Hemostasis defects in patients with urolithiasis
DOI: 10.32364/2587-6821-2020-4-2-101-104
A.G. Berezhnoy, S.S. Dunaevskaya, A.O. Mamontov, M.A. Berezhnaya
Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation
Aim: to identify typical defects of coagulation (as a component of hemostasis) in patients with urolithiasis who develop early postoperative hemorrhagic complications.
Patients and Methods: 174 patients with urolithiasis who underwent urological surgeries were enrolled in the study. Shock-wave lithotripsy was performed in 41 patients (23.6±1.41%), percutaneous nephrolitholapaxy in 40 patients (23.0±1.27%), percutaneous mini-nephrolitholapaxy in 62 patients (35.6±1.03%), and ureteroscopic lithotripsy in 31 patients (17.8±1.23%). Conservative treatment was prescribed considering postoperative specifics and according to clinical guidelines. Patients were subdivided in two groups. Group I included 93 patients without postoperative hemorrhagic complications. Group II included 81 patients with postoperative hemorrhagic complications of various severity. Before and 3 days after the surgery, the following parameters of hemostasis were measured: activated partial thromb oplastin time (APTT), prothrombin time (PT), thrombin time (TT), prothrombin index (PI), the level of D-dimer, international normalized ratio (INR), plasma level of fibrinogen, plasma level of soluble fibrin monomer complexes (SFMCs), antithrombin III activity, platelet count, spontaneous and ADP-induced platelet aggregation, and the level of protein C.
Results: in urolithiasis, hemostasis is characterized by chronic hypercoagulation and moderate increase in fibrinogen levels without acute thrombinemia. Additionally, in group II, the activity of prothrombin complex factors was elevated. High thrombinemia, signs of chronometric hypercoagulation, fibrinogenemia, and activity of prothrombin complex factors are typical for early postoperative period.
Conclusion: patients with high predictable risk of hemorrhagic complications require individual choice of surgical strategy and postoperative management to provide hemostatic efficacy.
Keywords: urolytiasis, hemostasis, nephrolitholapaxy, lithotripsy, postoperative complications, hemorrhagic complications.
For citation: Berezhnoy A.G., Dunaevskaya S.S., Mamontov A.O., Berezhnaya M.A. Hemostasis defects in patients with urolithiasis. Russian Medical Review. 2020;4(2):101–104. DOI: 10.32364/2587-6821-2020-4-2-101-104.
About the authors:
Aleksandr G. Berezhnoy — MD, PhD, associate professor of the Department of Urology, Andrology, and Sexology of the Institute of Postgraduate Education, ORCID iD 0000-0002-7487-8671;
Svetlana S. Dunaevskya — MD, PhD, Professor, professor of Prof. M.I. Gul’man Department of General Surgery, ORCID iD 0000-0002-0817-9573;
Artem O. Mamontov — MD, resident of the Department of Urology, Andrology, and Sexology of the Institute of Postgraduate Education, ORCID iD 0000-0002-0500-5332;
Mariya A. Berezhnaya — Student of the 3rd course of Medical Faculty, ORCID iD 0000-0001-8427-4057.
Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University. 1, Partizan Zheleznyak str., Krasnoyarsk, 660022, Russian Federation.
Contact information: Svetlana S. Dunaevskya, e-mail:
vikto-potapenk@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or meth od mentioned. There is no conflict of interests. Received 09.02.2020.
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