Standard Anticoagulant Therapy Research Articles

Pregnancy-associated pulmonary embolism (PA-PE): catheter-directed thrombolysis as first-line rescue

Pregnancy-associated pulmonary embolism (PA-PE) is a life-threatening presentation however literature surrounding its optimal management is limited. This case describes a case of PA-PE treated with catheter-directed thrombolysis after clinical deterioration despite standard anticoagulation therapy. Careful multidisciplinary planning is required to successfully manage the deteriorating patient with PA-PE with catheter-directed thrombolysis being considered as potential first-line therapy in these patients.

Role of PCSK9 Inhibitors in Venous Thromboembolism: Current Evidence and Unmet Clinical Needs.

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have recently emerged as promising therapeutic agents for lowering low-density lipoprotein cholesterol and reducing the risk of cardiovascular events. Moreover, preliminary evidence from randomized controlled trials (RCTs) suggests that PCSK9i may also offer beneficial effects for patients following venous thromboembolism (VTE), with the most significant reductions in risk appearing over time, particularly beyond the first year of treatment. However, there is a lack of randomized controlled data supporting their efficacy and safety in conjunction with standard anticoagulation therapy. This article aims to critically evaluate the existing evidence for the use of PCSK9i as a complementary therapy for VTE risk reduction, while also identifying unmet clinical and research needs and proposing potential strategies to address these knowledge gaps.

Prevalence and clinical outcomes of acute myocardial infarction in patients presenting with major trauma

BackgroundThe occurrence and sequelae of acute myocardial infarction (AMI) in major trauma patients is underexplored across both trauma and cardiology specialties. Coronary reperfusion greatly reduces the risk of significant morbidity and mortality in AMI. However, in patients presenting with significant injuries, concurrent AMI presents a competing management priority given the increase in risk of bleeding with standard anticoagulation and antiplatelet therapy, which may be contraindicated. This study aimed to evaluate the epidemiology and clinical outcomes associated with AMI in a contemporary major trauma cohort. MethodsThis study used data from the Victorian State Trauma Registry (VSTR). All adult patients with major trauma from 1 January 2013 to 31 December 2022 were included. Patients that died prior to hospital arrival were excluded. AMI was identified by ICD-10-AM diagnosis codes recorded against the first hospital admission. Clinical outcomes included in-hospital mortality, length of stay, and discharge destination. Results28,928 patients were identified over the 10-year study period. AMI occurred in 401 patients (1.4 %). AMI patients were older, had more comorbidities and were more frequently on anticoagulation or antiplatelet therapy. Low impact fall was the most common trauma mechanism in AMI patients. Patients with AMI experienced longer hospital stays (12 [7–20] versus 7 [4–12] days, p < 0.001) and higher rates of in-hospital mortality (adjusted RR 1.45, 95 % CI 1.25–1.65). ConclusionAMI in the setting of major trauma occurs in an older, more comorbid, and vulnerable group of patients. AMI is associated with an increased risk of in-hospital mortality and prolonged hospital stay in the setting of major trauma, underscoring the importance of identifying and treating major trauma associated AMI in a timely and effective manner.

Perioperative Management and Outcomes after Endovascular Mechanical Thrombectomy in Patients with Submassive (Intermediate-Risk) Pulmonary Embolism: A Retrospective Observational Cohort Study.

Pulmonary embolism (PE) embodies a large healthcare burden globally and is the third leading cause of morbidity and mortality worldwide. Submassive (intermediate-risk) PE accounts for 40% of this burden. However, the optimal treatment pathway for this population remains complex and ill-defined. Catheter-directed interventions (CDIs) have shown promise in directly impacting morbidity and mortality while demonstrating a favorable success rate, safety profile, and decreased length of stay (LOS) in the intensive care unit and hospital. This retrospective review included 22 patients (50% female) with submassive PE who underwent mechanical thrombectomy (MT). A total of 45% had a contraindication to thrombolytics, the mean pulmonary embolism severity index was 127, 36% had saddle PE, the average decrease in mean pulmonary artery pressure (PAP) was 7.2 mmHg following MT, the average LOS was 6.9 days, the 30-day mortality rate was 9%, the major adverse event (MAE) rate was 9%, and the readmission rate was 13.6%. A total of 82% had successful removal of thrombus during MT with no major bleeding complications, intracranial hemorrhage events, or device-related deaths. Acknowledging the limitation of our small sample size, our data indicate that MT in the intermediate-high-risk submassive pulmonary embolism (PE) cohort resulted in a decreased hospital length of stay (LOS) and in-hospital mortality compared to standard anticoagulation therapy alone.

