Prevention Of Venous Thromboembolic Complications Research Articles

Development and attestation of a standard sample of calcium nadroparin

Introduction. The widespread use of heparin preparations for the treatment and prevention of venous thromboembolic complications is known. One of the low molecular weight heparin drugs successfully used in clinical practice is calcium nadroparin. The modern approach to assessing the quality of medicines involves the use of standards, in comparison with which the quality control of the drug is carried out – standard samples (SS). The most important specific parameter in assessing the authenticity of low molecular weight heparins is the characteristic of the fractional composition.Aim. The aim of the work was to develop, attestation and determine the stability during the shelf life of a secondary standard sample to determine the authenticity of calcium nadroparin as part of improving the quality control system of the enterprise with the prospect of creating a domestic pharmacopoeia standard sample.Materials and methods. The object of development and attestation was the standard sample of the enterprise – low molecular weight heparin, obtained on the basis of the Technology implementation center of Siberian state medical university. The certified standard sample was obtained by purification of calcium nadroparin by solid-phase extraction. The completeness of the purification was confirmed by comparing the chromatograms of the purified samples with the chromatograms of the international standard sample. The characteristics of the molecular weight distribution were determined chromatographically. The stability of the certified SSE (the standard sample of the enterprise) was studied under two storage conditions – at a temperature below 8 °C in a dry state for 16 months and in solution at –40 °C for 6 months by evaluating trends in molecular weight distribution.Results and discussion. For each batch of the certified standard sample, the molecular weight and molecular weight characteristics are calculated in 2 parallel definitions, and a representative chromatogram is presented. The values of the relative standard deviation of the molecular weight of the samples and the content of the controlled fractions did not exceed 2.5 %. A detailed analysis of the molecular weight distribution showed the "classical" dependence of RSD (relative standard deviation) from the average value with a significant increase up to 30 % for small fraction values (less than 0.5 %). It was found that during 16 months at a storage temperature below 8 ºC, the molecular weight and molecular weight characteristics of standard samples of low molecular weight heparin did not significantly change. However, in the SSE solution at a storage temperature of minus 40 °C for 6 months, they degraded by more than 10 %.Conclusion. According to the results of the study, a protocol has been developed for obtaining a standard sample of low-molecular-weight heparin for the standardization of the calcium nadroparin substance according to the indicator "molecular weight distribution". The established shelf life of the sample is at least 16 months at temperatures below 8 °C. The stability of solutions of the standard sample at a storage temperature of –40 °C for 3 months is shown.

Treatment and prevention of venous thromboembolic complications: focus on sulodexide

Venous thromboembolic complications (VTEC) are a common pathology that includes pulmonary embolism and deep vein thrombosis of the lower extremities. Modern drug therapy for VTEC includes taking anticoagulants, which reduce the risk of VTEC recurrence to 1–2% of cases. The article discusses the drug sulodexide, which belongs to the class of heparinoids. Sulodexide is a relatively safe drug that has anti-inflammatory and antithrombotic effects, reducing the release of cytokines, chemokines and growth factors, as well as proteinases and degrading enzymes. When taken orally, there is no pharmacological interaction with substances aimed at treating vascular diseases, so it can be prescribed to patients with concomitant diseases.

Recurrent pulmonary embolism and non-ST elevation acute myocardial infarction: current problems of diagnosis and treatment (clinical case)

A clinical case of a patient with recurrent pulmonary embolism (PE) and non-ST elevation acute myocardial infarction (NSTEMI) is presented. Underestimation of the history data, the clinical course of non-massive pulmonary embolism under the mask of syncope, eventually led to the development of massive pulmonary embolism and clinical death of the patient. The article discusses non-massive PE masks, principles of treatment and secondary prevention of venous thromboembolic complications in a patient with acute NSTEMI.

