Risk Of Thromboembolic Complications Research Articles

Unusual Late Onset Recurrent Venous Thrombosis in Two Young Post Renal Transplant Recipients – Challenges in Diagnosis and Management with Review of Literature

The risk of thromboembolic complications, including recurrence, remains elevated in renal transplant recipients. We discuss two young patients seven and eight years post renal transplant with recurrent venous thrombosis necessitating indefinite anticoagulation. One patient received tenecteplase for pulmonary thromboembolism twice without any complication.

#1912 Assessment of the dynamics of renal anemia in patients with atrial fibrillation and chronic kidney disease stage IIIb-V during anticoagulant therapy

Abstract Background and Aims Therapy with oral anticoagulants prevents the development of most ischemic strokes and systemic embolisms in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), and also helps to increase life expectancy, improving its quality. It should be emphasized that with CKD, the risk of hemorrhagic complications also increases, which in turn can lead to the progression of renal anemia and deterioration in the patient's general condition. The main complication of anticoagulants is an increased risk of major bleeding, including intracranial, life-threatening bleeding. The purpose of the study is to assess the benefits and risks of anticoagulant therapy in patients with renal anemia in AF and stage IIIb-V CKD. Method From February 2022 to July 2023, 2983 patients with AF were admitted to cardiology departments. The majority of patients with AF had hypertension (94%), chronic heart failure (71%), coronary heart disease (65%), and type 2 diabetes mellitus (23%). CKD was diagnosed according to KDIGO criteria, glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. Indications for anticoagulant therapy (ACT) were determined according to European guidelines for AF using the scales for assessing the risk of thromboembolic complications (TEC)—CHA2DS2-VASc and the risk of bleeding—HAS-BLED. Results GFR up to 45 ml/min/1.73 m2 was detected in 2189 (73%) patients with AF, GFR less than 45 ml/min/1.73 m2 in 794 (27%) patients with AF (CKD stages IIIb–V in 516 (65%) cases, for the first identified sustained decrease in glomerular filtration rate (FISD in GFR) of less than 45 ml/min/1.73 m2 was detected in 278 (35%) cases). Among patients with AF and CKD, renal anemia was diagnosed in 23% of cases, in 63% (n = 505) of cases with AF and GFR <45 ml/min/1.73 m2. With a GFR of 45-30 ml/min/1.73 m2, renal anemia was detected in 59%, with a GFR of 30-15 ml/min/1.73 m2—in 89%, with a GFR <15 ml/min/1.73 m2—in 97%, with FISD in GFR <45 ml/min/1.73 m2—in 51%. When stratifying thromboembolic risk according to the CHA2DS2-VASc scale in patients with AF and CKD stages IIIb–V, 0-1 points were scored by 1% (n = 11), 2-5 points by 53% (n = 420), ≥6 points by 46% (n = 363) patients. The results of the analysis of the risk of bleeding according to the HAS-BLED scale showed the following data: 0-1 point—8% (n = 64), 2 points—15% (n = 118), ≥3 points—77% (n = 612). When studying the frequency of ACT prescription, it was revealed that rivaroxaban was prescribed in 21%, apixaban—22%, dabigatran—10%, warfarin—25%, low molecular weight heparins—3%, ACT not recommended—9%, ACT of choice—10% of cases (Table 1). In mild renal anemia (in 39% of patients), taking ACT led to a reduction in the risk of developing TEC—RR 0.55 with 95% CI 0.38-0.79; in case of moderate renal anemia (in 47.3% of patients), the risk of TEC did not decrease RR 1.03 with 95% CI 0.69-1.58; with severe renal anemia (in 13.7% of patients), the risk of TEC was also not reduced—RR 1.6 with 95% CI 1.17-2.2). Conclusion Every fourth patient in the cardiology department with AF showed a decrease in GFR <45 ml/min/1.73 m2, while 1/3 of them had FISD in GFR <45 ml/min/1.73 m2, and it is in these patients that the most common the dose of the prescribed anticoagulant did not correspond to the GFR; 50% of patients with GFR <45 ml/min/1.73 m2 and 32% with GFR <30 ml/min/1.73 m2 are recommended to use direct oral anticoagulants. Patients with stage V CKD were not prescribed direct oral anticoagulants; in 50% of cases, none of the anticoagulants was recommended.