Abbreviated Versus Standard Dual Antiplatelet Therapy Times After Percutaneous Coronary Intervention in Patients With High Bleeding Risk With Acute Coronary Syndrome: Insights From the SWEDEHEART Registry.

Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention. Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88-1.11], P=0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94-1.25]), or their components between groups. The results were consistent among all of the investigated subgroups. In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.

Outcomes of venous thromboembolism in patients with inherited thrombophilia treated with direct oral anticoagulants: insights from the RIETE registry.

While direct oral anticoagulants (DOACs) are frequently used to treat venous thromboembolism (VTE), the outcomes of patients with inherited thrombophilia (IT) receiving DOACs for VTE remain understudied. We used data from the international RIETE registry to compare the rates of VTE recurrences, major bleeding, and mortality during anticoagulant treatment in VTE patients with and without IT, grouped by the use of DOACs or standard anticoagulant therapy. Among 103,818 enrolled patients, 21,089 (20.3%) were tested for IT, of whom 8422 (39.9%) tested positive: Protein C deficiency 294, Protein S deficiency 726, Antithrombin deficiency 240, Factor V Leiden 2248, Prothrombin gene mutation 1434, combined IT 3480. Overall, 14,189 RIETE patients (6.2% with IT) received DOACs, and 89,629 standard anticoagulation (8.4% with IT), mostly with heparins followed by vitamin K antagonists. Proportions of patients receiving DOACs did not differ between IT-positive and IT-negative patients. Rates of VTE recurrence on anticoagulant treatment were highest in patients with AT deficiency (P < 0.01). Rates of on-treatment major bleeding and all-cause mortality were lowest among patients with Factor V Leiden (FVL) or PT G20210A mutations, compared with patients who tested negative. Patients with IT who received DOACs had lower rates of major bleeding than those receiving standard anticoagulation. Excluding FVL and Protein S deficiency, patients with IT had lower rates of VTE recurrence with DOACs than with standard anticoagulation. DOACs are equally safe and effective in VTE patients with IT, with lower bleeding rates than those on standard anticoagulation.

Presentation and Management of Cerebral Venous Sinus Thrombosis After Supratentorial Craniotomy.

Cerebral venous sinus thrombosis (CVST) after supratentorial craniotomy is a poorly studied complication, for which there are no management guidelines. This study assessed the incidence, associated risk factors, and management of postoperative CVST after awake craniotomy. This is an observational, retrospective, monocentric analysis of patients who underwent a supratentorial awake craniotomy. Postoperative CVST was defined as a flow defect on the postoperative contrast-enhanced 3D T1-weighted sequence and/or as a T2* hypointensity within the sinus. In 401 supratentorial awake craniotomies (87.3% of diffuse glioma), the incidence of postoperative CVST was 4.0% (95% CI 2.5-6.4): 14/16 thromboses located in the superior sagittal sinus and 12/16 located in the transverse sinus. A venous sinus was exposed during craniotomy in 45.4% of cases, and no intraoperative injury to a cerebral venous sinus was reported. All thromboses were asymptomatic, and only two cases were diagnosed at the time of the first postoperative imaging (0.5%). Postoperative complications, early postoperative Karnofsky Performance Status score, and duration of hospital stay did not significantly differ between patients with and without postoperative CVST. Adjusted independent risk factors of postoperative CVST were female sex (adjusted Odds Ratio 4.00, 95% CI 1.24-12.91, P = .021) and a lesion ≤1 cm to a venous sinus (adjusted Odds Ratio 10.58, 95% CI 2.93-38.20, P < .001). All patients received standard prophylactic-dose anticoagulant therapy, and none received treatment-dose anticoagulant therapy. No thrombosis-related adverse event was reported. All thromboses presented spontaneous sinus recanalization radiologically at a mean of 89 ± 41 days (range, 7-171). CVST after supratentorial awake craniotomy is a rare event with satisfactory clinical outcomes and spontaneous sinus recanalization under conservative management without treatment-dose anticoagulant therapy. These findings are comforting to neurosurgeons confronted with postoperative MRI reports suggesting CVST.

