Laboratory monitoring of the haemostatic system changes during orthotopic liver transplantation.

INTRODUCTION: In liver diseases, all components of the haemostatic system are changed and the degree of dysfunction is proportional to hepatocellular damage. During the liver transplantation, values of haemostatic parameters show substantial changes, while postoperatively there is a gradual normalisation of the haemostatic system function. OBJECTIVE: The aim was to monitor the changes of the haemostatic system intraoperatively and postoperatively, including the dynamics at which physiological values of parameters are reached after transplantation. METHODS: There were 17 cadaveric transplantations performed at the Clinical Centre of Vojvodina in the period from June 2008 to February 2012. The following parameters were tested: platelets, activated partial thromboplastin, prothrombin and thrombin time, fibrinogen, euglobulin clot lysis time, D-dimer, antithrombin and heparinemia.The results were presented intraoperatively in phases of transplantation, and postoperatively from day 1 to day 7, ending with postoperative day 14. RESULTS: During transplantation, the most pronounced disorders among those observed are: thrombocytopenia (96 +/- 66.1 x 10(9)/L), prolonged activated partial thromboplastin (1.80 +/- 0.8 R), prothrombin (1.59 +/- 0.4 R) and thrombin time (2.03 +/- 1.7 R), hypofibrinogenemia (2.13 +/- 0.5 g/L), hyperfibrinolysis (29 +/- 12.0 min), increase of D-dimer (1393 +/- 1220.4 ng/mL) and decrease of antithrombin (61 +/- 18.0%). Further monitoring after transplantation from postoperative day 1 revealed a gradual normalisation in the values, reaching physiological values for all parameters on postoperative day 14, except for the sustained high value of D-dimer (2606 +/-1055.1 ng/mL). Heparinemia was within the prophylactic range (0.26 +/- 0 IU/mL). CONCLUSION: Thorough monitoring of the haemostatic system parameters in liver transplantations is of great importance, as it enables the use of optimal substitution therapy during and after transplantation, as well as an adequate postoperative thromboprophylaxis. Our study has shown normalisation of investigated laboratory parameters within 7-14 days after transplantation.

[Incidence of complications of antithrombotic treatment in patients with atrial fibrillation]. / Ucestalost komplikacija antitromboznog tretmana kod bolesnika sa atrijalnom fibrilacijom.

INTRODUCTION: Atrial fibrillation increases the risk of ischemic stroke five fold, while the application of long-term anticoagulant therapy is associated with the occurrence of hemorrhagic complications. The aim of our study was to evaluate the incidence of thrombotic and hemorrhagic complications in patients with atrial fibrillation during antithrombotic treatment. MATERIAL AND METHODS: The study included 504 patients that were administered the primary (n=345) or secondary thromboprophylaxis after ischemic stroke (n=159), by applying vitamin K antagonists, or the combination of vitamin K antagonists and low-dose aspirin. The patients were followed for five months in the period of 24 years from 1988 to 2012, the total number of patient's years being 1884, at the Clinical Center of Vojvodina Thromboembolic and hemorrhagic complications were registered during regular check-up examinations. RESULTS AND DISCUSSION: Our results indicate the low incidence of thromboembolic complications (0.01 patient per a year), with a lower incidence in the vitamin K antagonists group than in the group with the combination of vitamin K antagonists and aspirin (0.008 patient per a year versus 0.01 patient per a year). The incidence of hemorrhagic complications was higher in the group with the combined treatment compared to the group treated with vitamin K antagonists (0.1 patient per a year versus 0.06 patient per a year). The frequency of major bleeding was as low as 0.01 patient per a year and more frequent in the group with combined treatment (0.03 patient per a year). CONCLUSION: The overall incidence of complications in the study group was 0.08 patient per a year. The combined antithrombotic treatment increases the risk of hemorrhagic complications and affects the severity of bleeding. Oral anticoagulant therapy is more efficient in the prevention of ischemic stroke and thromboembolic complications in patients with atrial fibrillation.