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CHANGES IN THE HAEMOSTASIS SYSTEM UNDER THE INFLUENCE OF TREATMENT OF PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN COMBINATION WITH OBESITY USING ADEMETHIONINE, ARGININE GLUTAMATE AND ROSUVASTATIN

N. R. Matkovska
Likarska sprava pp 42-49; doi:10.31640/jvd.1-2.2020(6)

Abstract: Introduction. The urgency of the problem of liver cirrhosis (LC) is caused by the increase in morbidity, prevalence, life-threatening complications, disability and increasing mortality of able-bodied population. The aim of the study was to examine the effect of complex treatment with ademethionine, arginine glutamate and rosuvastatin on changes in the haemostasis systemin patients with alcoholic liver cirrhosis (ALC) in combination with obesity. Research methods. The study included 105 patients diagnosed with ALC in combination with obesity. The assessment of the effectiveness of a three-month treatment regimen with ademethionine, arginine glutamate and rosuvastatin in obese patients with alcoholic liver cirrhosis (ALC) included indicators of synthetic liver function and hemostasis (total protein, albumin, fibrinogen, platelet count, factor Von Willebrand factor, activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), prothrombin index (PI), D-dimer, tissue plasminogen activator (tPA), 1 plasminogen activator (PAI-1), tPA/PAI-1 index, asymmetric dimethylarginine (ADMA)), as well as liver cirrhosis severity (Child-Pugh score) and 3-month MELD mortality score. Results. Decreased levels of total protein, albumin, fibrinogen, PI, platelet count and increased levels of Von Willebrand factor, prothrombin time (PT), APTT, TT, INR, D-dimer, tPA and PAI-1, ADMA were revealed. Such changes worsened with increasing liver cirrhosis decompensation and were accompanied by an increase in the Child-Pugh and MELD scores (P < 0.05). There was a more pronounced increase in levels of PAI-1 than tPA, that was accompanied by a decrease in tPA/PAI-1 index. A number of researchers indicate that an increase in PAI-1 levels can cause a hypercoagulable state, so its increase with a decrease in tPA/PAI-1 index in patients with ALC in combination with obesity indicates a risk of thrombogenic conditions. This is also evidenced by the increasing number of D-dimers. Therefore, the fibrinolytic/antifibrinolytic factors should be considered in the treatment of such patients to prevent LC complications. Conclusions. The inclusion of ademethionine, arginine glutamate and rosuvastatin in the treatment regimen for 3 months improved the levels of total protein, albumin, fibrinogen, PI, platelet count, Von Willebrand factor, PT, APTT, TT, INR, D-dimer, tPA and PAI-1, ADMA, which was accompanied by a decrease in Child-Pugh severity score and MELD 3-month mortality score.
Keywords: Protein / child / liver cirrhosis / treatment regimen / Meld Scores / Mortality Score / Combination with Obesity

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