Ryabukha V. Aggregation and morphofunctional proprieties of platelets in patients with ischemic heart disease in the dynamic of treatment with antiplatelet agents and stat-ins.5742

Object of the study: stable and progressive angina of effort. Purpose of the study: to elaborate a differential approach to the administration of antithrombocytic therapy in patients with coronary disease (CD) (stable and progressive angina of effort) depending upon the state of thrombocytic haemostasis and sensitivity to antiaggregants. Methods of the investigation: general methods of investigation: general clinical, laboratory ones, luminescent microscopy, study of the induced (adenosine diphosphate, adrenalin) aggregation of thrombocytes; revealing of aspirin resistance (by Kotovshchikova’s method), a new express method was devised for revealing sensitivity to acetylsalicylic acid (ASA) with help of adrenalin-induced aggregation of thrombocytes in vitro; statistical methods. Theoretical and practical results: the expediency of a parallel assessment of the morphological and aggregation properties of thrombocytes for revealing the earliest activation of the thrombocytic haemostasis is shown. A differential approach is suggested for the administration of aspirin, Clopridogel and their combinations on the basis of revealing sensitivity to ASA. On the basis of the assessment of the thrombotic potential of blood, the expediency of a short-term administration of a combination of antiaggregants in patients with a stable course of CD during 30 days was established. It is found out that additional administration of Symvastatin in patients with CD contributes to a higher sensitivity to ASA. Novelty: criteria for assessing sensitivity to the antiaggregation effect of ASA on the basis of the devised express method are sug-gested. Dependence of the sensitivity to ASA upon the morpho-functional and aggregation properties of thrombocytes in patients with stable and progressive angina of effort was revealed. Infor-mation precursors of the thrombocytic haemostasis activation in patients with stable and progressive angina of effort were estab-lished on the basis of the study of the morphological (the number of diskocytes, megathrombocytes) and aggregation properties of thrombocytes (the total index of thrombocytes aggregation, aggre-gation rate). Peculiarities in the change of the aggregate state of blood and the qualitative content of thrombocytes in the dynamics of treatment with use of aspirin, Clopridogel and their combina-tions were revealed. An advantage was shown for the combined antithrombocytic therapy in patients with stable angina of effort and a high risk of developing thrombotic events during 30 days on the basis of the data of aggregometry and comparison of the corre-lation of certain morphological types of thrombocytes. A relation-ship was shown between the levels of total cholesterol, triglyc-erides, low density lipoproteins and a higher functional activity of thrombocytes. For the first time, it was found out that a distur-bance o lipid metabolism in patients with CD contributes to the development of aspirin resistance, manifested by an insufficient inhibition of aggregation of thrombocytes under the influence of ASA, the maximum changes occurring in dyslipidaemia (DLA) of II B type. It was shown for the first time, that the use of Symvas-tatin contributed to a rise in the sensitivity to ASA, both in pa-tients with normolipidaemia and those with DLA; the maximum effect being observed in DLA in the end of 3-month treatment with Symvastatin. Degree of introduction: results of the thesis were introduced to medical practice of clinical departments of Malaya Institute of Therapy (Academy of Medical Sciences of Ukraine), cardiology departments of the Chernigiv Regional Hospital, Donetsk Central City Hospital No. 1, Infarction Department of Zaporizh’a City Hospital of Urgent and First Aid, Ivano-Frankivsk Regional Car-diology Dispensary. The new method of diagnosing resistance to aspirin is elucidated in materials of lectures and practical classes at Department of Hospital Therapy No. 1 and Department of Therapy No. 3 of Ivano-Frankivsk State Medical University, as it is testified to by corresponding acts on introduction. Sphere of application: medicine, cardiology.