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Peculiarities of the hemostasis system associated with cardiorenal syndrome in patients with chronic heart failure of ischemic origin

Mironchuk N. N., Mirsaeva G. Kh.

Keywords: hemostasis, cardiorenal syndrome, CHF

DOI: 10.18087 / rhfj.2013.6.1880

Background. State of the hemostasis system in patients with CHF is quite well studied; however features of the hemostasis system associated with cardiorenal syndrome require clarification. Aim. Studying peculiarities of the hemostasis system in relation to severity of renal functional disorders in patients with CHF associated with postinfarction cardiosclerosis. Materials and methods. 82 patients with different CHF NYHA FCs who had a history of Q wave MI were evaluated. Mean age of patients was 54.0 (50.0–64.0) years. The control group consisted of 30 subjects without apparent disease who were sex- and age-matched with the patients. The patients were divided into three groups: group 1, patients with glomerular filtration rate (GFR) of 60–89 ml / min / 1.73m2 without signs of renal injury (n=41); group 2, patients with GFR of 60–89 ml / min / 1.73 m2 and signs of renal injury (n=26); and group 3, patients with GFR of 59–30 ml / min / 1.73 m2 (n=15). Plasma platelet count, mean platelet volume (MPV), spontanenous and ADP-induced platelet aggregation; thrombomodulin concentration, von Willebrand factor (vWF) activity; APTT, prothrombin and INR, fibrinogen, heparin cofactor activity of antithrombin, and D dimer were measured. Results. Patients with signs of chronic renal disease (CRD) associated with CHF were older and had more severe clinical symptoms of CHF. The increased severity of renal disorders was accompanied by lower platelet count and higher MPV and spontaneous aggregation. The vWF activity and thrombomodulin concentration were higher in CHF patients than in the control group but they did not depend on severity of renal dysfunction. Among plasma coagulation factors of hemostasis, D dimer was the most sensitive responder to aggravation of renal disorders. Correlations were found between GFR and spontaneous platelet aggregation (r= –0.26; p=0.02), albuminuria level and plasma concentration of D dimer (r=0.24; p=0.03), albuminuria level and heparin cofactor activity of antithrombin (r= –0.24; p<0.05). CHF NYHA FC correlated with MPV (r=0.23; p=0.04), prothrombin (r= –0.35; p=0.001), INR (r=0.34; p=0.002), and D dimer concentration (r=0.27; p=0.015). Conclusion. Impaired renal function in CHF patients affects all components of the hemostasis system. D dimer can be considered the most sensitive marker for hemostasis activation in patients with cardiorenal syndrome. The D dimer index may be an appropriate part of routine hemostasis evaluation in CHF patients with renal dysfunction.
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Mironchuk N. N., Mirsaeva G. Kh. Peculiarities of the hemostasis system associated with cardiorenal syndrome in patients with chronic heart failure of ischemic origin. Russian Heart Failure Journal. 2013;14 (6):334-340

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