Risk Of Venous Thromboembolic Complications Research Articles

Location of metastasis and complications in patients with venous thromboembolism and cancer: systematic review

According to current guidelines, patients with venous thromboembolism (VTE) and active cancer should receive prolonged anticoagulant treatment (>6 months). In patients with cancer-associated thrombosis (CAT), metastasis is a factor in recurrent VTE and bleeding; however, the function of metastasis location remains unclear. In order to assess the risk of complications (such as bleeding or recurrent VTE) based on the location of metastases in patients with CAT, we conducted a systematic review. The PubMed database search was used to perform a systematic review. MESH terms pertaining to metastasis, VTE, and neoplasms were employed. Patients with CAT who were at least eighteen years old and receiving therapeutic doses of anticoagulants were included, as were details regarding the locations of metastases and the availability of patients who had complications (bleeding or recurrent VTE). Among the 1,447 articles found by the search, 7 retrospective studies met all eligibility requirements and were added to the analysis. The majority of these studies addressed brain metastases. Studies found that intracranial hemorrhage occurred between 4% and 19% of the time. In the context of brain metastases and VTE, other studies examined the safety and effectiveness of direct oral anticoagulants in comparison to low-molecular-weight heparin. This systematic review draws attention to the paucity of data regarding the impact of metastasis location on complications in CAT patients. Further research is required to assess the effect of metastasis location on the risk of VTE complications in patients with CAT.

Features of the systemic influence of cervical cancer on peripheral blood and hemostasis according to the tumor histological subtype

Aim. To identify the features of the systemic effect on hematopoiesis and the blood coagulation system of different histological subtypes of cervical cancer (CC).Materials and methods. A single-center retrospective cohort study of 428 patients (61 patients with high grade squamous intraepithelial lesion (carcinoma in situ) and 367 patients with CC) examined from 1997 to 2022 in the Polyclinic of P. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia. The age of patients was from 18 to 90 years (median age – 42 [34; 51] years). Patients were divided into 4 groups: group 1 – patients with high grade squamous intraepithelial lesion and 3 groups depending on tumor’s histological subtype (squamous cell, glandular squamous cell, adenocarcinoma). Demographic and clinical data were analyzed including laboratory tests (general blood count, biochemical blood test and iron metabolism and coagulograms (total 32 variables)) compared to clinical and surgical stages of CC.Results. High grade squamous intraepithelial lesion does not have a systemic effect on the parameters of general, biochemical blood tests and hemostasis (p >0.05). On the other hand, statistically significant changes were found in the parameters of routine laboratory blood tests, which correlate with the results of microinvasive analysis of CC, thus revealing the systemic effect of a malignant tumor: at p ≤0.001 for thrombin time, total protein, alkaline phosphatase levels; at p ≤0.05 for alanine aminotransferase, aspartate aminotransferase, C-reactive protein, serum iron and urea levels. Among patients with CC, statistically significant (p<0.001) correlations were obtained between hematological, hemostasiological and biochemical blood parameters. Of statistical significance, the presence of the glandular component in the tumor increases the systemic effect of CC on blood parameters, hemostasis, markers of inflammation and iron metabolism: leukocytosis and maximum erythrocyte sedimentation rate values compared to CC, high fibrinogen and the level of soluble fibrin-monomer complexes which increased activation of coagulation hemostasis along the common coagulation pathway (thrombin time) (p<0.001). It leads to an increase in the risk of venous thromboembolic complications in this category of patients.Conclusion. The identified changes in blood parameters made it possible to reveal the unique biological characteristics of each histological subtype of CC, including biochemical ones, which will help in developing an improved diagnosis of CC depending on the histological subtype and stage of the disease, along with developing preventive measures and treatment methods adapted to each specific case.

A modern approach to the study of the problem of pathogenesis and prevention venous thromboembolic complications in patients with trauma (literature review)

