[Laboratory control over warfarin therapy in patients with acute coronary syndrome].

AIM: To elicit the most sensitive and reliable method of control over administration of indirect anticoagulants. MATERIAL AND METHODS: Sixty patients with acute coronary syndrome were studied. They received varfarin under the control of international normalized ratio (INR) calculated by the tables in cases of prothrombin time (PT) estimation on a stationary turbidynamic hemocoagulometer from venous and capillary blood by thromboplastins. In parallel, PT was estimated from whole capillary blood on individual portable coagulometer "Coagu Check C" by means of standard test-strip (prothrombin test--PT) on the study day 1, 3, 5, 7, 14 and 21. The results were assessed on the study day 21. All the patients were treated in hospital then outpatiently. RESULTS: The assessment of PT results implied calculation of variation coefficient (VC) and error (m) by each index obtained with thromboplastins. VS and m were the lowest when INR was made from whole capillary blood on coagulometer "Coagu Check C". CONCLUSION: An optimal method of control over efficacy of varfarin treatment is calculation of INR from capillary blood on coagulometer "Coagu Check C" as calculation of INR from capillary and venous blood on stationary coagulometer is complicated and reliability depends on thromboplastin used.

[Functional state of the vascular wall in patients with coronary arteriosclerosis and different types of reactions to psycho- emotional stress]. / Funktsional'noe sostoianie stenki sosudov u bol'nykh koronarnym aterosklerozom s razlichnymi tipami reagirovaniia na psikho- emotsional'nuiu nagruzku.

With changes in psychoemotional stress, antithrombogenic properties of the vascular wall and hemostatic parameters were evaluated in 25 healthy subjects and 46 patients with coronary heart disease (CHD) who differently performed a leader function when intrapersonal interaction was simulated by using a bioengineering "Gomeostat" device. There was a significant increase in the functional activity of the hemostatic system involving enhanced platelet functional activity and diminished blood procoagulative fibrinolytic activity and decreased antithrombogenic activity of the vascular wall in patients with CHD who showed a managerial tactics during simulated intrapersonal interaction in a minor group as compared to a group of followers among CHD patients.

[Willebrand's factor, functional activity of blood platelets and antiaggregation activity of the vascular wall in ischemic heart disease]. / Faktor Villebranda, funktsional'naia aktivnost' trombotsitov i antiagregatsionnaia aktivnost' stenki sosudov pri ishemicheskoi bolezni serdtsa.

Fifty coronary male patients aged 34 to 63 (the mean age 46) and 32 normal male subjects aged 18 to 32 (mean age 23) were examined for the levels of Willebrand's factor, induced platelet aggregation, beta-thromboglobulin, thromboxane, prostacyclin levels, and vascular wall antiaggregation activity (by the cuff test). Basing on literature data and their own findings the authors come to a conclusion that elevated plasma concentration of Willebrand's factor combined with increased functional activity of platelets and reduced vascular wall antiaggregation activity is the key factor in the pathogenesis of atherosclerosis development and progress.

[Disorders of the antithrombogenic properties of the vascular wall in patients with ischemic heart disease and their restitution using a complex of pharmaceutical preparations]. / Narushenie antitrombogennykh svoistv stenki sosudov u bol'nykh ishemicheskoi bolezn'iu serdtsa i vosstanovlenie ikh s pomoshch'iu kompleksa farmakologicheskikh preparatov.

Hemostatic studies were carried out in 98 patients with various types of coronary disease and 31 normal subjects, both at relative rest and during the cuff test. High platelet activity in combination with reduced blood anticoagulation and fibrinolytic activity were demonstrated. The cuff test showed reduced antithrombogenic (antiaggregation, anticoagulation, fibrinolytic) properties in the vascular wall. Combined medication has been developed to repair antithrombogenic activity of the vascular wall.

[Effect of clopheline on thrombocyte aggregation]. / Vliianie klofelina na agregatsiiu trombotsitov.

Data on clopheline effect on platelet aggregation, both spontaneous and ADP- or adrenaline-induced, in normal donors are reported. Clopheline is shown to slightly increase aggregation in normal subjects, exhibiting properties of a weak aggregation inductor. Where adrenaline is present in the aggregating system, clopheline undermines its platelet aggregation-inducing effect and, consequently, shows properties of a more competitive antagonist, as compared to adrenaline.

[Antithrombogenic properties of the vascular walls and intravascular platelet activation in ischemic heart disease]. / Protivotrombogennye svoistva stenki sosudov i vnutrisosudistaia aktivatsiia trombotsitov pri ishemicheskoi bolezni serdtsa.

A study of 150 coronary patients demonstrated compromized athrombogenic endothelial properties, as compared to normal subjects whose vascular wall endothelial cells show high anti-aggregation and anti-coagulant activity and prevent intravascular platelet aggregation. The cuff test performed in coronary patients during acute myocardial infarction or an anginal attack induced no release of prostacycline, antithrombin III or plasminogen activators from endothelial cells into the blood flow. Coronary patients demonstrated intravascular platelet activation, impaired platelet release and increased factor 4, thromboxane B2 and beta-thromboglobulin levels.

