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Vojnosanitetski pregled
2019, vol. 76, br. 4, str. 431-436
jezik rada: engleski
vrsta rada: originalan članak
doi:10.2298/VSP170204110J

Creative Commons License 4.0
Agregabilnost trombocita i aktivnost antikoagulantnih proteina tokom stres ehokardiografije sa dobutaminom kod asimptomatskih bolesnika četiri meseca nakon perkutane koronarne intervencije
aMilitary Medical Academy, Clinic of Cardiology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
bInstitute of Clinical Biochemistry, Belgrade
cUniversity of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade
dClinical Center, Department of Cardiology, Kragujevac + University of Kragujevac, Faculty of Medical Sciences, Kragujevac

e-adresa: zockydr@sezampro.rs

Sažetak

Uvod/Cilj. Agregabilnost trombocita i proces aktivacije hemostaze tokom ishemije miokarda u sklopu fizičkog ili mentalnog stresa mogu biti jedan od brojnih faktora koji utiču na proces tromboze stenta nakon perkutane koronar-ne intervencije (PKI). Cilj rada bio je da se ispita povezanost agregabilnosti trombocita i aktivnosti antikoagulantnih pro-teina sa miokardnom ishemijom tokom dobutamin stres ehokardiografije (DSE) kod asimptomatskih bolesnika, četiri meseca nakon PKI. Metode. Studijsku populaciju činila su 74 asimptomatska bolesnika koja su imala uspešnu PKI četiri meseca pre visokodozne DSE. Agregabilnost trombocita na epinefrin (EPI) i adenozin difosfat (ADP) određena je metodom optičke agregometrije – light transmission aggregometry (LTA) zajedno sa aktivnošću proteina C i antitrombina u plazmi pre i u piku opterećenja tokom stres testa. Bolesnici su bili podeljeni u nekoliko grupa shodno tome da li su imali poremećaje kontraktilnosti određenih segmenata miokarda u miru ili u naporu. Svi bolesnici su u vreme DSE bili na terapiji klopidogrelom i aspirinom. Rezultati. Nije bilo statistički značajne razlike u agregabilnosti trombocita na ADP (47,50 vs 50,20; p = 0,970) kao ni na EPI (59,30% vs 60,30%; p = 0,600) pre i u piku DSE. Statistički značajna razlika je utvrđena u aktivnosti antikoagulantnih proteina, antitrombina (84,85% vs 74,75%; p = 0,001) i proteina C (77,75% vs 67,60%; p < 0,001). Značajnost razlike u aktivnosti antitrombina i proteina C odnosi se na rezultat pre i u piku testa. Nije utvrđena značajna razlika u agregabilnosti trombocita i aktivnosti antikoagulantnih proteina u plazmi kod bolesnika sa ili bez indukovane ishemije u piku DSE. Bolesnici koji su imali povišen indeks pokretljivosti zida leve komore (wall motion score index) u piku DSE su imali veću agregabilnost trombocita na EPI nego bolesnici sa normalnom kontraktilnošću miokarda (68,60% vs 54,70% p = 0,017). Zaključak. Nema promena vrednosti u agregabilnosti trombocita pre i posle DSE, međutim, dolazi do smanjenja aktivnosti antikoagulantnih proteina u plazmi u piku testa. Agregabilnost trombocita na EPI značajno raste u piku DSE kod bolesnika sa segmentnom hipokontraktilnošću miokarda.

Ključne reči

antitrombini; ehokardiografija, stres; perkutana koronarna inervencija; trombociti agregacija

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