Preliminary results of studying the prevalence of atrial fibrillation and the adequacy of prevention of thromboembolic complications

Abstract Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia that complicates the course of various cardiovascular diseases, and is also accompanied by the frequent development of thromboembolic complications (TEC), primarily ischemic stroke. In this regard, AF represents a huge socio-economic problem for the health system and society as a whole. Purpose study the real situation in terms of the incidence of various forms of AF and the adequacy of the prevention of TEC among the population of family clinic (FC) №5 in Tashkent. Materials and methods To achieve this goal, out of 12 districts of Tashkent, a (FP) №5 of M. Ulugbek district of Tashkent was selected with a total population of 21,606 people. After exclusion from the study of persons under 18 years of age (n=3546), the total number of adults was 18060 people. Random selection (n=1407) was performed using computer programs with the function of a random number generator in Microsoft Excel. The risk of TEC and bleeding in patients with various forms of AF was assessed using the CHA2DS2-VASc and HAS-BLED score. The study of the situation regarding the compliance of the use of anticoagulants with the current recommendations of the ESC (2020) was carried out by analyzing the structure of the pharmacological prevention of feasibility studies at the time of the survey. Research results: A total of 1407 (725 (51.53%) men) of the population were examined, registered with FC№5 in the M. Ulugbek district of Tashkent. It was found that 406 (28.86%) of the examined patients were diagnosed with coronary heart disease and/or hypertension, 5 (0.36%) of the population were diagnosed with chronic rheumatic heart disease and 369 (26.23%) people with a disease of other organs and systems. In 627 (44.56%) examined patients, non-organic pathologies were found. In general, it was found that 16 (1.13%) out of the total number of examined patients had various clinical forms of AF of both valvular (18.75%) and non-valvular etiology (81.25%). In general, among the identified clinical forms of AF, the permanent form of AF prevailed, amounting to 56.25%, and persistent ones, including long-term persistent and paroxysmal AF were detected in 4 (25%) and 2 (18.75%) patients, respectively. An analysis of the characteristics of the pharmacological prevention of thromboembolic complications showed that at the time of the survey, only 50% of patients were taking the oral anticoagulant therapy recommended in the standards (12.5% warfarin, without proper control of INR and 37.5% of novel oral anticoagulants). Conclusions 1) It was found that the prevalence of various forms of AF was 16 (1.13%) of the total number of patients examined: of these, 56.25% had a permanent form, 25% had a persistent form, and 18.75% had a paroxysmal form. 2) According to the ESC 2020 recommendations, the prevention thromboembolic complications in patients with AF is assessed as unsatisfactory.

Firstline Treatment with Ruxolitinib Versus Best Available Therapy in Patients with Polycythemia Vera: Pre-Specified Interim Analysis of the Randomized Phase 2b Ruxobeat Clinical Trial of the German Study Group for Myeloproliferative Neoplasms (GSG-MPN)