Features of various options for anticoagulant therapy for a new coronavirus infection against the background of obesity

BACKGROUND: When treating a new coronavirus infection, the prevention of venous thromboembolic complications in obese patients is of particular importance.
 AIM: To analyze various options for anticoagulant therapy in obese and non-obese patients in the treatment of a new coronavirus infection.
 MATERIAL AND METHODS: The patients were divided into two groups: the first group — obese patients — 151 (40.8%) people [average age 63 (56–69) years], the second group without obesity — 219 (59.2%) people [average age 63 (51.5–71.0) years], p=0.998. According to the prescribed anticoagulant and the presence of obesity, patients were divided into subgroups: subgroup 1 — non-obese + low-molecular-weight heparin (n=114), subgroup 2 — non-obese + unfractionated heparin (n=58), subgroup 3 — obesity + low-molecular-weight heparin (n=76), subgroup 4 — obesity + unfractionated heparin (n=66). Venous thrombotic complications and bleeding rates were assessed. Analysis of qualitative indicators was performed using Pearson χ2 and Fisher tests. The distribution of quantitative indicators was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests (p 0.05). Due to the non-normal distribution of indicators, mean values were presented as median (Me) and interquartile range (Q1–Q3), and analysis was carried out using Wilcoxon, Mann–Whitney and Kruskal–Wallis tests.
 RESULTS: In nonobese patients, a comparable incidence of deep vein thrombosis was noted on low molecular weight heparin and unfractionated heparin — 1 (0.9%) case versus 3 (5.2%) cases (p=0.102). At the same time, there was a statistically significant difference in the frequency of pulmonary embolism without a source according to autopsy data — 2 (1.8%) versus 4 (6.9%) cases (p=0.004). In obese patients receiving unfractionated heparin, the incidence of this complication was higher and amounted to 9 (13.6%), and in patients receiving low molecular weight heparin — 2 (2.6%) cases (p=0.004). A higher incidence of bleeding was observed in patients with obesity compared to patients without it (10.6 vs 4.7% of cases, p=0.045). When analyzing hemorrhagic complications, it was found that the incidence of major and significant bleeding was higher in patients receiving unfractionated heparin rather than low molecular weight heparin (16.7 vs 5.3% of cases, p 0.001).
 CONCLUSION: The use of low molecular weight heparin in obese patients with new coronavirus infection was associated with a low incidence of pulmonary embolism and bleeding compared with patients receiving unfractionated heparin.

Laboratory Predictors of Hemorrhagic Complications in Patients With Total Hip Arthroplasty and Treatment With Direct Oral Anticoagulants

Introduction. Direct oral anticoagulants (DOAC) rivaroxaban and apixaban have significantly reduced the risk of developing venous thromboembolic complications (VTEC). However, the use of DOAC may be associated with a higher risk of bleeding, especially actual in patients after total hip arthroplasty (THA).Material and methods. We enrolled 38 patients with moderate osteoarthritis of the hip joints undergoing THA. The mean age of patients was 58 (33; 85) years. All the patients received rivaroxaban or apixaban in the doses specified by Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Retrospectively, in the postoperative period, the patients were divided into two groups: Group 1 — 31 patients (20 women and 11 men), who had no hemorrhagic complications after hip replacement; and Group 2 — 7 patients (4 women and 3 men) who experienced hemorrhagic events in the form of hematomas in the wound area. Laboratory tests were performed for all patient baseline (1st day of hospitalization), after surgery (1st day after THA), and on the 7th day after THA. Analyses included the determination of hemostasis parameters (INR, aPPT, fibrinogen, D-dimer), hematological (HGB, PLT, RBC) and biochemical parameters (calcium, ionized calcium, serum iron, hs-CRP).Results. The analysis of biochemical parameters in patients with hemorrhagic complications revealed a significant increase of fibrinogen (p=0,023) compared with uncomplicated cases. Serum iron concentration in men with hemorrhagic complications in the postoperative period was significantly lower than in patients without complications. In patients with hemorrhagic complications, the ionized calcium was lower (p=0,032) than in patients without complications, but within the reference values. The hs-CRP concentration in the group with hemorrhagic complications was twice higher than in the group without complication and eight times above the reference values.Conclusion. The concentration of iron in the blood serum in men below 11 mmol/l and a slight hyperfibrinogenemia of 4.65 g/l in all the patients are the risks of developing hematomas in the area of surgery. These parameters should be used to predict the risk of hemorrhagic complications in patients before THA and recommended for control before the surgery and on the 1st day after THA (hs-CRP).

