Dynamics of Thrombocytaric Hemostasis Markers in Patients with Increased Body Mass Index and Polytrauma

The hemostasis system is one of the body's rapid response systems. Changes in its functional state that occur under the influence of various stimuli, in particular, polytrauma are considered to be manifestations of a reaction aimed at maintaining homeostasis. It should be noted that in patients with obesity there may be both an increase in coagulation and a violation of the processes of fibrinolysis. Platelets are central to these processes. The purpose of our work was to analyze the dynamics of platelet hemostasis in patients with increased body mass index with polytrauma. A study of complex hemostasiograms was conducted in 224 patients with increased body mass index during the month of hospital stay with a diagnosis of polytrauma and on the 360th day of the outpatient visit, which included a study of cellular hemostasis parameters: platelet count, ADP-aggregation, ristomycin-aggregation. Material and methods. The patients had the same severity at the time of admission on the APACHE II scale of 14±5.8 and were divided into 3 stratified clinical groups depending on the starting numbers of anthropometric indicators and body mass index. So, group I included 88 patients with a body mass index at the time of admission to 29.9 (26.1±3.1), group II comprised 84 patients with a body mass index at the time of admission to 30.0 - 39.9 (35.2±3.8), in group III there were 52 patients with a body mass index at the time of admission to > 40.0 (46.2±5.8). Results and discussion. The number of platelets during our study, depending on the body mass index at the time of admission of patients to the hospital varied ambiguously. A gradual increase in their number was noted from the 14th to the 30th day, hyperthrombocytosis was found 312.7±10.2 • 109 / l and 351.6±16.4 • 109 / l, respectively, which changed with the development of thrombocytopenia in the time period up to 1 year from the receipt of polytrauma. So in the post-traumatic period, the platelet aggregation properties were changed in all examined patients. In group I (body mass index ≤ 29.9), this process was less pronounced: shortening of the aggregation time was detected during stimulation with ristomycin by 25% from the 1st to the 3rd day. Later, a slight lengthening was determined by 10% on the 14th day when stimulated with ADP and ristomycin; then the index was fully restored. In patients of group II (body mass index 30.0-39.9), platelet hyperagregation was detected with the addition of ADP from the 1st to the 3rd and from the 30th to the 360th day of the examination, when the time was shortened by 36% compared with control; Ristomycin was administered from the 1st to the 7th day with a minimum on the 3rd day - 8.3±1.1 * s (p <0.05), from the 30th to the 360th day with a minimum of 360th day of the examination - 11.2±2.7 s (p <0.05). In patients of group III (body mass index ≥ 40.0), there was a slightly different dynamics of these indicators. ADP-aggregation was reduced by day 1 by 34%. Then there was a period of hypoaggregation from the 3rd to the 14th day, when the rate was increased by an average of 33% compared to the control, which then changed to a stable hyperaggregation from the 30th to the 360th day (reduction of the aggregation time by 25%). Ristomycin-aggregation was extended from the 1st to the 7th day with a maximum on the 3rd day - 17.1±1.3 s (p <0.05), then there was a steady hyperaggregation from the 14th to the 360th day with a reduction in time by an average of 35%. Conclusions. All these data testified to the intense functional interest of platelets and their individual response to injury, depending on the comorbidity and severity of polytrauma.