Introduction: Polycythemia vera (PV) is characterized by trilineage blood cell expansion, PV-associated symptoms, and the risk of thromboembolic complications, progression to post-PV myelofibrosis, and acute leukemia. Cytoreductive treatment with hydroxyurea (HU) or ropeginterferon-alpha is approved in EU for the treatment of high-risk patients (pts) with PV. In addition, ruxolitinib (RUX) is approved for HU-intolerant/-resistant PV. However, RUX vs. best available therapy (BAT) has not been investigated as first-line treatment of pts with untreated PV. We hypothesized that RUX may have higher efficacy in such early-line PV pts. Methods: The clinical trial entitled “Ruxolitinib versus Best Available Therapy in pts with high-risk PV or high-risk ET” (RuxoBEAT; NCT02577926) is a multicenter, open-label, two-arm phase-IIb trial with a target population of 190 pts in each stratum. Crossover from BAT to RUX is possible in eligible pts after 6 months. Pts with PV in the RUX arm received a starting dose of 10 mg BID and may increase their dose up to 20 mg BID. The primary endpoint is the clinicohematologic complete response (CR) rate at month 6, as defined by Barosi et al (Blood 2009), using a strict score of zero for the four symptoms by patient-reported outcome measures (PROM, Table 2) and an adjusted level alpha = 0.005 at a power of 80%. Secondary endpoints include overall response rate (CR+PR), freedom from phlebotomy, changes in blood counts, spleen size, and PROM, using p values descriptively. The interim trial data were recently reviewed by the DMC, and, due to the low likelihood of reaching the primary endpoint (CR rate improvement), the DMC has recommended that the trial should continue without recruitment of new pts. Therefore, this pre-specified interim analysis was performed after 78 (instead of 95) PV pts were randomized 1:1 to RUX vs. BAT. A maximum of 6 weeks of previous PV-directed therapy was allowed. Differences between RUX and BAT at month 6 and between baseline and end of month 6 data for each treatment were calculated using Fisher´s exact test/ McNemar Test (for unpaired/ paired binary variables) or the Mann-Whitney-U test/ Wilcoxon signed-rank test (for unpaired/ paired ordered or continuous variables). Results: 78 first-line pts (33% were pre-treated for a median of 22 days [range 1-42]) were included in the intention-to-treat set (n=44 vs 34 randomized to RUX vs. BAT, resp.) and analyzed at the 6-month time point. Baseline characteristics are listed in Table 1. In pts on RUX or BAT, CR rates at 6 months were comparable (2.3% and 2.9%, p=1.0), while overall response (CR+PR) rates were 77.3% with RUX and 55.9% with BAT (p=0.054). Also, at month 6 (Table 2), pts on RUX showed significantly lower hematocrit (40.8% vs 42.1%, p=0.046), and PROM symptom points for pruritus (1 vs 4, p=0.001) and fatigue (2.5 vs 5, p=0.031), and a trend towards less headache, abdominal discomfort, and weight loss, while the number of platelets was lower with BAT vs. RUX (254/nl vs 386/nl, p=0.013). There was no difference between RUX and BAT in the number of white blood cells (WBC), spleen size, or other symptoms at this time point. When each treatment arm was analyzed separately for changes between baseline and month 6, RUX treatment significantly reduced platelet counts, WBC, hemoglobin and hematocrit, phlebotomy rates, spleen size and fraction of pts with splenomegaly (Table 2), and significantly improved PROMs for pruritus, early satiety, and quality of life. During the same time period, BAT significantly reduced platelet counts, WBC, hematocrit, and phlebotomy rates, but failed to impact on hemoglobin, spleen size, fraction of pts with splenomegaly, or any of the symptoms (Table 2). Safety analysis revealed 301 adverse events (AE) in both assigned treatment groups, including 153 AE in the RUX and 148 AE in the BAT group (11.8% and 8.1% grade ≥3, resp.). There was no significant difference in the percentage of grade ≥3 AE between both groups (p=0.358), and there were no consistent patterns of grade ≥3 AE in either of the two arms. Conclusion: In this interim analysis, first-line treatment with ruxolitinib for 6 months in high-risk pts with PV led to clinically meaningful improvements in overall response, hemoglobin and hematocrit, phlebotomy rates, splenomegaly, and patient-reported pruritus and fatigue severity, while BAT only improved platelet counts, WBC, hematocrit, and phlebotomy rates, without having an impact on symptoms.

Edema and the Risk of Thromboembolic Complications in Nephrotic Syndrome: A Cohort Study

Edema and the Risk of Thromboembolic Complications in Nephrotic Syndrome: A Cohort Study

Challenges in Coagulation Management in Neurosurgical Diseases: A Scoping Review, Development, and Implementation of Coagulation Management Strategies.

Bleeding and thromboembolic (TE) complications in neurosurgical diseases have a detrimental impact on clinical outcomes. The aim of this study is to provide a scoping review of the available literature and address challenges and knowledge gaps in the management of coagulation disorders in neurosurgical diseases. Additionally, we introduce a novel research project that seeks to reduce coagulation disorder-associated complications in neurosurgical patients. The risk of bleeding after elective craniotomy is about 3%, and higher (14-33%) in other indications, such as trauma and intracranial hemorrhage. In spinal surgery, the incidence of postoperative clinically relevant bleeding is approximately 0.5-1.4%. The risk for TE complications in intracranial pathologies ranges from 3 to 20%, whereas in spinal surgery it is around 7%. These findings highlight a relevant problem in neurosurgical diseases and current guidelines do not adequately address individual circumstances. The multidisciplinary COagulation MAnagement in Neurosurgical Diseases (COMAND) project has been developed to tackle this challenge by devising an individualized coagulation management strategy for patients with neurosurgical diseases. Importantly, this project is designed to ensure that these management strategies can be readily implemented into healthcare practices of different types and with sustainable integration.

