Napovedna vrednost spremljanja tvorjenja trombina in celokupnega hemostatskega potenciala za napoved pogostosti restenoze po angioplastiki stegenske arterije

Sobočan, Nina (author), Božič Mijovski, Mojca (mentor)

Perkutana transluminalna angioplastika je minimalno invaziven postopek za ponovno vzpostavitev pretoka krvi skozi zožano ali zamašeno arterijo. Gre za varno in tehnično zelo uspešno metodo. Glavno omejitev predstavlja ponovna zožitev žilne svetline (restenoza), ki se v šestih do dvanajstih mesecih pojavi pri 40 do 60 % bolnikov. Z dobrim poznavanjem kazalnikov tveganja za restenozo lahko pri bolnikih njihovo tveganje za restenozo napovemo. Ob izvedbi angioplastike pogosto pride do poškodbe žilne stene, ki ima zelo pomembno vlogo v hemostazi. Iz tega sklepamo, da ima hemostaza pomembno vlogo pri nastanku restenoze po angioplastiki. V okviru magistrske naloge smo želeli s pomočjo globalnih preiskav hemostaze oceniti povezavo med hemostazo in restenozo. Preučevali smo naslednjo hipotezo: bolniki z restenozo dvanajst mesecev po perkutani transluminalni angioplastiki so imeli dan pred in takoj po posegu pomembno spremenjen celokupni koagulacijski potencial ter hiperkoagulabilni trombogram. V ta namen smo analizirali plazmo bolnikov odvzeto pred in po perkutani transluminalni angioplastiki. Bolnikom razdeljenim v dve skupini (bolniki s prehodnimi arterijami in bolniki z restenozo) smo z uporabo dveh metod (celokupni hemostatski potencial in spremljanje tvorjenja trombina) določili parametre za oceno hemostatskega ravnovesja. Testiranje hipoteze je pokazalo, da lahko s spremljanjem tvorbe trombina pomembno razlikujemo med bolniki s prehodnimi arterijami in bolniki z restenozo, saj so imeli slednji daljšo fazo mirovanja in daljši čas do dosega maksimalne koncentracije trombina. Metoda celokupnega hemostatskega potenciala ni razlikovala med bolniki z restenozo in bolniki s prehodnimi arterijami. Z regresijo smo za vse spremenljivke spremljanja tvorjenja trombina določili neodvisno povezavo z restenozo. Z večjim tveganjem za restenozo povezujemo daljšo fazo mirovanja, povečan endogeni trombinski potencial, povečano maksimalno koncentracijo trombina in daljši čas do dosega trombinskega vrha. Celokupni hemostatski potencial v nobeni od spremenljivk ni bil neodvisno povezan z restenozo. Pri tem smo ugotovili, da ima spremljanje tvorjenja trombina dobro napovedno vrednost za restenozo, medtem ko se celokupni hemostatski potencial ni izkazal kot dober kazalnik.

• Language: Slovenian
• Keywords: celokupni hemostatski potencial, hemostaza, perkutana transluminalna angioplastika, restenoza, spremljanje tvorjenja trombina
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2021
• PID: 20.500.12556/RUL-131441
• Publication date in RUL: 27.09.2021

Secondary language

• Language: English
• Title: Predictive value of thrombin generation assay and overall hemostatic potential for the restenosis frequency assessment after femoral artery angioplasty

Abstract

Percutaneous transluminal angioplasty is a minimally invasive procedure for repeated establishment of blood flow through occluded or stenosed arteries. It is a safe and technically very successful method. The main limitation is the re-narrowing of the lumen (restenosis), which occurs in 40 to 60 % of patients within six to 12 months. With a good knowledge of restenosis risk indicators, we can predict prevalence of restenosis. When angioplasty is performed, the vascular wall, which plays a very important role in haemostasis, is often damaged. This suggests that haemostasis plays an important role in the development of restenosis after angioplasty. Therefore, the aim of this thesis was to investigate the relationship between haemostasis and restenosis using two global haemostasis tests (overall haemostatic potential and thrombin generation assay). We tested the following hypothesis: patients who develop restenosis within 12 months after angioplasty have had significantly altered overall coagulation potential and hypercoagulable thrombogram before and after the procedure. Patients plasma was analysed before and after percutaneous transluminal angioplasty. Alterations in haemostasis were detected by measuring overall haemostatic potential, thrombin generation, D-dimer and fibrinogen levels. Haemostasis tests results were compared with the prevalence of restenosis after angioplasty. Hypothesis testing of the difference between the two samples showed that thrombin generation significantly differentiated between subjects who developed restenosis and those who did not. Subjects who developed restenosis had a longer lag time and time to peak. There was no significant difference in overall haemostatic potential. Using regression, we demonstrated an independent association with restenosis for all angioplasty variables. Prolonged lag time and time to peak and increased endogenous thrombin potential and peak height are associated with a higher risk of restenosis. Overall haemostatic potential was not independently associated with restenosis in any of the variables. We found that thrombin generation assay has a fairly good predictive value for restenosis, while the overall haemostatic potential method did not prove to be a good indicator.

• Keywords: hemostasis, overall hemostatic potential, percutaneous transluminal angioplasty, restenosis, thrombine generation assay