Relevance. Patients with trauma are at increased risk of venous thromboembolic complications (VTE), which includes deep vein thrombosis of the lower extremities (DVT) and pulmonary embolism (PE). Within surgical and trauma clinics, thromboembolic complications are the most common preventable cause of in-hospital mortality. Numerous studies have shown that the incidence rate of deep vein thrombosis (DVT) in trauma patients without prevention varies from 5 to 80%.Aim. To analyze the pathogenesis of the development of venous thrombosis and explore existing approaches to prevent VTE in trauma patients.Materials and methods. In the course of the work, topical literary sources of domestic and foreign authors on a given topic were analyzed.Results. The mechanism of thrombus formation in trauma involves slowing blood flow, damage to the vessel wall and impaired blood clotting in the form of hypercoagulation. The state of hypercoagulation combined with prolonged immobility increases the risk of VTE. LMWH is the treatment of choice for the prevention of VTE in trauma. Today, there are ongoing studies related to the correction of preventive doses of LMWH and the search for a single standard, depending on numerous factors.Conclusion. Severity and multiplicity of lesions correlate with severity of systemic inflammation, hypercoagulation, and incidence of venous thrombosis. However, this correlation has not been sufficiently studied in the scientific literature. The search for specific methods for the prevention of deep vein thrombosis leading to PE is an urgent problem of surgery of injuries both peaceful and wartime.

Recurrent failure of ART, thrombosis and thrombophilia

In recent years, the number of risk factors for thrombosis associated with pregnancy has increased substantially due to the active introduction of new medical technologies not used 30 years ago or because their role in emerging thrombosis has not been studied, e.g., during pregnancy after assisted reproductive technologies (ART) particularly in vitro fertilization (IVF). The risk of venous thromboembolic complications (VTEС) related to ovarian hyperstimulation during ART is often overlooked. We present the case of a 37-year-old woman who developed thrombosis of the right internal jugular vein 3 weeks after embryo transfer within the IVF protocol. Ovarian hyperstimulation during hormonal IVF protocols provokes procoagulant changes in the hemostasis and fibrinolysis system able to result in venous and arterial thrombosis. The localization of VTEС typical to ART is more often located in the internal jugular vein being accompanied by neck pain and edema. Thrombosis risk factors should be assessed in all women in the IVF program, and appropriate thromboprophylaxis should be carried out to all high risk subjects.

The possibilities of the thrombodynamics test in predicting, diagnosing and monitoring the effectiveness of the treatment of venous thromboembolic complications in planned surgical interventions

Introduction. The problem of venous thromboembolic complications after planned surgical interventions remains relevant and requires special research and analysis, which was the purpose of this work. Objective. To study and evaluate the possibilities of the thrombodynamics test for predicting, diagnosing, and monitoring the effectiveness of treatment of postoperative venous thromboembolic complications in planned surgical interventions. Materials and methods. In this study, we implemented the thrombodynamics test in parallel with ultrasound examination of the veins of the lower extremities and pelvis before planned surgery and in the postoperative period on 1–3, 7–9, 14–16, and 30 days in 120 patients with common surgical pathology (chronic calculous cholecystitis, external abdominal hernias, and varicose veins of the lower extremities) stratified into risk groups for postoperative venous thromboembolic complications. Results. It was revealed that, in the preoperative period, 16.6 % of patients have hypercoagulation at normal standard blood counts and 65 % of them are patients from a low-risk group of venous thromboembolic complications. In the postoperative period, the number of cases of hypercoagulation increased to 34.2 % due to elderly and senile patients from groups with an estimated moderate and high risk of venous thromboembolic complications. Deep vein thrombosis was detected in 18 (15 %) subjects (6 patients from each risk group) within 2–15 days after surgery and in all cases it developed in the presence of preoperative hypercoagulation. Conclusions. It is shown that the thrombodynamics test is highly informative in predicting, diagnosing and evaluating the effectiveness of venous thromboembolic complications treatment during planned surgical interventions.

Activation of intravascular blood coagulation in the early postoperative period in reconstructive abdominoplasty

Purpose of the study: to determine the activity of intravascular blood coagulation during the abdominoplasty and justify pharmacological thromboprophylaxis.Material and Methods. An open prospective study was conducted on a group of 100 patients undergoing abdominoplasty. The risk of venous thromboembolism (VTE) before the surgery was assessed using the Caprini risk assessment model in 2010. Prothrombin (PT) and fibrinogen (FG) levels, soluble fibrin-monomer complexes (SFMC), euglobulin clot lysis time (ECLT), antithrombin III (AT-III) level, and protein C (PC) level were determined before and after the surgery.Results. Using the Caprini risk assessment model, patients were categorized by VTE risk as follows: moderate risk – 64% and high risk – 36%. After the surgery, an increase in PT by 12.3% and 15.5% on days 3 and 5 was observed (p < 0.01); an increase in FG by 0.49; 2.34 and 2.04 g/L on days 1, 3, and 5 was observed (p < 0.01); an increase in SFMC at all postoperative stages by 4.7; 8.2; 10.8 and 10.0 times (p < 0.01); an increase in ECLT by 2.8; 9.7, and 6.3 minutes on days 1, 3, and 5 (p < 0.001); and a decrease in AT-III and PC levels immediately after the operation by 18.8% and 8.9%, on day 1 by 14.2% and 11.2%, and on day 3 by 8.8% and 6.3% (p < 0.01).Conclusion. All patients undergoing abdominoplasty require pharmacological thromboprophylaxis due to moderate and high risk of venous thromboembolic complications. Abdominoplasty in the early postoperative period is accompanied by activation of plasma coagulation, inhibition of fibrinolytic system activity, and reduced activity of natural anticoagulants, which justifies the need for pharmacological thromboprophylaxis for at least 5 days.