Venous thromboembolism: risk factors and prophylaxis

Venous thromboembolism is an important complication in tumour patients as it occurs frequently in these patients and causes relevant morbidity. The risk of thromboembolic complications in tumour patients is 3-9 times higher than in non-tumour patients and is the second most common cause of death in tumour patients. The risk of thrombosis depends on tumour-induced coagulopathy and on individual factors, type and stage of cancer, time since cancer diagnosis as well as type of systemic cancer therapy. Thromboprophylaxis in tumour patients is effective but can be associated with increased bleeding. Even though there are currently no dedicated recommendations for individual tumour entities, international guidelines recommend prophylactic measures in high-risk patients. A thrombosis risk of >8-10% can be considered an indication for thromboprophylaxis, which is indicated by a Khorana score ≥2, and should be calculated individually using nomograms. In particular, patients with a low risk of bleeding should receive thromboprophylaxis. Risk factors and symptoms of a thromboembolic event should also be intensively discussed with the patient and materials for patient information should be handed out.

Staged, Hybrid Repair Of Bilateral Common Femoral, Profunda, Superficial Femoral, And Popliteal Artery Aneurysms

We report a case of a 69-year-old man with asymptomatic aneurysms of the aorto-ilio-femoropopliteal arteries. CTA showed right side diameters of CFA 3 cm, SFA 2.1 cm, profunda 2.5 cm, popliteal 3.2 cm, and left side CFA 2.6 cm, SFA 2.1 cm, profunda 3.8 cm, popliteal 4.2 cm. Given risk of thrombo-embolic complications, extent of artery disease, and patient preference for limited open surgery, a staged, hybrid approach was utilized. He underwent left-sided bifurcated Dacron interposition graft from the EIA to the SFA and profunda with reimplantation of the largest profunda branch. A Viabahn stent was placed from the SFA anastomosis to P3, sized using IVUS. The right side was addressed seven weeks later with a shorter bifurcated interposition graft from the right EIA to SFA and profunda, with reimplantation of the largest profunda branch. Three branches of the profunda were embolized and a Viabahn stent placed from the profunda anastomosis to a distal target. The popliteal was stented from the SFA anastomosis to P3. Three months post-intervention the left profunda limb thrombosed, though the reimplanted profunda remained patent. He had stable residual endoleaks of the right profunda and bilateral popliteal arteries. He was asymptomatic. Genetic work up showed no pathogenic variants, except for a variant of undetermined significance in the cystathionine beta synthase gene. While optimal management is unclear in such rare pathology, we have found success in short term follow up with a hybrid repair. Patients presenting with this require extensive follow up and multidisciplinary care. View Large Image Figure Viewer Download Hi-res image

The role of von Willebrand factor in hemostasis pathology

Von Willebrand factor (VWF) is a multimeric plasma glycoprotein present in endothelial cells, megakaryocytes, platelets, and connective tissue. It mediates platelet adhesion in small arteries. VWF also binds and protects coagulation factor VIII from degradation. Moreover, VWF is involved in inflammatory response, linking hemostasis and inflammation. VWF multimers and platelets attached to damaged or activated endothelium mediate leukocyte recruitment, facilitating local inflammatory response. At shear rates above 5000 s–1, VWF molecules are capable of hydrodynamic activation that changes their conformation from globular to fibrillar. Therefore, VWF plays a key role in cellular hemostasis at high shear rates. Acquired and inherited disfunction, defective synthesis or increased proteolysis of VWF multimers lead to bleeding, as in von Willebrand disease or Heyde syndrome. Pathological activation of VWF may lead to the development of thrombotic complications of coronary artery disease. COVID-19, especially severe form, is characterized by prothrombotic shift in pulmonary vascular bed. Following endothelial damage, VWF plasma level rises and ADAMTS-13 activity decreases. In patients with COVID-19, a change in the VWF/ADAMTS-13 ratio is associated with an increase in the risk of thromboembolic complications. Therefore, assessment of hydrodynamic activation of VWF under flow conditions may be valuable in fundamental research and laboratory diagnostics.