Case report: hunting the hidden: surgical treatment of chronic silent thrombus in the left ventricle in a young alcoholic patient with myocardial bridging

BackgroundA silent left ventricular thrombus is dangerous. The current standard anticoagulation therapy was ineffective in our case or similar, and the outcome was poor.Case presentationA 33-year-old man with a silent left ventricular thrombus was detected incidentally by transthoracic echocardiography. After admission, anti-coagulation with low-molecular-weight heparin therapy was carried out. The CAG revealed 70% systolic stenosis in the middle of the right coronary artery along with myocardial bridging. Unfortunately, an acute left temporal embolism emerged 5 days later, then the patient was transferred to the neurology department for further treatment. One month later, the patient underwent left ventricular thrombectomy, ventricular aneurysm resection, and coronary artery bypass grafting (CABG) and was discharged uneventfully after surgery.ConclusionsSurgical treatment should be a priority for patients with giant or hypermobile left ventricular thrombus or recurrent systemic emboli.

Efficacy and Safety of Intensified vs Standard Prophylactic Anticoagulation Therapy in Patients Hospitalized With Coronavirus Disease 2019: Updated Systematic Review and Meta-analysis.

Efficacy and Safety of Intensified vs Standard Prophylactic Anticoagulation Therapy in Patients Hospitalized With Coronavirus Disease 2019: Updated Systematic Review and Meta-analysis.

Выбор метода профилактики тромботических осложнений у пациентов с хирургическими заболеваниями желудка высокого риска

INTRODUCTION: Despite the significant advances in the prevention and treatment of venous thromboembolic complications (VTEC), pulmonary embolism (PE) remains the most common preventable cause of hospital postoperative mortality. One of the causes of thrombosis is surgical operations, especially laparoscopic, associated with the activation of the hemostasis system. Aim: The choice of a prevention method of thrombotic complications in comorbid patients with signs of varicose veins of the lower extremities requiring laparoscopic surgical treatment of benign gastric diseases (BGD). MATERIALS AND METHODS: The study is based on a treatment analysis of 128 patients with BGD in combination with a high comorbid background. The treatment of these patients was divided into several stages, which included both vascular interventions for the prevention of VTEC and a laparoscopic stage aimed at treating the underlying disease. The patients were divided into 3 groups comparable in gender and age. The first group, consisting of 45 people, VTEC prevention was carried out using a standard conservative technique (anticoagulant therapy in combination with mechanical prophylaxis). The second group included 43 patients who underwent both standard conservative therapy and open surgery aimed at correcting venous insufficiency in the great saphenous vein system. The third group is represented by 40 patients who, in addition to the standard conservative prevention of VTEC, underwent a combined surgical treatment (crossectomy and endovenous laser coagulation (EVLC) of the trunk of the great saphenous vein by retrograde method). All patients underwent coagulogram analysis and ultrasound triplex scanning of the veins of the lower extremities at each stage of the treatment. RESULTS: In the first group of patients, the largest number of thrombotic complications was noted — 24.4%, in the second group their number was 14%, while in the third group, thrombotic complications were detected in only 7.5% of patients. In the second and third groups, there was no development of PE, both after the first operation and after the main laparoscopic stage of treatment. In the first group, on the contrary, 2 episodes of PE (4.4%) were noted after the main surgical treatment. In turn, the standard anticoagulant therapy carried out in all three groups led to the development of both small and large hemorrhagic complications. At the same time, it should be noted that their frequency was comparable in all three groups, and their number did not exceed the number of such complications based on literature data. CONCLUSION: Carrying out active operative prevention of thrombotic complications significantly reduces their frequency in comorbid patients with signs of varicose veins of the lower extremities, thereby allowing to improve the result of the treatment. Considering that laparoscopic surgical interventions on the stomach increase the risk of developing VTEC in comorbid patients, according to our data, performing EVLC in combination with crossectomy, as the first stage of prophylaxis, prevents the development of PE and reduces the risk of venous thrombotic complications by 16.9%.