PE041 - The impact of lymph-node dissection during radical prostatectomy on the risk of venous thromboembolic complications – a population-based study

PE041 - The impact of lymph-node dissection during radical prostatectomy on the risk of venous thromboembolic complications – a population-based study

Risk of venous thromboembolic complications in patients with diabetes mellitus and COVID-19

The article assesses concomitant diabetes mellitus as a risk factor for venous thromboembolic complications in patients with covid-19 in hospital settings. We analyzed 123 case histories of patients hospitalized for new coronavirus infection in the first wave of COVID-19. The results showed that diabetes mellitus was not an independent risk factor for venous thromboembolic complications in patients with COVID-19.

Incidence of Thromboembolic Complications Following Kidney Transplantation with Short and Extended Aspirin Prophylaxis: A Retrospective Single-Center Study.

BACKGROUND Aspirin prophylaxis has been associated with reduced graft-related thrombosis following kidney transplantation. Aspirin cessation, however, can increase risk of venous thromboembolic complications, including pulmonary thromboembolism and deep venous thrombosis. This single-center, retrospective, pre-post interventional study from Brisbane, Australia, aimed to compare the rate of thrombotic complications in 1208 adult kidney transplant recipients receiving postoperative aspirin for 5 days or >6 weeks. MATERIAL AND METHODS We enrolled1208 kidney transplant recipients who received 100 mg aspirin for 5 days (n=571) or >6 weeks (n=637) postoperatively. The primary outcome was venous thromboembolism (VTE) in the first 6 weeks after transplant, examined by multivariable logistic regression analysis. Secondary outcomes were renal vein/artery thrombosis, 1-month serum creatinine, rejection, myocardial infarction, stroke, blood transfusion, dialysis at day 5 and day 28, and mortality. RESULTS Sixteen (1.3%) patients experienced VTE (5-day n=8, 1.4%; >6-week n=8, 1.3%; P=0.8). Extended aspirin duration was not independently associated with a reduction in VTE (OR 0.91, 95% CI 0.32-2.57; P=0.9). Graft thrombosis was rare (n=3, 0.25%). Aspirin duration was not associated with cardiovascular events, blood transfusion, graft thrombosis, graft dysfunction, rejection, or mortality. VTE was independently associated with older age (OR 1.09, 95% CI 1.04-1.16; P=0.002), smoking (OR 3.59, 95% CI 1.20-13.2; P=0.032), younger donor age (OR 0.96, 95% CI 0.93-1.00; P=0.036), and thymoglobulin use (OR 10.5, 95% CI 3.09-32.1; P≥0.001). CONCLUSIONS Extended-duration aspirin use did not significantly reduce the incidence of VTE in the first 6 weeks following kidney transplantation. An association was identified between anti-human thymocyte immunoglobulin and VTE, which requires further assessment.

A clinical case of successful thrombolysis in pulmonary embolism during pregnancy

The risk of venous thromboembolic complications among pregnant women and puerperas is higher than in the general population, which is due to traditional risk factors, as well as physiological and anatomical changes that occur during pregnancy. Symptoms and signs of venous thromboembolic complications during pregnancy are often nonspecific and may coincide with the consequences of changes, including dyspnea, limb edema, and tachycardia. D-dimer levels may be elevated during ongoing pregnancy, limiting its use as a laboratory marker. Identification of the source of thromboembolism in the veins of the lower extremities can be difficult due to the proximal localization of thrombosis in pregnant women, the rare detection of thrombi in this area is associated with incompressibility of the veins due to their intrapelvic location, as well as with altered blood flow mechanics. The main method of treatment is the use of low molecular weight heparins, however, in case of massive thromboembolism, leading to hemodynamic instability and a high risk of mortality, thrombolytic therapy is indicated. Thrombolytic therapy is associated with an increased risk of hemorrhagic complications. The use of warfarin and direct oral anticoagulants during pregnancy is contraindicated due to the possibility of penetration of drugs through the placental barrier. The article presents a clinical case of successful thrombolysis in a patient with pulmonary embolism in late pregnancy. The chosen tactics of management corresponded to the clinical guidelines and made it possible to successfully treat pulmonary embolism without complications for the mother and fetus. Drugs were used that do not penetrate the placental barrier and do not have teratogenic effects.

