rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2022-09-07rpcardio-2822Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТThrombodynamics Test in Assessing the Risk of Thrombus Formation in Patients with Atrial Fibrillation Taking Direct Oral AnticoagulantsТест «Тромбодинамика» в оценке риска тромбообразования у пациентов с фибрилляцией предсердий, получающих прямые оральные антикоагулянтыhttps://orcid.org/0000-0001-6901-5663ГебековаЗ. А.GebekovaZ. A.

 Гебекова Зарема Алиосмановна

 Москва 

 Zarema A. Gebekova 

 Moscow 

zarema.gebekova@inbox.ruhttps://orcid.org/0000-0003-3438-069XИвановИ. И.IvanovI. I.

 Иванов Илья Игоревич  

 Москва 

 Ilya I. Ivanov 

 Moscow 

https://orcid.org/0000-0001-5399-7586АсамбаеваА.AsambayevaA.

Айлар Асамбаева

eLibrary SPIN 6153-0573

Москва 

 Ailar Asambayeva 

 Moscow 

https://orcid.org/0000-0001-6753-1365СкрипкаА. И.SkripkaA. I.

 Скрипка Алена Игоревна 

 Москва 

 Alena I. Skripka 

 Moscow 

https://orcid.org/0000-0001-5938-8917СоколоваА. А.SokolovaA. A.

Соколова Анастасия Андреевна

eLibrary SPIN 2153-3542

Москва 

 Anastasya A. Sokolova 

 Moscow 

https://orcid.org/0000-0001-6241-2711НапалковД. А.NapalkovD. A.

Напалков Дмитрий Александрович

eLibrary SPIN 2894-5010

 Москва 

 Dmitry A. Napalkov 

 Moscow 

https://orcid.org/0000-0003-3491-1884ВуймоТ. А.VuimoT. A.

 Вуймо Татьяна Алексеевна

 Москва 

 Tatiana A. Vuimo 

 Moscow 

Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationНациональный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия РогачеваРоссияDmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and ImmunologyRussian Federation202203112022185544552Copyright © Gebekova Z.A., Ivanov I.I., Asambayeva A., Skripka A.I., Sokolova A.A., Napalkov D.A., Vuimo T.A., 20222022Гебекова З.А., Иванов И.И., Асамбаева А., Скрипка А.И., Соколова А.А., Напалков Д.А., Вуймо Т.А.Gebekova Z.A., Ivanov I.I., Asambayeva A., Skripka A.I., Sokolova A.A., Napalkov D.A., Vuimo T.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2822Aim

Aim. To evaluate thrombus characteristics in patients with atrial fibrillation (AF) taking different direct oral anticoagulants (DOACs) using Thrombodynamics test.Materials and methods. Thrombodynamics test was performed in 100 patients with paroxysmal and permanent forms of AF taking different DOACs, dose choice was done in accordance with the instructions for drugs use. For analysis samples of fresh citrated platelet-free plasma were taken just before regular DOACs dose intake (trough concentration). Statistical data processing was carried out using R software packages.Results. All patients had no history of thrombosis or bleeding before inclusion in this study. All parameters of Thrombodynamics test taken at residual concentration of DOACs were in general within reference values, that is in the area of normal coagulation: spatial clot growth rate (V) – 26.56 (25.0; 29.2) μm/min, the time to the start of clot growth (Tlag) – 1.05 (0.85; 1.27) min, initial spatial clot growth rate (Vi) – 44.3±7.7 μm/min, stationary spatial clot growth rate (Vst) – 26.5 (24.9; 28.4) μm/min, clot size (CS) – 999.7 (912.9; 1084.7) μm, clot density (D) – 22883.1±3199.9 arb. units. D was appeared to be higher in women [22947.7 (21477.5; 22947.7) vs men [22124.8 (19722.8; 22124.8), p=0.035] and Tlag was significantly higher in patients with chronic heart failure [1.2 (1.0; 1.2) vs 1.0 (0.8; 1.0), p=0.008]. A correlation was found between level of creatinine and Tlag parameter, glomerular filtration rate (GFR) and clot density. With an increase in the level of creatinine in the blood and a decrease in GFR, respectively, there was an increase in Tlag parameter (p-value 0.038); with an increase in GFR, clot density decrease (p-value 0.005).