Unusual suspect in a common diagnosis: think beyond ‘minimal’

Nephrotic syndrome is a glomerular disease commonly seen in paediatric population. The disease is characterized by a hypercoagulable state and risk of thromboembolic complications. Cerebral venous thrombosis (CVT) is a rare complication in children associated with nephrotic syndrome with an incidence of 0.67/100000 with very few case reports described. 12-year-old girl with steroid dependent nephrotic syndrome- minimal change disease, with a background of recent COVID-19 infection, presented with vomiting, headache, altered sensorium and an episode of generalized tonic clonic seizure. Diagnosis established by magnetic resonance imaging (MRI) brain and MR venogram which showed superior sagittal sinus thrombosis. Child was started on anticoagulant therapy, gradually recovered with no neurological sequelae. Thrombosis should be suspected in nephrotic syndrome with the added risk of hypercoagulable state associated with COVID-19 infection. Cortical vein thrombosis, even though rare, should be considered in any patient with nephrotic syndrome who presents with neurological signs or symptoms, especially in this era of COVID-19 pandemic. This highlights the importance of suspecting and recognizing post COVID hypercoagulability as a triggering factor for neurological complications associated with the same. Thromboembolic events are rare in paediatric patients with COVID-19 infection, but a high index of suspicion should be maintained in children, particularly those with comorbidities.

A personalised approach to the choice of oral anticoagulants in elderly and senile patients with atrial fibrillation

Introduction. In recent years, data have been accumulated regarding possible associations between cognitive impairment and atrial fibrillation. The results of retrospective and prospective studies confirm that anticoagulant therapy in patients with AF can reduce the risk of cognitive impairment and dementia.Objective. To study the individual characteristics of elderly and senile patients with atrial fibrillation, influencing the choice of anticoagulant therapy, with a view to its subsequent optimization.Materials and methods. The study included 159 patients with atrial fibrillation of non-valvular genesis aged over 60 years. 4 groups of patients were formed. The largest number of patients received rivaroxaban and warfarin (36.4% and 34.6%, respectively). 26 (16.3%) patients were treated with dabigatran, 20 (12.6%) patients with apixaban. The risk of thromboembolic complications was assessed on the CHA2DS2-VASc scale. The HAS-BLED scale was used to assess the risk of bleeding. A pharmacogenetic study (carriage of polymorphic alleles of the CYP2C9 and VCORC1 genes) was conducted in 138 patients. Cognitive impairment was assessed by a Mini-Cog test and a battery of frontal tests.Results. Taking oral anticoagulants reduces the risk of stroke and dementia in patients; the presence of cognitive impairment, in turn, significantly reduces the patient’s adherence to therapy and reduces the effectiveness of therapy. Patients’ adherence to therapy was significantly lower by 10–20% in patients with cognitive impairment according to the Mini-Cog test and a battery of frontal tests. In the absence of pronounced cognitive impairment (higher adherence to treatment) and availability and willingness to control INR, warfarin remains the drug of choice in patients with renal insufficiency.Conclusions. A number of problems with the use of oral anticoagulants in elderly patients with atrial fibrillation have been identified. The ease of use of new oral anticoagulants, the absence of the need to select doses and monitor therapy is an important factor when choosing a drug.

Identifying risk factors for perioperative thromboembolic complications in patients treated with the Woven EndoBridge device.

