[Dynamics of platelet hemostasis indices in patients with cardioembolic stroke against the background of atrial fibrillation]. / Dinamika pokazatelei trombotsitarnogo gemostaza u patsientov s kardioembolicheskim insul'tom.

OBJECTIVE: To study the parameters of platelet hemostasis in patients with cardioembolic ischemic stroke on the background of atrial fibrillation and taking warfarin to assess the effectiveness of antiplatelet drugs in the prevention of recurrent ischemic strokes. MATERIAL AND METHODS: 93 patients with ischemic stroke on the background of atrial fibrillation were examined, of which the main group consisted of 43 patients who took warfarin and 50 patients from the reference group without warfarin. The study of the platelet link of hemostasis using inductors (adrenaline, ristomycin, arachidonic acid, collagen, ADP) in patients of both groups was carried out. In the group of patients taking warfarin there was a significant increase in platelet aggregation for adrenaline up to 57.15 [29.51; 62.61] (p=0.0315), spontaneous aggregation 2.46 [1.39; 6.75] (p=0.047), reduction of platelet aggregation for collagen 14.45 [4.80; 43.63] (p=0.008). In 35 patients of the study group (n=93), laboratory resistance to aspirin was also revealed in terms of platelet aggregation to arachidonic acid, which is a criterion for evaluating the effectiveness of preventive measures for recurrent ischemic strokes with antiplatelet drugs. CONCLUSION: The obtained data are additional risk factors for recurrent strokes. It is also recommended to study platelet aggregation for arachidonic acid to assess the effectiveness of antiplatelet drugs prophylaxis of recurrent ischemic strokes.

[Characteristics of microcirculation in patients with acute ischemic stroke and chronic cerebral ischemia]. / Osobennosti sostoianiia mikrotsirkuliatsii u patsientov s ostrym ishemicheskim insul'tom i khronicheskoi ishemiei golovnogo mozga.

OBJECTIVE: To study microcirculation in patients with acute ischemic stroke (IS) using the method of laser Doppler fluorimetry (LDF). MATERIAL AND METHODS: We examined 19 patients with acute carotid IS, including 12 patients who received thrombolytic therapy. The reference group included 22 patients with chronic cerebral ischemia without a history of IS. Computed and magnetic resonance tomography of the brain, ultrasound diagnosis of head and neck vessels, the study of the changes in neurological status, emotional sphere, cognitive functions and laboratory methods were used. RESULTS: An index of total blood flow in the microcirculatory bed on the side of stroke was lower compared to that in patients with chronic cerebral ischemia. The study of parameters of microcirculatory bed regulation revealed an increase of blood inflow into the microcirculatory bed with the augmentation of the myogenic activity of arterioles and primarily the nutritional regimen of microhemocirculation. A decrease in the myogenic activity in the microcirculation system and nutritional direction of microhemodynamics were noted in patients with large IS. In some cases, non-nutritional regimen and/or venule congestion were observed. CONCLUSION: The study of the microcirculation system with the LDF method can be used as the method of early diagnosis of unfavorable variants of cerebral microcirculation that is necessary for outcome prognosis and its correction.