АНАЛИЗ МАРКЕРОВ СИСТЕМЫ ГЕМОСТАЗА У ПАЦИЕНТОВ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ НЕКЛАПАННОГО ГЕНЕЗА С ТРОМБОЭМБОЛИЧЕСКИМИ ОСЛОЖНЕНИЯМИ

Introduction. Atrial fibrillation (AF) is one of the most common heart rhythm disorders. The risk of developing thromboembolic complications, including ischemic stroke, in patients with AF is 5 times higher than that in patients with sinus rhythm; therefore, one of the main directions in the treatment of patients with this rhythm disorder is the prevention of thromboembolic complications. Objective: to study the markers of monitoring the blood coagulation system in the blood serum of patients with non-valvular AF receiving anticoagulant therapy and having a history of thrombotic and thromboembolic complications. Materials and methods. The study included 31 healthy volunteers (without a history of AF, thrombosis) and 31 patients over 18 years of age with a diagnosis of AF (mean age 66.2±8.1), receiving anticoagulant therapy and having a history of thrombotic and thromboembolic events. complications. Therapy taken by patients at the time of inclusion in the study was in line with current recommendations and included standard conventional antiarrhythmic and anticoagulant therapy, as well as therapy for the underlying cardiovascular disease. Biomarkers of thrombus formation and pro-inflammatory activation (L-selectin, thrombomodulin) were determined by enzyme immunoassay using diagnostic kits from BiomedicaGmbH, Austria. Results. During the screening of 2820 patients treated in the Department of CHLSRS&amp;EX for the nosology of AF in the period 01.2020-01.2023, 31 patients were included in the study, who were diagnosed with thrombotic and thromboembolic complications (0.01% of the total number of screened patients) against the background of regular anticoagulant therapy . Among all patients included in the study, thrombotic complications in AF were as follows: thrombosis of the left atrial appendage was noted in 17 patients (54%), spontaneous echo contrast of grade II or more in 5 patients (16%), cardioembolic stroke - in 3 patients (10%) , thrombosis of peripheral arteries (2 (6%)), thrombosis on EKS electrodes (2 (6%)). The concentration of soluble thrombomodulin in the blood serum of patients with thrombotic and thromboembolic complications was reduced compared with the group of healthy volunteers (2073.0±548.6 vs. 2845.3±726.4 pg/ml; p=0.004). Serum levels of L-selectin in patients with thrombotic and thromboembolic complications were reduced compared to healthy volunteers (1.5±0.6 vs. 2.4±1.3 µg/mL; p=0.04). Conclusion. In patients with thrombotic and thromboembolic complications that occurred against the background of adequate anticoagulant therapy, there was a decrease in serum soluble thrombomodulin and L-selectin, which may indicate damage to the endothelium, activation of thrombus formation and inflammation.

Recurrent bleeding during standard anticoagulant therapy in comorbid patients with atrial fibrillation: a clinical case report

The question of the safety of direct oral anticoagulants (DOACs), despite their high efficacy in the prevention of thrombotic events in atrial fibrillation (AF), remains relevant due to the risk of developing hemorrhagic events while taking standard doses, which requires a thorough personalized approach. The article presents a clinical case of the development of spontaneous hematomas on the skin of the upper and lower extremities and hemarthrosis of the knee joint while taking 20 mg of rivaroxaban in a 72-year-old patient with AF without impaired renal and hepatic function. Due to the increase in the residual plasma concentration of rivaroxaban, a pharmacogenetic study and the Thrombodynamics (TD) test were performed. A pharmacogenetic study did not reveal significant gene polymorphisms associated with the metabolism of rivaroxaban. However, TD allowed us to confirm the presence of significant hypocoagulation at the peak of the residual blood concentration of the drug in the blood, which could cause recurrent hemorrhagic events in the patient. In addition, the patient is taking amiodarone at a dosage of 200 mg per day, which does not allow us to rule out drug-drug interaction, despite the inconsistency of the literature data.

A MALDI Mass Spectrometry Imaging Sample Preparation Method for Venous Thrombosis with Initial Lipid Characterization of Lab-Made and Murine Clots.