Conclusion

Conclusion. All parameters of Thrombodynamics test on residual concentration of DOACs were within reference values that indicated optimal anticoagulant effect of all DOACs. The obtained data of normal coagulation at the residual concentration of the anticoagulant are consistent with the previously obtained data on the safety and effectiveness of DOACs using other methods. Further studies with clinical end points are needed to assess the clinical value of this method.

Цель. Изучить характеристики процесса тромбообразования у пациентов с фибрилляцией предсердий (ФП), принимающих различные прямые оральные антикоагулянты (ПОАК), с помощью теста «Тромбодинамика».Материалы и методы. Тест «Тромбодинамика» был выполнен у 100 пациентов с пароксизмальной и постоянной формами ФП, принимающих различные ПОАК, доза антикоагулянта была подобрана в соответствии с инструкцией к препарату. Для анализа использовалась свежая цитратная безтромбоцитарная плазма, забор крови осуществлялся перед очередным запланированным приемом ПОАК (остаточная концентрация).Результаты. Все пациенты не имели в анамнезе тромботических или геморрагических событий на момент включения в исследование. Все параметры теста «Тромбодинамика», выполненного при остаточной концентрации ПОАК, были преимущественно в пределах референсных значений, что соответствует нормокоагуляции: время роста сгустка (V) – 26,6 (25,0; 29,2) мкм/мин, время задержки роста сгустка (Tlag) – 1,05 (0,85; 1,27) мин, начальная скорость роста сгустка (Vi) – 44,3±7,7 мкм/мин, стационарная скорость роста сгустка (Vst) – 26,5 (24,9; 28,4) мкм/мин, размер сгустка (CS) – 999,7 (912,9; 1084,7) мкм, плотность сгустка (D) – 22883,1±3199,9 усл. ед. Параметр D оказался значимо выше у женщин: 22947,7 (21477,5; 22947,7) против 22124,8 (19722,8; 22124,8) у мужчин (p=0,035); параметр Tlag был значимо выше у пациентов с хронической сердечной недостаточностью: 1,2 (1,0; 1,2) против 1,0 (0,8; 1,0), p=0,008. Была выявлена корреляция между уровнем креатинина и Tlag, а также скоростью клубочковой фильтрации (СКФ) и плотностью сгустка. С повышением уровня креатинина крови и снижением СКФ повышалось значение Tlag (p=0,038), а с повышением СКФ уменьшается плотность сгустка (p=0,005).Заключение. Все параметры теста «Тромбодинамика», выполненного на остаточной концентрации ПОАК, были преимущественно в пределах референсных значений, что отражает оптимальный антикоагулянтный эффект всех ПОАК. Полученные данные о нормальной свертываемости крови при остаточной концентрации антикоагулянта согласуются с данными о безопасности и эффективности применения ПОАК, полученных ранее с помощью других методов. Для оценки клинического значения данного метода необходимы дальнейшие исследования с учетом конечных точек.

тромбообразованиефибрилляция предсердийпрямые оральные антикоагулянтылабораторные методыкровотечениетест «Тромбодинамика»blood clottingatrial fibrillationdirect oral anticoagulantslaboratory assaysbleedingthrombodynamics testИсследование проведено при поддержке Сеченовского Университета, Российского национального исследовательского медицинского университета имени Н.И. Пирогова, Национального медицинского исследовательского центра детской гематологии, онкологии и иммунологии имени Дмитрия Рогачева.The study was performed with the support of the Sechenov University, Pirogov Russian National Research Medical University, Dmitry Rogachev National Medical Research Center Of Pediatric Hematology, Oncology and Immunology.ReferencesBenjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. DOI:10.1161/CIR.0000000000000659.Benjamin EJ, Muntner P, Alonso A, et al. 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The authors declare that there are no conflicts of interest present.