Риски венозных тромбоэмболических событий при больших акушерских синдромах

Aim: Based on the study of the history, course of pregnancy and childbirth, to assess the risks of venous thromboembolic events among women with major obstetric syndromes. Design: Retrospective cohort study using the continuum sampling method. Materials and methods. 200 birth histories were analyzed: group 1 — 55 women with great obstetric syndromes, group 2 — 145 pregnant without them. The history of women, pregnancy outcomes were studied, and an analysis of the risks of venous thromboembolic complications was carried out. Results. Anamnestic risk factors for major obstetric syndromes were a family history aggravated by early thromboembolic events (RR = 3,13; 95% CI: 1,34–7,30), unemployed status (RR = 1,73; 95% CI: 1,32–2,65), preeclampsia in the past (RR = 23,46; 95% CI: 1,28–428,80), first pregnancy (RR = 1,63; 95% CI: 1,04–2,55), chronic arterial hypertension (RR = 8,45; 95% CI: 1,76–40,66). There was a significant increase in the risk of venous thromboembolic complications in patients of group 1 during pregnancy (1 (1–2) points; p < 0.001) and in the postpartum period (3 (1–4) points; p < 0.001). Conclusion. Prognostic markers of great obstetric syndromes were aggravated family and personal obstetric anamnesis, parity, low social status, chronic arterial hypertension. A significant increase in the risk of venous thromboembolic complications in pregnant women and puerperas with major obstetric syndromes was revealed. Keywords: great obstetric syndromes, preeclampsia, risk factors, venous thromboembolic complications.

Диабетопороз и риск тромбозов

Aim. To assess the risk factors for thrombosis in patients with osteoporosis-induced diabetes mellitus. Key points. Osteoporosis is a common multifactorial disease with a high risk of venous thromboembolic complications (VTEС). This is due to the main pathology — diabetes mellitus, the use of medications for the prevention and treatment of osteoporosis. The main pathogenetic patterns of VTEС development in patients with diabetoporosis are considered. These include hemostasis disorders, the calcification or calcification of blood vessels, drug inducers, age-related estrogen deficiency, etc. Conclusion. Patients with diabetes mellitus, mainly type 2, on the background of obesity, older age and with osteoporosis have an increased risk of developing VTEС. Thorough examination of patients with thrombosis risk factors and dynamic monitoring of them, individualization and personification of approaches to the treatment of osteoporosis are advisable. Keywords: osteoporosis, diabetoporosis, thrombosis, therapy.

Adherence to the use of the caprini score among Russian specialists: results of an electronic survey

The aim of the study was to assess the adherence of Russian doctors to the use of the Caprini risk assessment score for venous thromboembolism complications in real clinical practice. On the basis of the Google Forms platform, an electronic questionnaire was created, with an invitation to complete it sent out by e-mail and through social networks of the educational project «School of Thrombosis». The survey was conducted from October 20 to October 30, 2021. The answers were received from 270 respondents, of which 260 questionnaires from specialists working in Russia were included in the analysis. Among the doctors, specialists in vascular surgery, including phlebology, and general surgery from private clinics and city clinical hospitals prevailed. Up to 90 % of the Russian doctors of various medical specialties are aware of the Caprini scale, up to 77 % actively use it in clinical practice, up to 74 % of the specialists use the score results to make decisions on the tactics of primary prevention of venous thromboembolism complications, and up to 28 % of the respondents interact with the scale integrated into medical records in paper or electronic format. Most respondents noted the availability of modern means of pharmacological prevention, in particular, LMWH and DOAC, in their medical institutions. As for mechanical prophylaxis, elastic bandages and compression stockings were almost equally available, but methods of actively accelerating blood flow could be afforded by no more than 15 % of the respondents. Conclusions: most of the Russian doctors surveyed note a high adherence to the use of the Caprini scale to assess the risk of venous thromboembolic complications in real clinical practice.

