ST segment yükselmesi olmayan miyokard infarktüsü olgularında enoksoparin tedavisinin etkinliğinin değerlendirilmesinde AntiFXa aktivitesi ve tromboleastogram yönteminin karşılaştırılması

Yıl 2021, Cilt: 46 Sayı: 4, 1478 - 1484, 30.12.2021

Ramazan Gündüz , Bekir Serhat Yildiz , İbrahim Halil Özdemır , Mehmet Burak Özen , Nurullah Çetın , Oğuz Yavuzgil

https://doi.org/10.17826/cumj.977136

Öz

Amaç: Tromboelastogram parametrelerindeki değişiklerin standart olarak önerilen AntiFXa aktivitesi ile karşılaştırılarak bu testin enoksaparin tedavisinin monitörizasyonundaki rolünün incelenmesidir.
Gereç ve Yöntem: ST segment yükselmesi olmayan miyokard infarktüsü tanısıyla koroner yoğun bakım ünitesine yatırılan 25 hasta çalışmaya alınmıştır. Hastalara yatış anında iki tüp kan alınmış ve 1mg/kg enoksapirinin üçüncü dozu yapıldıktan 4 saat sonra iki tüp kan daha alınmıştır. Hastalara AntiFXa, tromboelastogram, aktive koagülasyon zamanı bakılmıştır.
Bulgular: Enoksoparin uygulaması sonrası aktive koagülasyon zamanı değerinde bir miktar artış izlenmekle birlikte bunun anlamlı olmadığı görüldü (p₌0.094). Enoksoparin sonrası tromboelastogram parametrelerinden maksimum amplitüde(MA) azalmış (MA bazal 65.4±11.9 sonra 63.4±7.8), R zamanı artmış (5±1.7 den 8.4±4.6,), K zamanı artmış (1.89±1.06 dan 2.56±1.4), açı azalmıştır. (66.34±5.6 dan 57.9±11.4). AntiFXa artmıştır (0.122±0.06 dan 0.501±0.359).
Sonuç: Tromboelastogram parametreleri değerlendirildiğinde tipik artmış bir prokoagülan aktivite olmamakla birlikte kısmen artmış bir fibrinolitik aktivite saptanmıştır.

Anahtar Kelimeler

enoksoparin, tromboleastogram, akut koroner sendrom

Comparison of anti-factorXa assay and rotational thromboelastogram in evaluating the efficacy of enoxaparine treatment in patients with acute coronary syndrome without ST- segment elevation

Öz

Purpose: The aim of this study was to compare anti-factor Xa assay and tromboelastogram in evaluation of efficacy of enoxaparin in patients with acute coronary syndrome without ST-segment elevation.
Materials and Methods: Twenty-five patients with acute coronary syndrome were involved. Two blood samples were taken on admission and 4 hours after the subcutaneous injection of third dose of 1mg/kg enoxaparin to the patients. AntiFXa, tromboelastogram, activated coagulation time were calculated.
Results: A non-significant increase in activated coagulation time was observed after the injection of enoxaparin. After injection enoxaparin thromboelastography parameters changed maximum amplitude(MA) increased (MA basal 65.4±11.9 after 63.4±7.8), R time increased (from 5±1.7 to 8.4±4.6,), K time increased (from 1.89±1.06 to 2.56±1.4), angle increased (from 66.34±5.6 to 57.9±11.4). AntiFXa increased. (from 0.122±0.06 to 0.501±0.359).
Conclusion: Tromboelastography method can be used in assessment of efficacy of enoxaparin in patients with acute coronary syndrome without ST-Segment elevation.

Anahtar Kelimeler

Thromboelastogram, Enoxaparin, Acute coronary syndrome

Kaynakça

• 1. Laposata M, Green K, Elisabeth MJAPLM. College of American Pathologist Conference XXXI on laboratory monitoring of low-molecular-weight heparin, danaparoid, hirudin and related compounds, and argatroban. Arch Pathol Lab Med. 1998;122:799-807.
• 2. Handeland G, Abildgaard U, Holm H, Arnesen KJEjocp. Dose adjusted heparin treatment of deep venous thrombosis: a comparison of unfractionated and low molecular weight heparin. Eur J Clin Pharmacol. 1990;39:107-12.
• 3. Alhenc-Gelas M, Jestin-Le Guernic C, Vitoux J, Kher A, Aiach M, Fiessinger J, Thrombosis F-SGJ, haemostasis. Adjusted versus fixed doses of the low-molecular-weight heparin Fragmin in the treatment of deep vein thrombosis.Thromb Haemost. 1994;72:698-702.
• 4. Boneu BJT, haemostasis. Low molecular weight heparin therapy: is monitoring needed? Thromb Haemost. 1994;72:330-4.
• 5. Ignjatovic V, Summerhayes R, Gan A, Than J, Chan A, Cochrane A, Bennett M, Horton S, Shann F, Lane GJTr. Monitoring unfractionated heparin (UFH) therapy: which anti factor Xa assay is appropriate? Thromb Res. 2007;120:347-51.
• 6. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999-3054.
• 7. Luddington RJC, Haematology L. Thrombelastography/thromboelastometry. Clin Lab Haematol. 2005;27:81-90.
• 8. Hirsh J, Raschke RJC. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:188S-203S.
• 9. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio AL, Crea F, Goudevenos JA, Halvorsen SJEhj. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-77.
• 10. Linkins L-A, Julian JA, Rischke J, Hirsh J, Weitz JIJTr. In vitro comparison of the effect of heparin, enoxaparin and fondaparinux on tests of coagulation. Thromb Res. 2002;107:241-44.
• 11. Antman EM, Morrow DA, McCabe CH, Jiang F, White HD, Fox K, Sharma D, Chew P, Braunwald E, journal E-TIJAh. Enoxaparin versus unfractionated heparin as antithrombin therapy in patients receiving fibrinolysis for ST-elevation myocardial infarction. Design and rationale for the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction study 25 (ExTRACT-TIMI 25). Am Heart J. 2005;149:217.
• 12. Artang R, Jensen E, Pedersen F, Frandsen NJJTr. Thrombelastography in healthy volunteers, patients with stable angina and acute chest pain. Thromb Res. 2000;97:499-503.
• 13. Artang R, Frandsen NJ, Nielsen JDJTJ. Application of basic and composite thrombelastography parameters in monitoring of the antithrombotic effect of the low molecular weight heparin dalteparin: an in vivo study. Thromb J. 2009;7:14.
• 14. Rao SV, O’Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F, Mahaffey KW, Califf RM, Harrington RAJTAjoc. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol. 2005;96:1200-6.
• 15. Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox K, Yusuf SJC. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006;114:774-82.
• 16. Moscucci M, Fox KA, Cannon CP, Klein W, López-Sendón J, Montalescot G, White K, Goldberg RJJEhj. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24:1815-23.