Prognostic value of hemostasis system indicators in patients with a traumatological profile when taking anticoagulants

Objective. To assess the state of the hemostasis system and the risk of hemorrhagic complications in patients before and after hip replacement while taking anticoagulants. Patients and methods. The study included 85 patients, 46 women (average age 62.8 ± 8.95) and 39 men (average age 55.1 ± 14.3) who were in the Clinic of Traumatology and Orthopedics of the I.I. Mechnikov NWSMU for planned hip replacement. All patients received rivaroxaban or apixaban at doses specified by Russian Clinical Guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications. Retrospectively, in the postoperative period, the patients were divided into 2 groups: group 1 — 78 patients (42 women and 36 men) who had no hemorrhagic complications after hip replacement, and group 2 — 7 patients (4 women and 3 men) who had hemorrhagic events in the form of hematoma in the wound area. All patients underwent laboratory tests before surgery, on the first day and on the 10th day after arthroplasty. The laboratory study included the determination of hemostasis parameters (PT in seconds, PT % activity, APTB, Fibrinogen, D-dimer), the concentration of rivaroxaban or apixaban in blood plasma, molecular genetic study of the polymorphism of the G(-455)A gene. Results. When assessing the traumatic factors of surgical intervention in patients with hemorrhagic complications, the volume of blood loss is significantly higher (p = 0,001) compared with cases of uncomplicated course. Minor hyperfibrinogenemia (Me 5,18 g/l) before surgery was detected in group 2 patients. A statistically significant increase in fibrinogen concentration (p = 0,006) occurred in patients on the background of surgery and is associated with traumatic factors of surgery. There was an increase in the concentration of fibrinogen and the level of D-dimer above the reference values on the 10th day after endoprosthesis, but no statistically significant differences were observed in both groups. The concentration of rivaroxaban in the blood was within the therapeutic interval throughout the entire observation period, and apixaban was higher than the therapeutic dose in the group of patients with complications on the 1st day after surgery, while thrombosis and bleeding were not found in patients. Conclusion. Hyperfibrinogenemia in patients in the preoperative period and after surgery may be an additional factor in the development of postoperative complications. Determination of the concentration of rivaroxaban and apixaban in blood plasma using an automatic chromogenic test allows you to evaluate their anticoagulant effect.

Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis

The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities.
 Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment.
 Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%.
 Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.

Modern approaches to the prevention of venous thromboembolic complications in patients with active cancer

Cancer is one of the most significant risk factors for venous thromboembolic complications (VTEC), which combines deep vein thrombosis and pulmonary embolism. Of the many well-known risk factors for VTEC, only cancer is associated with a 4-fold increased risk of venous thrombosis, and in cancer patients receiving chemotherapy the risk increases by up to 6.5-fold. Venous thrombosis is increasingly common in cancer patients and contributes significantly to the course of the underlying disease and mortality, especially when combined with additional risk factors, the most significant of which are surgery and chemotherapy treatment. The prevention and treatment of VTEC in cancer patients is a challenge, primarily due to the pathogenesis of cancer-associated thrombosis, the presence of additional risk factors associated with cancer, the high risk of haemorrhagic complications, reduced renal function and the recurrent nature of VTEC. Aspects of safe prevention remain an integral part of the management of patients with active cancer. The most vulnerable periods for the development of VTEC are the periods when the patient is hospitalised for surgical or therapeutic treatment and the long period of chemotherapy treatment on an outpatient basis. A comprehensive approach to the prevention of VTEC in patients with cancer should primarily involve careful selection of high-risk patients at each stage of treatment of the malignancy; these patients are the ones who will benefit most from drug thromboprophylaxis. The treatment of an already confirmed VTEC in a cancer patient always involves the additional challenges of drug interactions and increased haemorrhagic risk due to prolonged use of treatment doses of anticoagulants, which may in turn affect the effectiveness of chemotherapy or the efficiency and safety of anticoagulant therapy.

