COMPARATIVE ANALYSIS OF ANTIFIBRINOLYTIC AGENTS PRESCRIBED IN PATIENTS WITH SKELETAL TRAUMA
Keywords:
polytrauma, coagulopathy, low-frequency piezoelectric thromboelastographyAbstract
Relevance. Patients with multiple injuries and hypothermia, acidosis and blood loss, has violation of the blood coagulation system. Materials and methods. The initial state of hemostasis system was studied in 83 patients with multiple injuries: Group 1 (n=41) — patients who were in the intensive care unit will be assigned to administration of tranexamic acid, 15 mg/kg every 6 hours for 3 days, and the patients in group 2 (n=42) — tranexamic acid was performed by administering a constant infusion rate of 60 mg/kg/day. Results. Complex assessment of the hemostatic system using the method of lowfrequency pyezoelectric thromboelastography (NPTEG) and developed methods for complex correction of hemostasis disorders, a comparative analysis of the effectiveness of various schemes of intensive therapy for haemostatic disorders in this group of patients. When analyzing the dynamics of fibrinolytic activity, it may be concluded that the dynamics of the index and index of retraction clot lysis (IRLS) 2 group is quite different from the dynamics of this indicator group 1 patients with trauma. Thus, in terms almost identical IRLS before treatment on day are the following differences. Indicator IRLS 2 group patients with trauma significantly lower when compared with the group 1 (p<0.05). On the 3rd day of group 1 patients saved the state a weak activation of fibrinolysis and in 2 group patients observed normalization of fibrinolysis for 3 hours. It should be noted that a daily dose of tranexamic acid, which has been prescribed patients was equal in both groups, and the groups differed only by multiplicity of administration. Conclusions. 1. Evaluation coagulation system status in patients with trauma should be carried out with the help of low-frequency pyezoelectric thromboelastography that can simultaneously assess changes at all levels of the system of regulation of blood aggregation. 2. In patients with trauma state of vascular-platelet coagulation system level must be regarded as a depression in conjunction with anticoagulation and high fibrinolysis. 3. Appointment of tranexamic acid to patients with polytrauma initial activation of fibrinolysis more appropriately by continuous infusion, which allows you to get the best dynamics of changes in the system of regulation of blood aggregation state compared with bolus administration of multiple medication.
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