REBOA in trauma and the risk of venous thromboembolic complications: A matched-cohort study

BackgroundResuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has been used as a damage control procedure in trauma patients. We hypothesized that REBOA increases risk of venous thromboembolic (VTE) complications. MethodsThis was an American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database study. Excluded were transfers, deaths within 24 h, and severe head injuries. Included were trauma patients receiving REBOA within 4 h from arrival. Outcomes in the two groups were compared after using propensity score matching (PSM) for demographic and clinical characteristics, body area abbreviated injury scale, injury severity score, pelvis and lower extremity fractures, angiographic intervention, preperitoneal pelvic packing, pharmacological VTE prophylaxis, laparotomy, laparotomy and specific orthopedic procedures. ResultsAfter PSM, 339 REBOA patients were matched with 663 patients with No REBOA. REBOA patients were significantly more likely to develop pulmonary embolism (PE) (5.3% vs. 2.7%, p = .037) and VTE (14.7% vs. 10.0%, p = .025). ConclusionREBOA is associated with an increased risk of PE and VTE complications. Patients managed with REBOA should receive adequate thromboprophylaxis and be monitored closely for VTE complications.

Predictors of thrombosis development in the acute period of stroke

Introduction. According to foreign studies, the frequency of asymptomatic deep vein thrombosis (DVT) in the acute period of stroke varies from 10 to 75%, clinically obvious — from 2 to 10%. DVT is a life-threatening complication as it can lead to the development of pulmonary embolism (PE).Purpose of the study: to identify predictors of DVT development in the lower extremities in patients with stroke according to the registry of the Regional Vascular Center (RVC).Materials and methods. 100 patients with stroke who were admitted to the wards/intensive care unit of the RVC from November to December 2021 were examined. In addition to the standard examination, all patients underwent duplex scanning of the veins of the lower extremities upon admission and on the 7th day of inpatient treatment.Results. The incidence of DVT was 13%. Compared with patients without DVT, patients with thrombosis were characterized by higher median values of age (77 vs 67 years, p = 0.015), time from stroke to hospital admission (24 vs 5 hours, p = 0.026), stroke severity by NIHSS score at admission (16 vs 5 points, p = 0.006) and completion of the first stage of treatment (10 vs 3 points, p = 0.010), movement disorders in the leg according to the Medical Research Council scale (4 vs 1 points, p = 0.011) and IMPROVE-VTE scales (4 vs 2 points, p < 0.001). In half of patients with DVT, thrombosis occurred already at admission to the hospital, in the rest it occurred during treatment. In a quarter of patients, thrombosis involved the proximal veins and was complicated by the development of PE in one patient, the rest had distal DVT. In all cases, DVT developed in the paretic limb. In all patients, thrombosis was initially regarded as asymptomatic and was diagnosed only by duplex scanning of the veins. The most significant risk factors for developing DVT in the acute period of stroke were age 64 years and over (OR = 8.1), stroke severity on the NIHSS scale at admission of 6 points and above (OR = 5.6), time to admission from 10 hours or more (OR = 3.8), leg strength not more than 3 points (OR = 4.5) and an IMPROVE-VTE score of 3 points or more (OR = 9.5). When building a logistic regression model using the identified risk factors, accuracy values were obtained equal to 83% and 85% for the training and test samples, respectively.Conclusion. DVT is observed in 13% of patients in the acute period of stroke and is associated with the age of patients, the severity of stroke and movement disorders, the time from the development of symptoms to hospital admission, and the risk of venous thromboembolic complications according to the IMPROVE-VTE scale.

Тромбоз вен нижних конечностей и его последствия в восстановительном периоде инсульта

Post-stroke lower extremity vein thrombosis can be the reason behind complications of embolic nature and death. This study aimed to investigate the influence of provoking factors, frequency and localization of acute thrombosis, post-thrombotic changes in the lower extremity veins during stroke recovery period. The study involved 1315 patients, 885 (67.3%) male and 430 (32.7%) female, ages 18–94 years, mean age 59.23 ± 13.7 years. All participants underwent lower extremity venous duplex scanning in the early and late stages of stroke recovery period. We found no evidence of interconnections between presence of signs of thrombosis and/or its consequences and the pathogenetic variant of stroke the patient had. Acute deep vein thrombosis was diagnosed significantly more often (p < 0.05) in the early stage of stroke recovery period. The frequency of acute lower extremity vein thrombosis was 7.8%, post-thrombotic changes — 5.6%. Isolated lesion of the lower leg veins was the most common complication associated with deep veins (49.6%). We have discovered a significant relationship between the side of lower extremity paresis (plegia) of and the side of deep vein thrombosis (p < 0.001). No relationship was found between lower extremity superficial and deep vein thrombosis and use of anticoagulants and antiplatelet agents (p > 0.05). Excess body weight was associated with damage to the lower extremity proximal veins (p < 0.05). Women had lower extremity vein thrombosis significantly more often (p < 0.05). Repeated lower extremity venous duplex scanning upon admission to the rehabilitation hospital allowed reducing the risk of venous thromboembolic complications that may develop during the stroke recovery period.

