The dynamics of coagulation hemostasis markers in patients with an increased body mass index with polytrauma
The hemostasis system is one of the fast response systems of the body. The aim of the work was to analyze the dynamics of coagulation hemostasis markers in patients with an increased body mass index (IBMI) with polytrauma. A study of complex hemostasiograms was conducted in 224 patients with IBMI during a month of hospital stay with a diagnosis of Polytrauma and on the 360th control day of the outpatient visit. The patients were divided into 3 groups depending on the starting numbers of the BMI. The study included the study of activated partial thromboplastin time, prothrombin index, antithrombin III, plasma tolerance to heparin and fibrinogen. To process the data obtained, Student’s t test and correlation analysis were used. The condition of the coagulation situation in patients with IBMI in group I (BMI≤29.9) included a slight increase in the aggregative capacity of platelets without disturbing their number, non-intensive increases in the hemostatic potential in all coagulation tests, dysfibrinogenemia and the absence of disturbances in the system of natural anticoagulants in the early period of traumatic illness. For patients in group II (BMI 30.0–39.9) in the early stages — up to the 14th day — hyperfibrinogenemia was characteristic, with a decrease in fibrinolytic activity. For patients in group III (BMI≥40.0), it was characteristic: in the first week there was dysfibrinogenemia, a sharp — by 50% decrease in antithrombin III, and a decrease in plasma tolerance to heparin. It should be noted that a significant and growing in dynamics reduction in the amount of antithrombin III was less than 80% unfavorable for the progression of coagulation disorders. Thus, it is necessary to note the clinical and pathogenetic significance of hemostasiological disorders in traumatic disease in patients with IBMI with polytrauma, the nature, intensity, dynamics and direction of which determine the consequences and possible complications, and require specific correction. In the future we plan to study the functional state of the system of immunological protection in traumatic disease in patients with IBMI.
Gray, S., & Dieudonne, B. (2018). Optimizing Care for Trauma Patients with Obesity. Cureus, 10 (7), e3021. Doi:10.7759/cureus.3021.
Kornblith, L. Z., Howard, B., Kunitake, R. (2015). Obesity and clotting: Body mass index independently contributes to hypercoagulability after injury. J. Trauma Acute Care Surg., 78 (1), 30–6. Doi: 10.1097/TA.0000000000000490
Andruszkow, H., Veh, J., Mommsen, P., Zeckey, C., Hildebrand, F., & Frink, M. (2013). Impact of the body mass on complications and outcome in multiple trauma patients: what does the weight weigh? Mediators Inflamm, 345702. Doi: 10.1155/2013/345702.
Premaor, M. O., Comim, F. V., & Compston, J. E. (2014). Obesity and fractures. Arq. Bras. Endocrinol. Metabol., 58 (5), 470–477. Doi: 10.1590/0004-2730000003274.
Dhungel, V., Liao, J., Raut, H., Lilienthal, M. A., Garcia, L. J., Born, J., & Choi, K. C. (2015). Obesity delays functional recovery in trauma patients. J. Surg. Res., 193 (1), 415–420. Doi: 10.1016/j.jss.2014.07.027.
Osborne, Z., Rowitz, B., Moore, H., Oliphant, U., Butler, J., Olson, M., & Aucar, J. (2014). Obesity in trauma: outcomes and disposition trends. Am. J. Surg., 207 (3), 387–392. Doi: 10.1016/j.amjsurg.2013.10.013.
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