Woven EndoBridge (WEB) is a new endovascular treatment option for wide necked bifurcation aneurysms. Results from the WEB-IT trial showed a 0% risk of thromboembolic complications within 30 days post-op but the rate reported in the literature is as high as 10%. We are exploring potential risk factors associated with immediate thromboembolic complications in patients treated with the WEB device. Retrospective study of forty-two patients with intracranial aneurysms who were treated with WEB at a single center from 2019-2021. Data was collected on patient demographics, comorbidities, aneurysm characteristics, procedural details, and hospital course. Bivariate analyses were performed to compare patients who experienced a periprocedural ischemic stroke to those who did not. Multiple logistic regression modeling was performed to identify independent risk factors for thromboembolic complications. Of the 42 patients that were treated with WEB, 6 suffered an ischemic stroke (AIS). These patients were more likely to have an underlying diagnosis of arrythmias (p value = 0.007). Furthermore, they had a median angle of 32.0° in the true neck view on diagnostic angiogram compared to 19.5° (p value = 0.046). Lastly, they had a longer procedure length of 228 min compared to 178 min (p value = 0.002). Patients with thromboembolic complications had a longer length of stay in the hospital and worse outcomes at three months follow up. On logistic regression modeling, these risk factors did not reach statistical significance. Risk factors of thromboembolic complications after WEB placement include cardiac arrythmias, acute aneurysmal angle in the true neck view and a longer procedure length.

The Role of Color Doppler Ultrasonography in the Prevention of Thromboembolic Disease after Total Hip Replacement

Orthopedic and trauma surgery carries a high risk of deep vein thrombosis (DVT) in the lower limbs and acute pulmonary embolism (APE). In traumatology, the greatest risk is in hip fractures of the proximal extremity of the femur, especially those of the neck, and intertrochanteric fractures. In orthopedics the risk of thromboembolic complications (TEC) is particularly high in hip and knee surgery, especially in prosthetic replacement, as general factors are associated with local factors such as trauma to vessels and / or blood stasis which further aggravate the perioperative imbalance of the coagulation system. In particular, hip replacement surgery is the one that shows a higher frequency of DVT (especially affecting the proximal large vessels), and of TEC, so much so that pulmonary embolism is one of the main causes of death after this intervention. In this paper, we review the different instruments used for the diagnosis of DVT such as phlebography, radiolabeled fibrinogen collection test, impedance, plethysmography, ultrasound, nuclear magnetic resonance and computed tomography. We also discuss the different prophylaxis methods for DVT and subsequent PE prevention. Then, we performed an experimental study on 420 patient’s operated on for total hip replacement at the 1st Orthopedic Clinic of the University of Florence and other private clinics in the period between 1994-1996. These are 286 first cemented implants, 36 first hybrid implants, 38 first cementless implants and 60 hip replacement reviews. This study showed the importance of color doppler ultrasonography in the prevention of DVT in hip replacement patients and subsequent APE prophylaxis. Significant relationship was found between APE and the protocole used to follow up with the patients (Pvalue 0.0007). Patients in group 2 in which only clinical control (no preoperative color doppler ultrasonography assessment) was performed have higher risk for APE To Occur Than patients in group 1 to whom pre and post-operative color doppler ultrasonography was routinely applied.

How to Optimize Cardioversion of Atrial Fibrillation.

Cardioversion (CV) is an essential component of rhythm control strategy in the treatment of atrial fibrillation (AF). Timing of CV is an important manageable factor in optimizing the safety and efficacy of CV. Based on observational studies, the success rate of CV seems to be best (≈95%) at 12–48 h after the onset of arrhythmic symptoms compared with a lower success rate of ≈85% in later elective CV. Early AF recurrences are also less common after acute CV compared with later elective CV. CV causes a temporary increase in the risk of thromboembolic complications. Effective anticoagulation reduces this risk, especially during the first 2 weeks after successful CV. However, even during therapeutic anticoagulation, each elective CV increases the risk of stroke 4-fold (0.4% vs. 0.1%) during the first month after the procedure, compared with acute (<48 h) CV or avoiding CV. Spontaneous CVs are common during the early hours of AF. The short wait-and-see approach, up to 24–48 h, is a reasonable option for otherwise healthy but mildly symptomatic patients who are using therapeutic anticoagulation, since they are most likely to have spontaneous rhythm conversion and have no need for active CV. The probability of early treatment failure and antiarrhythmic treatment options should be evaluated before proceeding to CV to avoid the risks of futile CVs.