Anticoagulants in oncology

Cancer patients are simultaneously at an increased risk of venous thromboembolic complications and a high risk of bleeding. The decision to conduct thromboprophylaxis in oncology patients should be based on an assessment of the individual risk of thrombosis and major bleeding.

Risk of Venous Thromboembolic Complications in Patients with Atrial Fibrillation: a Systematic Review and Meta-analysis

Aim: The aim of this meta-analysis and systematic review was to evaluate the possible connection between AF and VTE.Material and methods. Atrial fibrillation (AF) and atrial flutter (AFL) contribute to intra-atrial blood stasis which leads to thrombus formation with its embolization. There is some evidence that AF can be a risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE). The following databases were searched: PubMed (MEDLINE), EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials. The time frame for conducting a systematic literature search ranged from January 1, 1990 to November 1, 2021. The diagnosis of atrial fibrillation had to be confirmed by using ECG. The diagnosis of VTE could be made with Doppler imaging, ventilation/perfusion scan, CT angiography, venography, angiography or autopsy. Only the three studies with 102192 patients meeting the requirement were included in the meta-analysis.Results. The prevalence of DVT and PE were assessed using incidence rate ratios (IRR) method of the inverse variance random effects model and its 95% confidence interval (CI). The significant association between atrial fibrillation and pulmonary embolism was found (IRR, 4.18 95% Cl 1.958.98). Also there is obvious association between DVT and AF (IRR, 2.97 95% Cl 2.18-4.03).Conclusion. It can be concluded that the increased risk of developing VTE is associatedwith concomitant AF.

Markers of hemostasis activation and endothelial damage in patients with active cancer

Introduction. Increased expression of tissue factor by tumor cells, formation of procoagulant microparticles and secretion of proinflammatory cytokines that activate leukocytes and endothelial cells are considered to be the main factors provoking blood coagulation activation in cancer patients.The aim of the investigation was to study the peculiarities of hemostasis activation markers and endothelial damage in patients with active cancer.Materials and methods. Patients with active cancer were included in the study. We determined the following biomarkers: fibrinogen (Fg), von Willebrand factor (vWF), D-dimer (D-d), growth differentiation factor 15 (GDF-15), vascular endothelial growth factor A (VEGF-A).Results. Twenty-two patients with active cancer were included in the study. The median follow-up of the patients was 180 days (minimum 90, maximum 240). The presence of metastatic lesion was found in 62% of patients. At the end of the follow-up period (after 6 months) remission of the underlying disease was observed in 45.5% of patients, and 54.5% of patients were found to have progressed oncoprocess. GDF-15 levels ranged from 1486 to 11,722 pg/ml and were above normal values in all patients. Significant variability was also revealed in the level of VEGF-A - from 1 to 2944 pkg/ml, and only in 7 (32%) patients its level corresponded to normal values (0-66 pkg/ml). High levels of Fg (>3.6 g/L), D-d (>500 ng/ml), and vWF (>160%) were detected in 19 (86%), 18 (82%), and 17 (77%) patients, respectively.Conclusions. The pilot study demonstrates a pronounced activation of the blood coagulation system and endothelial damage in patients with active cancer receiving chemotherapy and having a high risk of venous thromboembolic complications. The detected relationship of markers characterizing blood coagulation activation (D-d) and endothelial damage (vWF) with the progression of oncoprocess necessitates their further study in this category of patients.

Risks of venous thromboembolic complications in related to combined oral contraceptives

Hormonal contraception is the most popular and effective reversible method for preventing unwanted pregnancy exerting multiple prophylactic and therapeutic effect along with contraceptive activity. The main adverse coupled to combined oral contraceptives (COCs) is its impact on the hemostasis and increased risk of venous thromboembolic complications. A great evolutionary path has been travelled after beginning application of hormonal contraception to reduce dose of its estrogen component and improving quality of gestagen component. Nevertheless, thrombotic complications related to COCs use still remain a pressing issue not only due to disease severity and high mortality rate from pulmonary embolism (PE), but also due to the difficulties in its timely diagnostics. Here we describe a clinical case of a 19-year-old patient suffering from vena cava inferior thrombosis complicated by PE after using COCs.