Changes of a coagulation component in hemostasis system after operations on an injured heart in the immediate postoperative period

The study is based on the analysis of the immediate postoperative period of 17 patients, operated for a penetrating chest trauma with heart and pericardium injuries. The average age of the patients was 35 ± 2 years. The tests were con- ducted on the 1-3; 5-7; 10-15 postoperative day. The first, second and final phase of blood coagulation process, fibrinolyt- ic state and DIC markers presence were studied. The examination of indicators of a hemostasis system coagulation compo- nent was performed by tube test. Total blood coagulation ability was studied, estimated by the whole blood clotting time value, plasma recalcification time, thrombin time. The first phase of blood coagulation process was characterized by acti- vated partial thromboplastin time (APTT), the range index of contact activation (RICA). The second phase was estimated by the prothrombin time value and prothrombin index; the final phase - by blood levels of fibrinogen and activity of blood coagulation factor XIII, fibrinolytic state - by Hageman-kallikrein test - dependent fibrinolysis. Presence of the markers of disseminated intravascular clotting (DIC) was determined by β-naphthol test, test for fibrinogen B, by estimation of soluble fibrin monomer complexes. The testing showed that changes in a hemostasis system coagulation component in patients, underwent surgery for the heart injuries, develop on the 5-7 postoperative day, when there is a shortening of the plasma recalcification time and thrombin time. It is caused by the increased formation of blood and tissue prothrombinase, which is evidenced by the reduction in activated partial thromboplastin time and prothrombin time. At the same time the third phase of blood coagulation is activated: fibrinogen level in blood increases. Along with that the activity of antithrombin III decreases, Hageman-dependent fibrinolysis increases. The examined patients showed signs of inopexia: the blood revealed an increase in DIC markers. Partial recovery of these indicators takes place on the 10-15 postoperative day.