Thromboelastometry to assess the effect of low-molecular-weight heparin prophylactic doses: 616.151.55

Abstract

Summary. Aim: to determine the thromboelastometric criteria for screening of prophylactic doses effect of low molecular weight heparins (LMWHs) and to evaluate the possibilities of their use in patients with acquired antithrombin III (AT-III) deficiency. Materials and Methods.
A prospective observational single-center study was conducted. During the first stage, 14 patients without heparin resistance factors (hyperfibrinogenemia and AT-III deficiency) underwent a NATEM thromboelastometry blood sample test without an anticoagulant. Additionally, three blood samples with in vitro nadroparin calcium activity (0.2, 0.3, and 0.4 IU/mL) were collected. During the second stage, the NATEM test was conducted on 45 patients who had undergone liver resections. The test was performed both before and after the prophylactic doses of nadroparin calcium. Fibrinogen concentration and AT-III activity were determined in all patients. The ROC-analysis was performed to determine the sensitivity and specificity of AT-III activity in relation to the upper limits of normal CT and CFT intervals following the use of an anticoagulant. Results. The thromboelastometry parameters observed during the first study stage significantly depended on anti- Xa activity level in vitro. The CT interval was found to exceed the norm in 95.2% of the cases, while the CFT interval exceeded the norm in 90.5%.
The results of the second study stage, in which an anticoagulant with normal AT-III activity was used, demonstrated no significant diffe rence from the initial parameters. During this stage, the CT interval exceeded the norm in 97% of the cases, while the CFT interval exceeded the norm in 90.3%. The correlation between AT-III activity and CT and CFT intervals was 0.401 (p < 0.01) and 0.246 (p < 0.05), respectively. AT-IIIactivity level greater than 50% for a CT interval above the normal upper limit had a sensitivity of 82.28% and a specificity of 71.43%. AT-III activity level of 70% or greater had a sensitivity of 39.24% and a specificity of 92.86%. Conclusion. The upper normal limit of the CT NATEM interval represents the optimal criterion for screening LMWHs effect. Screening will allow identifying patients with a high risk of thrombotic complications and personalizing prevention strategies for venous thromboembolic complications in patients with AT-III deficiency.

For citation: Yudin D. V., Shulutko E. M., Savushkin A. V. Thromboelastometry to assess the effect of low-molecular-weight heparin prophylactic doses. Tromboz, gemostaz i reologiya. 2024;(4):36–45. (In Russ.).

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