Predicting development of thromboembolic complications and complications in patients after mitral valve replacement with mechanical prostheses

The aim of the study. To develop a mathematical model for predicting the development of thromboembolic complications and bleeding in patients after mitral valve replacement with mechanical prostheses based on an analysis of a number of risk factors – age, compliance, heart rate at the postoperative stage, prosthesis manufacturer, hemostasis indicators.Materials and methods. There were examined 260 patients. The following risk factors were analyzed: patient compliance (Morisky-Green test), heart rate at the postoperative stage, prosthesis manufacturer (MedInzh, Carbomedics, ATS, On-X), hemostasis indices (international normalized ratio, activated partial thromboplastin time, D-dimer, fibrinogen, soluble fibrin-monomeric complexes).Results of the study and conclusion. The frequency of thromboembolic complications was 5.2 cases, bleeding 4.7 cases per 1000 patient-months. With an increase in the level of soluble fibrin-monomeric complexes by 1 g/L, the risk of thromboembolic complications increases by 1.63 times, the presence of a MedInzh’s prosthesis increases the risk of thromboembolic complications by 2.04 times compared to prostheses of other companies, with paroxysmal or permanent forms of atrial fibrillation the risk thromboembolic complications increase 16.29 times compared with patients with sinus rhythm. In compliant patients, the risk of bleeding is 52.5 (1/0.08) times lower than in non-compliant patients; with an increase in the activated partial thromboplastin time by 1 sec, the risk of bleeding increases by 1.07 times.

Neurophysiological status of patients with non-valvular atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. The reduction of the risk of stroke in patients with AF is achieved with the help of continuous administration of oral anticoagulants (OAC). The presence of cognitive impairment in a patient may be a significant risk factor for low adherence to antithrombotic therapy, therefore, the medico-social significance of impaired cognitive functions in patients with AF is high. At the same time, it is still unclear which neurophysiological mechanisms and areas of the brain are responsible for the development of cognitive disorders in this pathology. Thus, further studies are needed to assess the state of higher cortical functions in patients with AF. Materials and methods The study included 50 patients with nonvalvular AF and a high risk of hemorrhagic and ischemic events, with a risk of thromboembolic complications on the CHA2DS2-VASc scale of at least 2 points and a risk of bleeding on the HAS-BLED scale of at least 3 points. The control group consisted of 17 relatively healthy individuals. Research results The analysis of indicators of extended neuropsychological testing made it possible to establish that, compared with healthy individuals of the same age, patients with AF perform worse on tests of neurodynamics, attention and short-term memory, Table. Patients with AF have a lower rate of complex sensorimotor reactions, a greater number of errors, especially in tests with biofeedback (brain performance test). Also, patients with AF have worse performance indicators and higher focused attention depletion (characterized by the number of characters processed in the 1st and 4th minutes of the proofreading test, respectively). As for the indicators of short-term memory, healthy subjects were superior to patients with AF in memorizing meaningless syllables and words, but not numbers. The power indicators of the theta EEG rhythms at rest with eyes closed were taken. The factors were identified - GROUP (2 levels: patients with AF; healthy individuals), AREA (5 levels: (frontal, central, temporal, parietal, occipital) and LATERALITY (2 levels: left, right hemisphere). In patients with cardiac arrhythmias, the increase in the power of the theta-2 rhythm biopotentials in the direction from the anterior to the posterior cortex is significantly pronounced (p = 0.000001), while in healthy individuals the gradient curve is flatter (p = 0.009). Conclusions It was found that about half of the examined AF patients have syndrome mild cognitive impairment (MCI). The most significant cognitive decline in these patients compared with relatively healthy individuals was noted for the speed of sensorimotor response, performance control indicators, and short-term memory, while decreased cognitive test scores were associated with a greater representation of slow waves in the resting EEG, mainly in the posterior regions of the cerebral cortex.

Aspartame and Platelets in Type II Diabetic Patients

Background: For type II diabetes (T2D) subjects to better regulate carbohydrate consumption and manage blood glucose levels, a non-nutritive sweetener (aspartame) is prescribed as an alternative to natural sugar. Previous studies show that there was a 68% rise in the probability of aspartame consumers developing T2D compared with non-consumers. In diabetes and inflammation, deformed red blood cells (RBCs) and atypical fibrin fibre formation or an altered fibrin structure are especially prevalent. Objective: The aim of this study was to investigate, in subjects with T2D taking aspartame, clot viscoelasticity and platelet structure. Methodology: Blood was drawn from 12 T2D subjects from the diabetic clinic at the Steve Biko Academic Hospital, South Africa. Blood was used to perform a full blood count, thromboelastography (TEG) and scanning electron microscopy (SEM). Results: SEM showed increased platelet activation and abnormal TEG parameters in T2D consuming aspartame. Conclusion: A hypercoagulable state can increase the risk of thromboembolic complications and an increased incidence of vascular disease. This knowledge may be used to build awareness among consumers of aspartame.