ОСОБЕННОСТИ ТЕЧЕНИЯ БЕРЕМЕННОСТИ С МАНИФЕСТАЦИЕЙ ИНФЕКЦИИ COVID-19 В ТРЕТЬЕМ ТРИМЕСТРЕ

Women during gestation are considered to be at high risk of viral respiratory infections with conversion to pneumonia due to physiological changes in the immune and cardiopulmonary systems. This research publication examined the peculiarities of the course of pregnancy, obstetric and perinatal outcomes during pregnancy against the background of a new coronavirus infection COVID-19 and assessed the changes in laboratory indices. Objective. to evaluate the features of the course of pregnancy with COVID-19 manifestation in the third trimester. Materials and Methods. 139 pregnant women at 28 weeks' gestation or more, including 112 pregnant women admitted to the obstetric department of an infectious diseases hospital with a confirmed diagnosis of COVID-19 and with mild to moderate degrees of infection, and 27 pregnant women in the antenatal clinic, who were conventionally healthy. The first group of pregnant women was divided into two subgroups, depending on the prescription of low molecular weight heparins for the prevention of venous thromboembolic complications (55 and 57 subjects, respectively). We evaluated the data of gynecological anamnesis, extragenital diseases, peculiarities of pregnancy course, clinical characteristics of COVID-19, comparison of laboratory tests. The features of the course of infection and pregnancy with altered blood parameters: lymphopenia, elevated levels of C-reactive protein, D-dimer were considered in the acute period of infection. The correlation between the gestational age at infection and the term of delivery as a result of the treatment was analyzed. The presence of iron deficiency anemia was considered as an additional risk factor for new coronavirus infection in pregnant women. Changes in the levels of fibrinogen, C-reactive protein, D-dimer may be the main markers in predicting the course of COVID-19 infection. Prescription of low-molecular-weight heparins at the initial stage of therapy may serve as a factor that allows prolongation of pregnancy to a pre-term term.

Current state of the problem of risk assessment and prevention of venous thromboembolic complications after thermal obliteration of superficial veins

Venous thromboembolic complications (VTEO) after modern minimally invasive superficial vein interventions are an infrequent but very dramatic event. This article presents a review of the literature, covering the issues of prevalence, prognosis and pharmacological prevention of VTEO. The performed studies demonstrate that the incidence of symptomatic thrombotic complications after endovenous thermal obliteration does not exceed 0,5%, but taking into account asymptomatic thermally induced thromboses and subclinical occlusions of the muscular veins of the lower leg, this figure can exceed 10%. There is a high heterogeneity of the data, possibly due to differences in the individual risk of VTEO. The most validated tool for assessing the latter is the Caprini Scale, which has not been sufficiently studied in the surgical treatment of varicose veins. The administration of prophylactic doses of anticoagulants after thermal obliteration of saphenous veins is widely used in routine clinical practice, despite the lack of convincing evidence for the appropriateness of this approach. In recent years, the use of direct oral anticoagulants against the official instruction (off-label) has gained great popularity as an alternative to heparin. The largest evidence base has accumulated for the use of rivaroxaban 10 mg, which is associated with high efficacy and safety. Based on completed clinical trials, it is not possible to formulate unequivocal recommendations for prophylactic anticoagulant doses after thermal obliteration of superficial veins at this time. Additional studies are required to identify patients with an individually increased risk of thrombosis in whom prophylactic doses of anticoagulants may be of maximum benefit.

The Effectiveness of Compression Therapy in the Prevention of Venous Thromboembolic Complications in Patients With COVID-19

Background The main method for preventing thrombotic complications in patients with coronavirus infection is anticoagulant therapy (ACT). However, its use is not always possible, in particular in patients with bleeding. The only method of prevention in this case is elastic compression (EC) of the lower extremities. Aim of study To evaluate the effectiveness of lower extremity EC for the prevention of venous thromboembolic complications (VTEC) in patients with a new coronavirus infection. Material and methods The study was approved by the local Ethics Committee of the Ryazan State Medical University of the Ministry of Health of Russian Federation and registered on the ClinicalTrials.gov platform (identifier NCT05143567). The study included 69 patients without prophylactic compression (Group 1) and 65 patients who used prophylactic compression stockings (Group 2). The patients were treated in the covid hospital from July to November 2021. All patients had verified coronavirus infection, they took ACT and underwent ultrasound duplex scanning of the veins of the lower extremities upon admission, in the intensive care unit and upon discharge. We assessed the frequency of venous thromboembolic complications (VTEC), hemorrhagic complications, and mortality. To assess the severity of bleeding, the classification of the Committee of the International Society on Thrombosis and Haemostasis (ISTH) was used. Results In patients without prophylactic compression (Group 1) there were 7 VTEC cases (10.14%); deep vein thrombosis (DVT) — 4 (5.8%), pulmonary embolism (PE) — 3 (4.3%). All 6 cases (8.7%) with PE were fatal. It was noted that 2 cases of PE (2.8%) were verified upon autopsy, and not clinically. In patients of the 2nd group with the use of elastic compression, the overall incidence of VTEC was only one case (1.6%). When analyzing the frequency of bleeding in the 1st group, there was one pulmonary bleeding (1.4%), in the 2nd group there was also one case of intense intermuscular hematoma (1.6%). Significant bleeding was observed in one patient (1.4%) of the 1st group, and in 3 (4.8%) cases of the 2nd group. The minor bleeding was observed in 11 patients (15.9%) of the 1st group, and in 8 (12.7%) patients of the 2nd group. The mortality during hospitalization was 11 (15.9%) cases in patients of the 1st group (without EC) and 7 (11.1%) in patients of the 2nd group (with EC) (p=0.419). Conclusions The mortality in patients with coronavirus infection without compression therapy is higher than in patients with compression stockings (p=0.419). Patients wearing compression stockings in the hospital had a low incidence of VTEC (1.6% of cases in group 2 versus 10.14% of cases in group 1, p=0.039). The study groups had the same frequency of bleeding (group 1 — one case (1.4%), group 2 — one case (1.6%). The use of preventive compression at the inpatient stage of treatment of a new coronavirus infection makes it possible to prevent VTEC in patients with bleeding when anticoagulant therapy is not possible.

