IMPROVEMENT OF THROMBOTIC COMPLICATIONS PREVENTION AFTER OPERATIONS OF ENDOPROSTHETICS OF THE ABDOMINAL DEPARTMENT OF AORTA

В статье представлены данные оригинального исследования по оптимизации антитромботической профилактики после хирургического лечения аневризм брюшного отдела аорты методом эндопротезирования. С этой целью произведен сравнительный анализ двух альтернативных друг другу подходов к предупреждению развития тромботических осложнений: 1) «традиционный подход» на основе использования препаратов дезагрегантов; 2) разработанная программа на основе использования препарата класса новых пероральных антикоагулянтов. Выдвинута научная гипотеза о том, что радикальная замена «традиционного подхода» на разработанную программу приведет к принципиальному снижению количества развивающихся послеоперационных тромботических осложнений. В независимых группах пациентов с использованием сравниваемых подходов к антитромботической профилактике произведена точная качественная и количественная оценка послеоперационных тромботических осложнений - тромбозов глубоких вен и тромбозов браншей протеза, а также ключевых клинико-лабораторных показателей системы гемостаза. После выполнения исследования было установлено, что принципиальная замена «традиционного подхода» на разработанную программу действительно приводит к принципиальному снижению уровня тромботических осложнений. При этом не происходит критических «сдвигов» как в сосудисто-тромбоцитарном, так и в коагуляционном звене системы гемостаза, и тем самым не создаются повышенный риск кровотечений. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к широкому использованию в практике сосудистой хирургии The article presents data from an original study on optimizing antithrombotic prophylaxis after surgical treatment of abdominal aortic aneurysms by endoprosthetics. To this end, a comparative analysis of two alternative approaches to preventing thrombotic complications has been made: 1) the «traditional approach» based on the use of disaggregant preparations; 2) a developed program based on the use of a drug of the class of new oral anticoagulants. A scientific hypothesis is put forward that the radical replacement of the “traditional approach” with the developed program will lead to a fundamental reduction in the number of developing postoperative thrombotic complications. In independent groups of patients, using the compared approaches to antithrombotic prophylaxis, an accurate qualitative and quantitative assessment of postoperative thrombotic complications - deep vein thrombosis and prosthetic branches thrombosis, as well as key clinical and laboratory parameters of the hemostasis system was performed. After carrying out the study, it was found that a fundamental replacement of the «traditional approach» with the developed program does lead to a fundamental decrease in the level of thrombotic complications. In this case, there are no critical «shifts» both in the vascular-platelet and in the coagulation unit of the hemostatic system, and thus there is no increased risk of bleeding. The results obtained have a high level of statistical significance, which allows us to recommend them for widespread use in the practice of vascular surgery

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OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

СИСТЕМНЫЙ АНАЛИЗ И УПРАВЛЕНИЕ В БИОМЕДИЦИНСКИХ СИСТЕМАХ ◽

10.36622/vstu.2020.19.2.007 ◽

2020 ◽

pp. 43-49

Author(s):

Андрей Анатольевич Иванов ◽

Александр Иванович Жданов ◽

Максим Сергеевич Шевелин ◽

Александр Сергеевич Брежнев

Keyword(s):

Comparative Analysis ◽

Postoperative Complications ◽

Statistical Significance ◽

Aortic Aneurysms ◽

Surgical Interventions ◽

Vein Thrombosis ◽

Scientific Hypothesis ◽

Abdominal Aortic ◽

Life Threatening ◽

High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

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THE THROMBOTIC COMPLICATIONS PREDICTION AFTER OPERATIONS AT THE ABDOMINAL DEPARTMENT ОF AORTA BY RISK FACTORS

СИСТЕМНЫЙ АНАЛИЗ И УПРАВЛЕНИЕ В БИОМЕДИЦИНСКИХ СИСТЕМАХ ◽

10.36622/vstu.2020.19.2.020 ◽

2020 ◽

pp. 139-146

Author(s):

Максим Сергеевич Шевелин ◽

Андрей Анатольевич Иванов ◽

Александр Сергеевич Брежнев ◽

Евгений Алексеевич Азаров

Keyword(s):