[Disorders in the status of the vessel-thrombocyte and plasma links of the hemostatic system in the pathogenesis of disseminated intravascular coagulation in ischemic heart disease]. / Znachenie narusheniia sostoianiia sosudisto-trombotsitarnogo i plazmennogo zven'ev sistemy gemostaza v patogeneze disseminirovannogo vnutrisosudistogo svertyvaniia krovi pri ishemicheskoi bolenzni serdtsa.

Platelet/vascular and plasma elements of hemostasis were investigated in normal subjects and coronary patients under stimulated emotional stress, following the assessment of vascular wall antithrombogenic properties on the basis of evidence from short-term local vascular ischemia (the cuff test). In normal subjects, vascular wall antithrombotic properties remained unchanged, providing a sufficient anticoagulant and thrombolytic support under emotional stress and thereby protecting the body against thrombosis. Coronary patients showed depressed vascular-wall antiaggregant, anticoagulant and fibrinolytic activity and latent disseminated intravascular microcoagulation that tended to progress under mental stress, creating a risk of intravascular thrombosis.

[Vascular-platelet link in the hemostatic system of diabetics]. / Sosudisto-trombotsitarnoe zveno sistemy gemostaza bol'nykh sakharnym diabetom.

Activation of the vascular-platelet link of the hemostasis system: an increase in platelet ADP-induced aggregation, the appearance of platelet aggregates in the vascular bed, an increase in the patients' plasma of beta-thromboglobulin concentration, thrombocytic factor 4, a decrease in antiaggregation activity of the vascular wall and sensitifity of patients' platelets to antiaggregation action of acetylsalicylic acid, was found in diabetes mellitus patients. In the authors' opinion, the above changes play a role in disorders of the microcirculation of the organs and tissues and development of complications in these patients.

[Dynamics of cyclase systems and hormonal indices in patients with ischemic heart disease in a state of emotional stress]. / Dinamika tsiklaznykh sistem i gormonal'nykh pokazatelei u bol'nykh ischemicheskoi bolezn'iu serdtsa v sostoianii émotsional'nogo napriazheniia.

A total of 64 male patients with varying forms of coronary heart disease (CHD), aged 43 to 65 years, and free of diabetes mellitus, obesity and arterial hypertension symptoms, were studied in conditions of emotional stress simulated, using the method of mental calculations with shifts of attention under time shortage. Pre- and post-exercise blood levels of cyclic nucleotides (cAMP and cGMP), the somatotropic hormone and immunoreactive insulin were measured. Stress-induced decrease in platelet cAMP/cGMP ratios, indicative of further increase in the functional activity of platelets, was demonstrated in coronary patients with marked coronary atherosclerosis, as contrasted to normal subjects and patients with milder disease. They also showed a more considerable (sixfold) increase in the somatotropic hormone levels and a tendency to decreased levels of immunoreactive insulin under stress, apparently as a consequence of the prevailing activation of alpha-adrenoreceptor pathways.

[Interaction of adrenocorticotropic hormone, cortisol and insulin during emotional tension among ischemic heart disease patients]. / Vzaimodeistvie adrenokortikotropnogo gormona, kortizola i insulina pri émotsional'nom napriazhenii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Blood levels of the adenocorticotrophic hormone (ACTH), cortisol and insulin were measured in normal subjects and patients with different forms of coronary heart disease (CHD), aged 35 to 60 years and showing no signs of diabetes mellitus, obesity and arterial hypertension, under simulated emotional stress. The majority of the patients, particularly those with unfavorable course of the CHD, showed stress-induced disturbances of hormonal control due to depressed insulin levels in the presence of an insignificant ACTH increment and high cortisolemia. Hormonal rations were shown to be of predictive value in stress-exposed normal subjects and coronary patients alike.

[Effect of emotional tension on intravascular coagulation in patients with angiographically established ischemic heart disease]. / Vliianie émotsional'nogo napriazheniia ba vnutrisosudistuiu koaguliatsiiu u bol'nykh s angigraficheski podtverzhdennoi ishemicheskoi bolezn'iu serdtsa.

The effect of simulated emotional stress (ES) on the platelet/vascular and plasma components of the hemostatic system was examined in normal subjects and coronary patients. In coronary patients, prestress hemostatic platelet/vascular and plasma factors were disturbed, their blood showing a tendency to activated intravascular coagulation. Stress further increased the blood thrombogenic potential of coronary patients, causing intravascular coagulation as evidenced by declining cAMP/cHMP ratio, enhanced release of soluble fibrin and fibrinogen-fibrin degradation products (FDPs), and reduced antithrombin III.