Expanding the possibilities of treatment and prevention of venous thromboembolic complications in cancer patients. The role of oral anticoagulants

Improving the quality of care for patients with oncological diseases due to the improvement of methods of chemoradiotherapy and surgical interventions, accessibility and modernization of diagnostic potential, is accompanied by a steady increase in the frequency of venous thromboembolic complications, which occupy one of the leading places among the causes of death.Patients with oncological diseases are subject to various risk factors for thromboembolic complications, which are caused by the presence of a malignant neoplasm, due to the development of many coagulation abnormalities, initiating not only an increased tendency to thrombosis, but also a tendency to bleeding. Cancer-associated venous thrombosis, growing out of the framework of certain medical specialties, act as comorbid pathological conditions that require an interdisciplinary approach in developing rational methods of prevention and treatment. Improving the understanding of the pathophysiological mechanisms of venous thrombosis in cancer patients contributes to the development of modern methods of prevention and treatment, among which anticoagulant therapy plays a dominant role. The appearance of oral anticoagulants on the pharmaceutical market, the effectiveness and safety of which is confirmed by a series of randomized clinical trials, opens up new prospects for improving the quality of life and long-term survival in patients with malignant neoplasms.

Increased risk of venous thrombosis in breast cancer patients receiving chemotherapy treatment after COVID-19.

e24106 Background: Immune suppression and coagulopathy development in cancer patients receiving chemotherapy determines a high incidence of complications, including venous thrombosis, and mortality from COVID-19 infection. There are still no explicit data on managing cancer patients when anticancer treatment is resumed after coronavirus disease. According to clinical guidelines for the prevention of venous thromboembolic complications in cancer patients receiving chemotherapy, patients with breast cancer are classified as having a low risk of these complications and do not require prophylactic anticoagulation. The purpose of this study was to assess the parameters of the blood coagulation system and the frequency of venous thrombosis in breast cancer patients with chemotherapy resumption after coronavirus disease. Methods: The study included 30 patients receiving anticancer medical therapy for breast cancer after COVID-19. Anticancer treatment was resumed no earlier than 4 weeks after clinical recovery, absence of SARS-CoV-2 RNAs in nasopharyngeal swabs, infiltrative lung damage according to a chest CT scan, exclusion of venous thrombosis by a lower extremity venous ultrasound. Control group included 20 breast cancer patients without a history of COVID-19. Stage I tumors were registered in 26.6% in the main group vs 15% controls; II - 40% vs 60%; III - 20% vs 15%. Some patients were diagnosed with distant metastases (stage IV- 13.3% vs 10%). Results: Initially, before chemotherapy resumption in the main group, half of the patients had elevated levels of fibrinogen and D-dimer compared with the control group (66.7% vs. 35%, p > 0.05). After a cycle of chemotherapy, a significant difference in the coagulation system parameters was noted (73.3% vs 30%). A lower extremity venous ultrasound after the end of the therapy cycle in the main group showed venous thrombosis in 3 patients (catheter-related n = 2, distal vein thrombosis of the lower extremities n = 1), while no venous thrombotic complications were detected in the control group (10% vs. 0%). Conclusions: Breast cancer patients after coronavirus disease 2019 have hemostasis abnormalities and higher risk of venous thrombosis, and the resumption of anticancer treatment increases the incidence of thrombotic complications. COVID-19 should be considered an additional risk factor of venous thrombosis in cancer patients and requires reconsideration of indications for prophylactic anticoagulation when resuming anticancer treatment for patients with breast cancer.

