Povezanost koncentracije glikiranoga hemoglobina i reaktivnosti trombocita u bolesnika sa šećernom bolesti koji se podvrgavaju elektivnoj kardiokirurškoj revaskularizaciji miokarda

doctoral thesis

• Title (english): Relationship between level of glycosylated hemoglobin and platelet reactivity in patients with diabetes mellitus undergoing elective coronary artery bypass grafting
• Author: Martina Zrno Mihaljević; VIAF: 305758761
• Mentor: Bojan Biočina (mentor)
• Committee member: Hrvoje Gašparović (predsjednik povjerenstva)
• Committee member: Davor Miličić (član povjerenstva)
• Committee member: Silva Zupančić-Šalek (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2021-02-25, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery
• Universal decimal classification (UDC): 617 - Surgery. Orthopaedics. Ophthalmology

Abstract

Uvod.
S obzirom na središnju ulogu trombocita u razvoju tromboze, koja je glavni uzrok ranog poslijeoperacijskog zatajenja grafta, te povećanu sklonost dijabetičara hiperreaktivnosti trombocita, cilj ovog istraživanja je utvrditi utjecaj prijeoperacijskog HbA1c na reaktivnost trombocita i klinički ishod ovih bolesnika. -----
Metode.
U prospektivnu opservacijsku studiju je uvršteno 225 bolesnika. Svim je bolesnicima prije operacije određena razina HbA1c, kao i funkcija trombocita, koja je reevaluirana četvrti poslijeoperacijski dan. Bolesnici su podijeljeni u dvije skupine: HbA1c < 7 % i HbA1c ≥ 7 %. Primarna mjera ishoda je procijeniti je li povećana razina prijeoperacijskog HbA1c predskazatelj veće prevalencije aspirinske rezistencije. Kao sekundarnu mjeru ishoda uspoređivali smo pojavu MACCE-a između dvije HbA1c skupine. -----
Rezultati.
U dvjema HbA1c skupinama možemo uočiti konzistentan porast poslijeoperacijske aspirinske rezistencije za otprilike 10 %. Osim toga, za 10 % je veća prevalencija aspirinske rezistencije u skupini bolesnika s HbA1c < 7 % prije i nakon operacije. Ovom studijom nismo dokazali razlike u kliničkim ishodima između HbA1c skupina. -----
Zaključak.
Kod bolesnika s dijabetesom neophodno je procijeniti poslijeoperacijsku reaktivnost trombocita kako bismo detektirali one s aspirinskom rezistencijom u svrhu primjene potentnije antiagregacijske terapije te na taj način reducirali stopu neželjenih ishemijskih događaja nakon kirurške revaskularizacije miokarda.

Abstract (english)

Introduction.
It is known that early thrombosis is a major cause of early postoperative graft failure and that patients with diabetes have an increased tendency for platelet hyperreactivity. Therefore, the aim of this study was to determine the impact of preoperative HbA1c on platelet reactivity and clinical outcome in these patients. -----
Methods.
All 225 patients had HbA1c levels as well as platelet function before surgery, which was reevaluated on the fourth postoperative day. Patients were divided into two groups: HbA1c < 7% and HbA1c ≥ 7%. The primary outcome measure is to assess whether an increased preoperative HbA1c level is a predictor of a higher prevalence of aspirin resistance. -----
Results.
In the two HbA1c groups, a consistent increase in postoperative aspirin resistance by approximately 10% can be observed. The prevalence of aspirin resistance was 10% higher in the group of patients with HbA1c < 7% before and after surgery. We did not demonstrate differences in clinical outcomes between HbA1c groups. -----
Conclusion.
In patients with diabetes, it is necessary to assess the postoperative platelet reactivity in order to detect those with aspirin resistance in order to apply more potent antiplatelet therapy and thus reduce the rate of adverse ischemic events after surgical myocardial revascularization.

• Keywords: glikirani hemoglobin; trombociti; šećerna bolest; revaskularizacija miokarda
• Keywords (english): glycated hemoglobin; platelets; diabetes; myocardial revascularization
• Language: croatian
• URN:NBN: urn:nbn:hr:105:835049
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 59 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-23 09:42:26