? / P. Verhamme, M. F. Hoylaerts // J. Thromb. – 2009. – Vol. 7. – P. 15.
The association of plasma IL-6 levels with functional disability in community-dwelling elderly / H. J. Cohen, C. F. Pieper, T. Harris [et al.] // J Gerontol A Biol Sci Med Sci. – 1997. – Vol. 52. – P. 201–208.
Van der Poll T. Tissue factor as an initiator of coagulation and inflammation in the lung / T. Van der Poll // Critical Care. – 2008. – Vol. 12 (Suppl 6). – P. S3.
Economic evaluation of enoxaparin as post discharge prophylaxis for deep vein thrombosis in elective hip surgery / L. M. Davies [et al.] // Value Health. – 2001. – Vol. 3, N 6. – P. 397–406.
Hirsh J. The Sixth (2000) ACCP Guidelines for Antithrombotic Therapy for Prevention and Treatment of Thrombosis / J. Hirsh, J. E. Dalen, G. Guyatt // CHEST. – 2001. – Vol. 119. – P. 1–2.