About the current situation with regard to the risks and prevention of venous thromboembolic complications after varicose vein surgery

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Role of anticoagulants in therapy and prevention of recurrent venous thromboembolism in patients with cancer: a meta-analysis of randomized trials with apixaban

Background Venous thromboembolic complications (VTEC) are a major non-oncological cause of death of patients with malignant neoplasm (MNP). This determines the high significance of antithrombotic therapy for the treatment and secondary prevention of VTEC in this population. During recent years, low-molecular weight heparins (LMWH) have been a "gold standard" for the treatment of cancer-associated venous thrombosis (CAVT). In the recent decade, direct oral anticoagulants (DOACs) have become extensively used for the treatment and prevention of VTEC relapse in non-oncological patients and also for primary prevention of VTEC following orthopedic surgery. Taking into account the oral route of administration, the predictable and convenient pharmacokinetic profile, and the absence of need for coagulation monitoring, it seems possible to use DOACs for the treatment and secondary prevention of VTEС in oncological patients. A meta-analysis of 4 randomized clinical trials (RCTs) showed a higher efficacy of DOACs compared to LMWHs, however, with a greater risk of bleedings in CAVT. In two of four studies using apixaban (more than 40% of weight in meta-analysis), no increase in bleedings was noted.Aim The aim of this study was to perform a systematic search for comparative clinical studies with apixaban and to perform a meta-analysis to answer the question on clinical efficacy and safety of apixaban in the treatment and secondary prevention of recurrent VTEC in patients with CAVT.Material and methods The systematic search was performed in three reference databases, Medline (PubMed), Cochrane Library (CENTRAL), and eLibrary. The search was aimed at publications containing results of RCTs using apixaban for the treatment and prevention of VTEC in patients with MNP. A totality of 678 titles was found; 15 articles were selected for detailed studying, and 4 RCTs were included into the final analysis. The meta-analysis was performed according to the criteria of PRISMA guidelines. Relative risk (RR) was used as a measure of the effect. The meta-analysis was performed by the Mantel-Haenszel method using the R software. Statistical heterogeneity was evaluated with the Cochran criterion (I2); heterogeneity was considered significant at I2 ≥50 %, which was a reason for performing a random-effects meta-analysis. For this meta-analysis, the primary outcome measure was new VTECs (symptomatic or detected proximal deep vein thrombosis and/or symptomatic, detected or fatal pulmonary thromboembolism plus symptomatic upper extremity thromboses, celiac veinous thromboses, and cerebral veinous thromboses if they were included into the efficacy endpoint of the primary studies). The primary safety measure was major bleeding according to ISTH criteria. Other variables included major and clinically significant minor bleedings as well as overall death rate.Results During the systematic search, 4 RCTs were selected. The meta-analysis of the treatment and secondary prevention of VTEC in patients with MNP showed that apixaban was more effective than the active control (88% of LMWHs) in prevention of VTEC relapse. The RR was 0.59; 95 % confidence interval (CI): 0.40-0.86 in the absence of statistically significant differences from the control in the risk of major bleedings (statistically non-significant decrease by 21%), the sum of major and clinically significant minor bleedings, and overall death rate.Conclusion According to the results of the meta-analysis, the DOAC apixaban may be a drug of choice for the treatment and prevention of VTEC relapse in patients with MNO.