THROMBOEMBOLIC COMPLICATIONS IN CHRONIC INFLAMMATORY BOWEL DISEASE

Patients with chronic inflammatory bowel disease (IBD) represented by Crohn disease (CD) and ulcerative colitis (UC) are at higher risk for thromboembolic complications (CTE) which are a major cause of morbidity. They are attributed to a pre-thrombotic state induced by the inflammatory activity of this disease. The thrombotic risk inpatients with IBD is underestimated and thromboprophylaxisis not widely implemented in the clinical practice. Many studies on thromboembolism in the IBD populationhave already been carried out, however the precisepathogenesis is still poorly understood. The aim of our study is to determine the prevalence, risk factors and clinical aspects of thrombosis during IBD.

Risk of thromboembolic complications during hormone therapy

The review presents modern data of the effect of hormonal contraceptives and hormone replacement therapy drugs on the risk of thromboembolic complications. The effect of components of the drugs and their dosages on the hemostasis system is presented, the use of hormonal therapy in women with extragenital diseases is discussed, the ways of reducing the thrombogenic risk of hormones with their mandatory use are debated.

Modern Anticoagulant Therapy for Atrial Fibrillation: Patient Adherence in Clinical Practice

Aim. To assess the adherence of doctors and patients to anticoagulant therapy for atrial fibrillation (AF).Materials and methods. An observational prospective study included 99 patients with AF at high risk of thromboembolic complications in Ryazan and Omsk. To study adherence, a questionnaire for quantitative assessment of treatment adherence ("QAA-25") was used. The questionnaire allows you to assess adherence by three main parameters separately: adherence to drug therapy, lifestyle modification and medical support. For the purposes of the study, adherence rates of less than 75% were regarded as insufficient, 75%. % or more as sufficient. To assess food preferences and determine the risk of changes in the activity of warfarin, a questionnaire of food preferences was used. The questionnaire allows you to assess the risk of alimentary increase (≥30 points) and decrease (≥60 points) of warfarin activity, as well as the overall risk of alimentary change (≥90 points) of warfarin activity in each patient, taking into account the volume and frequency of consumption of products that affect the activity of warfarin.Results. After the first visit, 99% of respondents received anticoagulant treatment. Rivaroxaban was the leader in prescribability among anticoagulants (36.7%). About a third of respondents were prescribed apixaban by a doctor (30.6%) and dabigatran (17.3%) and warfarin (19.4%) were prescribed almost twice as rarely as rivaroxaban. Respondents with the highest rates of adherence to drug therapy, lifestyle modification and medical support are AF patients taking apixaban. The respondents who were prescribed rivaroxaban had the lowest level of adherence to drug therapy and lifestyle modification. And the lowest level of commitment to medical support is among respondents who have been prescribed warfarin. The number of people with a sufficient level of commitment did not reach half. Only 43.9% were ready to take prescribed medications and slightly more than a third (34.7%) agreed to come to appointments for a long time. But, despite the importance of lifestyle modification in patients with AF, only 16.3% of respondents said they were ready to give up bad habits, lose weight and lead a more active lifestyle. The proportion of people with sufficient adherence to drug therapy was the smallest in the group taking rivaroxaban (25.7%). The least number of respondents with sufficient commitment to medical support in the group taking dabigatran (25%). Only one in ten patients (11.1%) taking warfarin had a sufficient level of commitment to lifestyle modification. 15% of the study participants had an increased risk of alimentary changes in the activity of warfarin.Conclusion. Assessment of adherence to anticoagulant therapy by doctors in two regional centers (Omsk and Ryazan) showed high prescribability of preventive antithrombotic therapy, which corresponds to modern therapeutic approaches. At the same time, patients demonstrated rather low levels of adherence to drug therapy, lifestyle modification, and medical support.