Fibrinolytic system in patients with pacemakers in the early postoperative period: 616.151.511

Abstract

Summary. Introduction. Permanent pacemaker implantation (PPI) is currently considered the most effective and often the only option to manage bradyarrhythmia. The PPI technique involves the insertion of leads through the patient’s venous system. Trauma to the venous wall at the site of vascular access and disruption of the laminar flow of venous blood are prerequisites for hemostasis activation. Aim: to assess changes in the fibrinolytic system and natural anticoagulant parameters in patients following PPI in the early postoperative period. Materials and Methods. The prospective, uncontrolled, observational, nonrandomized study included 158 patients: 85 (53.7%) men and 73 (46.3%) women with a mean age of 73 (68–71) years and indications for PPI. All patients underwent peripheral venous blood sampling to determine the levels of soluble fibrin monomer complex (SFMC), D-dimer, plasminogen activator inhibitor-1 (PAI-1), plasminogen, antithrombin III (AT-III), and protein C (PrC) prior to surgery and 7 and 30 days after surgery. Results. A total of 148 patients completed the follow-up period. Their levels of SFMC and D-dimer were found to have increased on day 7 (p < 0.001 and p = 0.004), subsequently decreasing 30 days after surgery (p = 0.013 and p = 0.003, respectively). The levels of PAI-1 and PrC were found to be lower on days 7 (p = 0.017 and p < 0.001) and 30 (p = 0.007 and p = 0.033, respectively) after PPI compared with their levels prior to surgery. The changes in plasminogen (p = 0.417) and AT-III (p = 1.0) levels during the follow-up period were statistically insignificant. Conclusion. The fibrinolytic system and natural anticoagulants provide balance to the hemostatic system, preventing the formation of excessive thrombi. PPI due to the intervention to the patient’s venous system results in a shift in the balance of the hemostatic system towards hypercoagulation and the activation of the fibrinolytic system.

For citation: Povarov V.O., Kalinin R.E., Mzhavanadze N.D., Zhurina O.N., Suchkov I.A. Fibrinolytic system in patients with pacemakers in the early postoperative period. Tromboz, gemostaz i reologiya. 2024;(2):68–75. (In Russ.).

References

1. Burri H., Starck C., Auricchio A. et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace. 2021;23(7):983–1008. DOI: 10.1093/europace/euaa367.
2. Kalinin R.E., Suchkov I.A., Povarov V.O. et al. Hemostasis system in patients with bradycardias after the implantation of dual-chamber pacemakers. Rossijskij mediko-biologicheskij vestnik imeni akademika I.P. Pavlova. 2021;29(4):497–504. (In Russ.). DOI: 10.17816/ PAVLOVJ79285.
3. Kalinin R., Suchkov I., Povarov V. et al. Perioperative coagulation activation after permanent pacemaker placement. World J Cardiol. 2023;15(4):174–83. DOI: 10.4330/wjc.v15.i4.174.
4. Zhang X., Li Y., Wang N. et al. Effects of permanent cardiac pacemaker implantation on vascular endothelial function, blood coagulation and cardiac function in patients with bradycardia. Exp Ther Med. 2018;16(6):4717–21. DOI: 10.3892/etm.2018.6808.
5. Kalinin R.E., Suchkov I.A., Povarov V.O. et al. The state of primary hemostasis in patients with pacemakers in the early postoperative period. Novosti hirurgii. 2022;30(3):255–63. (In Russ.). DOI: 10.18484/2305-0047.2022.3.255.
6. Sierra C., Moreno M., García-Ruiz J.C. The physiology of hemostasis. Blood Coagul Fibrinolysis. 2022;33(Suppl 1):S1–S2. DOI: 10.1097/ MBC.0000000000001099.
7. Smith S.A., Travers R.J., Morrissey J.H. How it all starts: initiation of the clotting cascade. Crit Rev Biochem Mol Biol. 2015;50(4):326– 36. DOI: 10.3109/10409238.2015.1050550.
8. Napolitano F., Montuori N. Role of plasminogen activation system in platelet pathophysiology: emerging concepts for translational applications. Int J Mol Sci. 2022;23(11):6065. DOI: 10.3390/ ijms23116065.
9. Thorsen S., Philips M., Selmer J. et al. Kinetics of inhibition of tissue-type and urokinase-type plasminogen activator by plasminogen-activator inhibitor type 1 and type 2. Eur J Biochem. 1988;175(1):33–9. DOI: 10.1111/j.1432-1033.1988.tb14162.x.
10. Sillen M., Declerck P.J. Thrombin activatable fibrinolysis inhibitor (TAFI): an updated narrative review. Int J Mol Sci. 2021;22(7):3670. DOI: 10.3390/ijms22073670.
11. Risman R. A., Kirby N. C., Bannish B. E. et al. Fibrinolysis: an illustrated review. Res Pract Thromb Haemost. 2023;7(2):100081. DOI: 10.1016/j.rpth.2023.100081.
12. Mehic D., Colling M., Pabinger I., Gebhart J. Natural anticoagulants: a missing link in mild to moderate bleeding tendencies. Haemophilia. 2021;27(5):701–9. DOI: 10.1111/hae.14356.
13. Davenport R.A., Guerreiro M., Frith D. et al. Activated protein C drives the hyperfibrinolysis of acute traumatic coagulopathy. Anesthesiology. 2017;126(1):115–27. DOI: 10.1097/ ALN.0000000000001428.
14. Dahlbäck B. Blood coagulation. Lancet. 2000;355(9215):1627–32. DOI: 10.1016/S0140-6736(00)02225-X.
15. Maroney S.A., Mast A.E. New insights into the biology of tissue factor pathway inhibitor. J Thromb Haemost. 2015;13 Suppl 1(0 1): S200–7. DOI: 10.1111/jth.12897.
16. Kalinin R.E., Suchkov I.A., Povarov V.O., Plotkin A.V. Local hemostatic drug application for prophylaxis of pacemaker pocket hematoma. Nauka molodyh (Eruditio Juvenium). 2021;9(3):397–406. (In Russ.). DOI: 10.23888/HMJ202193397-406.
17. Venher I.K., Rusin V.I., Kostiv S.Ya. et al. Hypercoagulable syndrome in the early postoperative period is a factor of venous thromboembolism. Novosti hirurgii. 2017;25(3):267–72. (In Russ.). DOI: 10.18484/2305-0047.2017.3.267.
18. Lelakowski J., Domagała T.B., Rydlewska A. et al. Effect of selected prothrombotic and proinflammatory factors on the incidence of venous thrombosis after pacemaker implantation. Kardiol Pol. 2012;70(3):260–7.
19. Christopoulou-Cokkinou V., Kourepi-Logotheti, Kontaxis A. et al. Evidence of low-grade intravascular coagulation in patients with transvenous pacemakers. Pacing Clin Electrophysiol. 1982;5(3):341– 4. DOI: 10.1111/j.1540-8159.1982.tb02240.x.
20. Abe H., Takahara K., Nakashima Y., Kuroiwa A. Effect of low dose aspirin on augmented plasminogen activator inhibitor type 1 activity in patients with permanent pacemakers. Pacing Clin Electrophysiol. 1994;17(2):146–51. DOI: 10.1111/j.1540-8159.1994.tb01365.x.