Clinical effect of electromyostimulation in the perioperative period of operations on the ankle joint

SummaryIntroduction. Surgical procedures can relieve pain symp-toms and improve function in patients with middle or late stage ankle osteoarthritis. However, the incidence of ve-nous thromboembolic complications in orthopedic sur-gery is 45–70%. Aim of the study. To study the effect of period treatment results after ankle joint surgery due to the use of electromyostimulation, as well as the possibil-ities to prevent deep vein thrombosis. Methods. 42 pa-tients with osteoarthritis of the ankle joint of the middle or late stage were divided into the control group and electromyostimulation group. The changes of preope-rative and postoperative measures of coagulation ana-lysis, duration of surgery, intraoperative blood loss, VAS score and quality of aid were observed between the two groups. Results. The coagulation analysis value and VAS score in the electromyostimulation group on the 7th day after surgery were significantly better than in the control group (р<0.05). However, there was no statistical differ-ence between the two groups in the duration of surgery, intraoperative blood loss, and quality of aid (р>0.05). Conclusions. Electromyostimulation has a significant impact on the prevention of venous thromboembolic complications, and it is safe and worthy of clinical appli-cation

Prevention of Thromboembolic Complications in Patients with Postphlebitic Lower Extremities Syndrome

Prevention of venous thromboembolic complications (pulmonary embolism, stroke, deep vein thrombosis) remains the most important clinical medicine problem and affects all doctors’ professional expertise areas without exeption due to an extremely high potential risk to the health and life of patients that might cause thromboembolic complications. A worldwide trend is to use conservative methods of treatment and prevention of pulmonary embolism, stroke, deep vein thrombosis, which are most often limited to the use of compression treatment, periodic appointment of phlebotropic medications courses. At the same time, effective and safe methods of using non-drug technologies for the prevention of thromboembolic complications in patients, in particular, with postphlebitic lower extremities syndrome, are in progress. They can prevent and/or significantly reduce the number of life-threatening complications and mortality with minimal risk of bleeding. The article presents a review of the literature data using the Russian and foreign sources on the use of medicinal and non-medicinal,mechanical methods of medical rehabilitation and sanatorium-resort treatment of patients with preventive effect on the dangerous thromboembolic complications occurrence.

PREVENTION OF THROMBOEMBOLIC COMPLICATIONS OF SURGICAL PATIENTS.

Summary. Aim. To analyze the clinical significance of the Caprini scale for the prevention of venous thromboembolic complications (VTEС) in urgent surgical patients.
 Materials and methods. The study is based on a retrospective assessment of inpatient medical records of 58 patients in the surgical department, who were divided into three clinical groups according to the characteristics of the Caprini scale.
 The results. The first clinical group - 11 (19%) patients with low risk VTEС. Prevention of VTEС was carried out only using compression stockings. The second clinical group consisted of 25 (43.1%) patients with moderate risk of VTEС. Prevention of VTEС was performed using compression stockings for (4.4 ± 0.6) days and the introduction of enoxaparin at a dose of 2000 anti-Xa IO 1 time per day for 5 days. The third clinical group consisted of 22 (37.9%) patients at high risk of VTEС. Prevention of VTEС was performed using compression stockings, the use of enoxaparin by subcutaneous injection at a dose of 4000 anti-Xa IO 1 time per day for 7 days.
 Conclusions. The study found that the Caprini scale is effective for assessing the risk of VTEС and allows you to choose rational tactics for the prevention of thromboembolic complications in urgent surgical patients.

Improvement of Perioperative Management of Patients Undergoing Surgical Treatment for Hip Periprosthetic Joint Infection

Two-stage revision arthroplasty in chronic hip periprosthetic joint infection cases is the “gold standard” treatment. First stage debridement leads to large intraoperative and drainage blood loss using standard protocols for thromboprophylaxis and drainage of the surgical wound, which is a significant disadvantage of perioperative management of such patients.The aim of the study was to determine the effect of modified management protocol with delayed start of thromboprophylaxis and a short period of drainage on the blood loss and the effectiveness of debridement with antibiotic-impregnated spacer placement in patients with hip periprosthetic joint infection.Materials and Methods. A single-center prospective study was conducted. 90 patients underwent endoprosthesis components removal and antibiotic-impregnated spacer placement. Patients were divided into 3 groups: start of thromboprophylaxis before surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 3–4 days of drainage; start of thromboprophylaxis no earlier than 12 hours after surgery and 1 day of drainage.Results. There was a statistically significant (p0.05) decrease of drainage and total blood loss, and transfused blood volume in cases with the delayed start of thromboprophylaxis and a short period of drainage. The proposed protocol was safe for prevention of venous thromboembolic complications and did not affect the frequency of periprosthetic hip joint infection recurrence. The effectiveness of the first stage of treatment — 89%, the second stage — 99% in 1 year after rehabilitation according to the second international consensus on musculoskeletal infection criteria.Conclusion. The modified protocol of perioperative management is an effective and safe as a blood-saving strategy and can be proposed for widespread use.