Venous thromboembolism (VTE) and its complications affect over 900,000 people in the U.S. annually, with a third of cases resulting in fatality. Despite such a high incidence rate, venous thrombosis research has not led to significant changes in clinical treatments, with standard anti-coagulant therapy (heparin followed by a vitamin K antagonist) being used since the 1950s. Mechanical thrombectomy is an alternative strategy for treating venous thrombosis; however, clinical guidelines for patient selection have not been well-established or accepted. The effectiveness of both treatments is impacted by the heterogeneity of the thrombus, including the mechanical properties of its cellular components and its molecular makeup. A full understanding of the complex interplay between disease initiation and progression, biochemical molecular changes, tissue function, and mechanical properties calls for a multiplex and multiscale approach. In this work, we establish a protocol for using matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging to characterize spatial heterogeneity of biomolecules in lab-made blood clots and ex vivo murine thrombi. In this work, we compared (1) tissue preservation and cryosectioning methods, (2) various matrixes, 9-aminoacridine hydrochloride monohydrate (9AA), 2,5-dihydroxybenzoic acid (DHB), and alpha-cyano-4-hydroxycinnamic acid matrix (CHCA), (3) plasma-rich versus red-blood-cell rich lab-made blood clots, and (4) lab-made blood clots versus ex vivo murine thrombi. This project is the first step in our work to combine mass spectrometry imaging with biomechanical testing of blood clots to improve our understanding of VTE.

Periprocedural Off-label Use of Rivaroxaban in Patient with Atrial Fibrillation and a Persistent Left Atrial Appendage Thrombus Despite Standard Anticoagulation Therapy: A Case Report

Periprocedural Off-label Use of Rivaroxaban in Patient with Atrial Fibrillation and a Persistent Left Atrial Appendage Thrombus Despite Standard Anticoagulation Therapy: A Case Report

Intravenous enoxaparin as alternative ECMO anticoagulation over a period of 94 days: a case report

BackgroundUnfractionated heparin is used worldwide as a standard anticoagulation therapy for extracorporeal membrane oxygenation (ECMO) machines. However, its use brings about significant bleeding and thrombotic complications for critically ill patients. This case report shows that low molecular weight heparin together with ECMO-produced primary haemostasis pathology can be used as an alternative way of ECMO anticoagulation.Case presentationThis paper presents the case of a patient with respiratory failure who subsequently suffered from cardiac failure and spent 94 days on combined V-V and V-A ECMO devices (two ECMO devices running simultaneously on one patient) with intravenous enoxaparin used instead of unfractionated heparin anticoagulation. No life-threatening bleeding/thrombotic events happened during this period, nor did any technical problems with ECMO occur.ConclusionsIn this case report, continuous intravenous low molecular weight heparin anticoagulation was used as a safe alternative to ECMO anticoagulation.

Clinical phenotype, treatment strategy and pregnancy outcome of non-criteria obstetric antiphospholipid syndrome.

To illustrate the clinical features, treatment strategy, and pregnancy outcome of patients with obstetric antiphospholipid syndrome (OAPS), non-criteria obstetric antiphospholipid syndrome (NC-OAPS) METHOD OF STUDY: A single-center nested case-control study was designed. Patients with a diagnosis of OAPS and NC-OAPS were enrolled. The medical history, coagulation status, and antibody profile data were collected. Patients were given standard anticoagulation therapy with or without glucocorticoids (GC) and/or hydroxychloroquine (HCQ) during pregnancy and were observed for their pregnancy outcome. A total of 47 patients with OAPS and 120 patients with NC-OAPS were finally included, of whom 55 patients met the clinical criteria (subgroup C) and 65 met the laboratory criteria (subgroup L). Pregnancy morbidity showed significant differences: gravida, pregnancy loss in OAPS versus NC-OAPS. The coagulation function was not significantly different between OAPS and NC-OAPS groups, while TT and FIB were significantly higher in the subgroup C. Thromboelastography (TEG) results showed a significantly lower ANGEL in the NC-OAPS group, a higher ANGEL and lower EPL, LY30 in the subgroup L. No differences between groups were observed in treatment strategy. The pregnancy outcomes were not significantly different between NC-OAPS and OAPS groups. Clinical and laboratory differences were found between OAPS and NC-OAPS groups in this study. Patients in different subgroups of NC-OAPS could be identified with different clinical phenotypes. A relatively hypercoagulable status existed in the OAPS group compared to NC-OAPS, and also in the subgroup L.

Endovascular management of cerebral venous thrombosis: a tertiary-centre experience.

