Гемостазиологические маркеры прогнозирования реокклюзии после тромболитической терапии у пациентов с кардиоэмболическим инсультом

Aim: to determine the prognostic significance of hemostasiological parameters in the development of reocclusion after thrombolytic therapy in patients with cardioembolic stroke. Materials and methods. The treatment of 52 patients with a cardioembolic type of ischemic stroke (the severity — 10–17 points according NIHSS scale) was analyzed. These patients received systemic thrombolysis according to national guidelines. Retrospectively patients were divided into 2 groups: with effective thrombolysis (n = 36) and with signs of reocclusion (n = 14). Results. Three hours after thrombolytic therapy in patients with further developed reocclusion powerful hemostasis activation was observed that manifested by a significant increasing of D-dimer level and formation of a pathologically dense clot on thromboelastogram. According to ROC analysis good prognostic accuracy of reocclusion development for D-dimer level (AUROC = 0,766; cut-o point — D-dimer ≥ 0,75 ng/ml) and excellent prognostic accuracy for parameter MA of thromboelastogram (AUROC = 0,903; cut-o point — МА ≥ 48 mm) were revealed. Conclusion. Further studies are needed for identification of patients with high risk of reocclusion who are prescribed the appointment of anticoagulants (antiaggregants) immediately after thrombolysis. REFERENCES 1. Jauch E.C., Saver J.L., Adams H.P. et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2013; 44: 870–947. 2. Yang X., Gao S., Ding J. et al. Plasma D-Dimer Predicts Short-Term Poor Outcome after Acute Ischemic Stroke. PLoS ONE. 2014; 9 (2): e89756. 3. Abd-Elhamid Y.A., Tork M.A., Abdulghani M.O. Prognostic value of D-dimer measurement in patients with acute ischemic stroke. Egypt J Neurol Psychiat Neurosurg. 2016; 53 (3): 146–50. 4. Hsu P.J., Chen C.H., Yeh S.J. et al. High Plasma D-Dimer Indicates Unfavorable Outcome of Acute Ischemic Stroke Patients Receiving Intravenous thrombolysis. Cerebrovasc Dis. 2016; 42 (1–2): 117–21. 5. Alexandrov A.V., Grotta J.C. Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator. Neurology. 2002; 59 (6): 862–9. 6. Rubiera M., Alvarez-Sabi n J., Ribo M. et al. Predictors of Early Arterial Reocclusion A er Tissue Plasminogen Activator-Induced Recanalization in Acute Ischemic Stroke. Stroke. 2005; 36: 1452–6. 7. Burgin W.S., Alexandrov A.V. Deterioration following improvement with tPA therapy: Carotid thrombosis and reocclusion. Neu- rology. 2001; 56: 568–70. 8. Sinkov S.V., Zabolotskikh I.B. Di erentiated approach to choose heparin for thromboprophylaxis [Di erencirovannyj podhod k vyboru geparina dlya provedeniya trombopro laktiki]. Tromboz, gemostaz i reologiya. 2015; 2: 31–6 (in Russ.). 9. Sinkov S.V., Zabolotskikh I.B. Diagnostics and correction of hemo- stasis disorders [Diagnostika i korrekciya rasstrojstv sistemy gemo- staza]. Moskva: Prakticheskaya medicina. 2017: 336 s (in Russ.). 10. Adeoye O., Sucharew H., Khoury J. et al. rt-PA plus Epti batide versus rt-PA Alone in Acute Ischemic Stroke: A Propensity Score Matched Post Hoc Analysis. Stroke. 2015; 46 (2): 461–4.