THE FUNCTIONAL STATE OF THE HEMOSTASIS SYSTEM IN PATIENTS WITH CAROTID ARTERY STENOSIS WHICH SUBJECT TO CAROTID ENDARTERECTOMY AGAINST THE BACKGROUND OF ANTICOAGULANT THERAPY
DOI:
https://doi.org/10.32782/2411-9164.21.2-8Keywords:
carotid artery stenosis, atherosclerosis, carotid endarterectomy, hemostasis system, rivaroxaban, enoxaparin, low-frequency piezoelectric thromboelastographyAbstract
The study is dedicated to assessing the functional state of the hemostasis system in patients with carotid artery stenosis (CAS) who underwent carotid endarterectomy against the background of anticoagulant therapy with rivaroxaban and enoxaparin. The aim of the research was to determine the state of the hemostasis system using low-frequency piezoelectric thromboelastography (LPTEG) and to find optimal methods for preventing thromboembolic complications in the perioperative period. The study involved 40 patients with CAS who received treatment between 2022 and 2024, as well as a control group of 20 healthy individuals. The patients were randomized into two groups: the first group received enoxaparin, while the second group was treated with rivaroxaban post-surgery. Hemostasis dynamics were evaluated before surgery and on the 1st, 3rd, 5th, and 7th postoperative days. The results showed that patients with CAS exhibited hypercoagulation and suppressed fibrinolysis against the background of increased vascular-platelet activation. After surgery, patients receiving rivaroxaban demonstrated faster normalization of hemostasis parameters compared to those receiving enoxaparin. Conclusion. The use of rivaroxaban ensures a faster normalization of hemostasis system parameters in patients with CAS after carotid endarterectomy, leading to a more effective reduction in the risk of thromboembolic complications.
References
Biller, J., & Barnett, H.J.M. (2022). Carotid artery stenosis: current treatment and future directions. Stroke. 53 (6), 1804–1811.
Cabrera, J.A., et al. (2021). Complications of carotid artery stenting: the role of antiplatelet therapy. Journal of Vascular Surgery, 74(4), 1321–1328.
Choudhury, K.R. et al. (2018). Hemostatic disorders in carotid endarterectomy: a systematic review. Journal of Neurosurgery. 128 (2), 243–250.
Hansson, GK (2020). Immune mechanisms in atherosclerosis. Arteriosclerosis, Thrombosis and Vascular Biology. 40(5), 1141–1149.
Kerkhoff, M. et al. (2019). Epidemiology of stroke and carotid artery stenosis. European Journal of Neurology, 26(1), 25–30.
Sacco, R.L., et al. (2019). Stroke: pathophysiology, diagnosis and treatment. Lancet Neurology. 18(5), 425–436.
Hirose, H., Takagi, M., & Kugimiya, T. (1999). Subclavian steal syndrome secondary to isolated innominate artery stenosis possibly due to fibromuscular dysplasia: a case report. Vasc Endovasc Surg. 33:711–715.
Damme, H.V., Caudran, D., Defraigne, J.O., & Limet, R. (1992). Brachiocephalic arterial reconstruction. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/1553848/Acta Chir Belg.
Grosveld, W.J., Lawson, J.A., Eikelboom, B.C., Windt, J.M., & Ackerstaff, R.G. (1988). Clinical and hemodynamic significance of innominate artery lesions evaluated by ultrasonography and digital angiography. Stroke. 19:958–962.
Grant, E.G., El-Saden, S.M., Madrazo, B.L., Baker, J.B. Kliewer, M.A. (2006). Innominate artery occlusive disease: sonographic findings. AJR Am J Roentgenol.
Wylie, E.J., & Effeney, D.J. (1979). Surgery of the aortic arch branches and vertebral arteries. Surg Clin North Am. 59.
Law, M.M., Colburn, M.D., Moore, W.S., Quinones-Baldrich, W.J., Machleder, H.I., & Gelabert, H.A. (1995). Stroke Carotid-subclavian bypass for brachiocephalic occlusive disease. Choice of conduit and long-term follow-up. 26:1565–1571.
A comparison of superficial versus combined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. Anesth Analg. 91 (2000).