Stroke related to cerebral venous thrombosis (CVT) is uncommon, with untoward lethal outcomes. Systemic anticoagulation is the treatment of choice. However, some patients can be resistant to this treatment. Endovascular management with thrombolysis and mechanical thrombectomy can be a viable option in such cases. We retrospectively reviewed the endovascular management used for CVT in 8 patients who failed to respond to standard anticoagulation therapy between December 2017 and December 2022 in our institute. Clinical profile, imaging parameters, endovascular procedure details, and outcomes in terms of angiographic findings and clinical follow-up were analysed. In this period, a total of 8 patients underwent mechanical thrombectomy. The procedure was successful in all cases (8/8 = 100%), and 50% of them showed near total/complete recanalization; Perforation of the cortical veins was noted in 2 cases (~25%). Among the 8 patients, one died (1/8 = 12.5%) due to cardiac aetiology; the remaining 7 patients (87.5%) showed good clinical outcome with a modified Rankin Scale score 0 to 2. Catheter-directed thrombolysis with mechanical thromboaspiration is a safe and effective treatment for cerebral venous sinus thrombosis not responding to anticoagulation.

Гепарин-индуцированная тромбоцитопения на фоне COVID-19 у онкологической пациентки

Patients with COVID-19 often have coagulation disorders and elevated D-dimer levels. The same changes are also typical for cancer patients. The standard anticoagulation therapy for these patients is the use of low-molecular-weight heparin, which in rare cases may cause heparin-induced thrombocytopenia (HIT), a serious complication associated with paradoxical autoimmune reactions to heparin. This article presents a clinical case of HIT against the background of severe COVID-19 in a patient with ovarian cancer. Key words: heparin-induced thrombocytopenia, coronavirus infection, COVID-19, low-molecular-weight heparin, thrombotic complications, thrombocytopenia, ovarian cancer

Clinical and radiological outcomes of adjuvant catheter-directed thrombolysis of acute iliofemoral venous thrombosis compared to standard anticoagulant therapy: a randomized controlled study

Clinical and radiological outcomes of adjuvant catheter-directed thrombolysis of acute iliofemoral venous thrombosis compared to standard anticoagulant therapy: a randomized controlled study

Динаміка рівня ендотеліального моноцитактивуючого пептиду-ІІ у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу

The purpose of the study was to investigate the dynamics of endothelial monocyte activating polypeptide-ІІ in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 six months after a coronary event. Materials and methods. 120 patients participated in the study: group 1 – patients with acute myocardial infarction with diabetes mellitus type 2 (n=70), group 2 – patients with acute myocardial infarction (n=50). The control group included 20 practically healthy people. All patients underwent laboratory and instrumental examination on the first day of acute myocardial infarction and 6 months after it. The level of endothelial monocyte activating polypeptide-ІІ was determined using the test system “Human Endothelial Monocyte Activating Polypeptide-ІІ ELISA KIT”. Results and discussion. The average level of endothelial monocyte activating polypeptide-ІІ on the first day of an acute myocardial infarction was: in patients who were part of the 1st group – 4.54 ± 0.331 ng/ml; 2nd – 2.74 ± 0.21 ng/ml; control group – 1.1 ± 0.037 ng/ml (р&lt;0.05). In patients of the 1st group, half a year after acute myocardial infarction, the average level of endothelial monocyte activating polypeptide-ІІ was equal to 3.6 ± 0.11 ng/ml; 2nd – 2.28 ± 0.05 ng/ml (р&lt;0.00001). Re-examination of patients, depending on treatment tactics, showed the following results: in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after cardiac ventriculography, the endothelial monocyte activating polypeptide-ІІ level was equal to 3.5 ± 0.04 ng/ml; in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after standard anticoagulant therapy it was 3.71 ± 0.03 ng/ml; in patients with isolated acute myocardial infarction after cardiac ventriculography – 2.24 ± 0.01 ng/ml; in patients with isolated acute myocardial infarction after standard anticoagulant therapy – 2.33 ± 0.04 (р&lt;0.01). Conclusion. Endothelial monocyte activating polypeptide-ІІ is a marker of endothelial dysfunction that has prognostic properties in relation to comorbid pathology in the form of acute myocardial infarction with. diabetes mellitus type 2. In patients with an acute myocardial infarction in the presence of diabetes mellitus type 2, a higher level of endothelial monocyte activating polypeptide-ІІ was noted on the 1st day of a coronary event and 6 months after it, compared to patients with an isolated acute myocardial infarction and individuals of the control group (p&lt;0.05). After cardiac ventriculography in patients, the level of endothelial monocyte activating polypeptide-ІІ was significantly lower compared to this indicator after standard anticoagulant therapy