Реалии применения антикоагулянтной терапии при COVID-19

Введение. Поступление вируса SARS-CoV-2 в организм человека сопровождается развитием COVID-19-ассоциированной коагулопатии, часто реализующейся в различных тромботических осложнениях. Актуальные клинические рекомендации описывают основные подходы к лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО), однако реализация их не всегда представляется возможной. В реальной практике встречается значительное количество отклонений и нарушений, в том числе носящих системный характер, связанных как с ограниченностью представлений клиницистов о патогенетических аспектах развития инфекционного процесса, так и с избыточным желанием предотвратить отдельные из них. Цель исследования: изучение состояния реальной клинической практики в области лечения и профилактики развития тромботических осложнений у пациентов c новой коронавирусной инфекцией COVID-19 (НКИ COVID-19). Материалы и методы. В основе работы лежит анонимный опрос 223 врачей-специалистов, занимающихся лечением пациентов с хроническими и острыми заболеваниями сосудов. В опросник включено 18 вопросов, описывающих отношение врачей к проблеме в целом, а также касающихся выбора тактики лечения, применения антикоагулянтных препаратов и методов контроля системы гемостаза. Результаты. Подавляющее большинство участников опроса информированы и озадачены увеличением риска тромботических осложнений при НКИ COVID-19. При этом приоритетной целью антикоагулянтной терапии (АКТ) в острой фазе заболевания участники назвали лечение COVID-19-ассоциированной коагулопатии, а в стадии реконвалесценции — профилактику ВТЭО. Максимальную степень доверия при назначении АКТ имеют низкомолекулярные гепарины. Прямые оральные антикоагулянты, несмотря на отсутствие качественных рандомизированных исследований, подтверждающих их эффективность, большая часть врачей использует на амбулаторном этапе. Вызывает озабоченность значительный разброс вариантов и невысокий процент корректных ответов в вопросах, посвященных лабораторному контролю за системой гемостаза при АКТ. Заключение. Выполненный нами анализ свидетельствует о существенном расхождении реального применения антикоагулянтных препаратов у пациентов с НКИ COVID-19 с действующими клиническими рекомендациями. Кроме того, полученные результаты свидетельствуют о необходимости повышения уровня образованности практикующих специалистов в вопросах свертывания крови. Background. The SARS-CoV-2 virus invasion lead to COVID-19-associated coagulopathy accompanied with increased incidence of thrombotic complications. Current clinical guidelines give the main approaches to the treatment and prevention of them; however their implementation is not always possible in practice. In fact, there are a lot of violations including with a systemic genesis and associated either with the low understanding of infectious process pathogenesis aspects by clinicians or with their excessive desire to prevent coagulation disturbances. the revealing of real clinical practice conditions in the treatment and prevention of thrombotic complications in patients with coronavirus infection COVID-19. Materials/Methods. We provided an anonymous poll for 223 experts treating patients with chronic and acute vascular diseases. The questionnaire included 18 questions to identify as the experts attitude to this challenge as a whole as well as to their choice of treatment tactics, and anticoagulant drugs, and methods of laboratory monitoring of blood coagulation. Results. Most participants know the increased risk of thrombotic complications in COVID-19 and they are puzzled by it The treatment of COVID-19-associated coagulopathy is considered as the priority goal of anticoagulant therapy in the acute phase of COVID-19 whereas the prevention of venous thromboembolic complications is noted as main goal in convalescences. Low molecular weight heparins have gotten the highest confidence in the administration among anticoagulants. In turn, the most of experts use direct oral anticoagulants in outpatients even despite no confirmation is for DOAC’s effectiveness from randomized trials in this time. Besides it was revealed wide spread of opinions and low count of correct responses about laboratory control of the hemostatic system and anticoagulants. Conclusion. The analysis showed a serious inconsistency between the real anticoagulants administration in patients with COVID-19 and the recommendations of clinical guidelines. This circumstance obviates the need to raise educational level of physicians and surgeons in the field of blood coagulation.