Risk Factors ◽

Statistical Significance ◽

Abdominal Aortic Aneurysms ◽

Risk Groups ◽

Aortic Aneurysms ◽

Specific Patient ◽

Planning Stage ◽

Abdominal Aortic ◽

Thrombotic Complications ◽

High Level

В статье представлены данные оригинального исследования по прогнозированию риска развития тромботических осложнений после хирургического лечения аневризм брюшного отдела аорты. С этой целью создана и реализована соответствующая программа исследования. В предоперационном периоде произведено обследование репрезентативной выборки тематических пациентов. Выделен комплекс факторов риска по развитию послеоперационных тромботических осложнений - тромбозов глубоких вен и тромбозов браншей протеза. В послеоперационном периоде определена фактическая вероятность их развития, выявлена диагностическая информативность (прогностическая значимость) оцениваемых периоперационных факторов риска. На основе наиболее значимых факторов разработана прогностическая математическая модель, позволяющая определять по их наличию и сочетанию высокий или низкий уровень риска развития осложнений. Работоспособность модели была проверена путем сравнения полученных клинических данных с результатами численного прогнозирования. Выявлен высокий уровень работоспособности. Верификация показала высокий уровень адекватности модели. Ее использование позволяет дифференцировать тематических пациентов на группы высокого, среднего и низкого риска по развитию послеоперационных тромботических осложнений. В соответствии с этим появилась возможность выбора рекомендации по использованию «стандартных» или «усиленных» программ антитромботической профилактики для каждого конкретного пациента. Полученные результаты имеют высокий уровень статистической значимости, что, в свою очередь, позволяет рекомендовать их к рассмотрению для использования в практике сосудистой хирургии на этапе планирования операций по поводу аневризм брюшного отдела аорты и составления программ профилактики послеоперационных тромботических осложнений The article presents data from an original study of predicting the risk of thrombotic complications after surgical treatment of abdominal aortic aneurysms. For this purpose, an appropriate research program has been created and implemented. In the preoperative period, a representative sample of thematic patients was examined. A complex of risk factors was identified for the development of postoperative thrombotic complications - deep vein thrombosis and thrombosis of prosthetics branches. In the postoperative period, the actual probability of their development was determined, diagnostic informativeness (prognostic value) of the estimated perioperative risk factors was revealed. Based on the most significant factors, a predictive mathematical model has been appearance that allows one to determine by their presence and combination a high, middle or low level of risk of complications. The performance of the model was tested by comparing the obtained clinical data with the results of numerical forecasting. A high level of performance has been identified. Verification showed a high level of model adequacy. Its use allows us to differentiate thematic patients into high and low risk groups according to the development of postoperative thrombotic complications. In accordance with this, it became possible to choose recommendations on the use of «standard» or «enhanced» antithrombotic prophylaxis programs for each specific patient. The results obtained have a high level of statistical significance, which, in turn, allows us to recommend them for consideration in the practice of vascular surgery at the planning stage of operations for abdominal aortic aneurysms and the development of programs for the prevention of postoperative thrombotic complications

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THE ELABORATION OF A THERAPEUTIC COMPLEX FOR UNSTABLE STENOCARDIA WITH THE TYPE II DIABETES MELLITUS BACKGROUND WITH ACCOMPANYING HYPERVENTILATIVE SYNDROME: ANALYSIS OF CLINIC-CARDIOLOGY AND RESPIRATORY-METABOLICPARAMETERS

СИСТЕМНЫЙ АНАЛИЗ И УПРАВЛЕНИЕ В БИОМЕДИЦИНСКИХ СИСТЕМАХ ◽

10.36622/vstu.2021.20.4.006 ◽

2021 ◽

pp. 38-46

Author(s):

Никита Игоревич Воронин ◽

Дмитрий Сергеевич Кузнецов

Keyword(s):

Diabetes Mellitus ◽

Traditional Approach ◽

Statistical Significance ◽

Type Ii Diabetes Mellitus ◽

Original Research ◽

Hyperventilation Syndrome ◽

Practical Development ◽

Concomitant Condition ◽

High Level ◽

New Generation

В статье представлены данные оригинального исследования по созданию терапевтического комплекса, направленного на улучшение интенсивного лечения нозологической ассоциации «нестабильная стенокардия (в качестве основного заболевания) + сахарный диабет второго типа (в качестве фоновой патологии) + гипервентиляционный синдром (в качестве сопутствующего состояния)». Разработанный комплекс основан на контролируемом изменении вспомогательной респираторной оксигенации «в сторону уменьшения» при условии обязательного дополнения базисной фармакотерапии сбалансированной комбинацией препаратов антигипоксического действия и дезагрегантом нового поколения. Проведено сравнительное исследование двух групп тематических пациентов - с применением разработанного комплекса и с использованием «традиционного подхода». Изучены ключевые параметры клинического кардиологического и респираторно-метаболического статуса пациентов. При использовании разработанного терапевтического комплекса по сравнению с «традиционным подходом» установлено принципиальное улучшение параметров клинико-кардиологического статуса при сохранении параметров респираторно-метаболического статуса в пределах адаптивных и безопасных значений. Полученные результаты имеют высокий уровень статистической значимости. Это доказало достаточную обоснованность авторской научно-практической разработки. Представленные в статье данные отличает новизна и практическая применимость, что позволяет рекомендовать их к дальнейшему использованию в практике специалистов клиники внутренних болезней The article presents the data of the original research on the creation of a therapeutic complex aimed at improving the intensive treatment of the nosological association «unstable angina pectoris (as the main disease) + type 2 diabetes mellitus (as a background pathology) + hyperventilation syndrome (as a concomitant condition)». The developed complex is based on a controlled change in auxiliary respiratory oxygenation «downward», provided that basic pharmacotherapy must be supplemented with a balanced combination of antihypoxic drugs and a new generation of antiaggregants. A comparative study of two groups of thematic patients was carried out - using the developed complex and using the «traditional approach». The key parameters of the clinical cardiological and respiratorymetabolic status of patients were studied. When using the developed therapeutic complex in comparison with the «traditional approach», a fundamental improvement in the parameters of the clinical and cardiological status was established while maintaining the parameters of the respiratory and metabolic status within the adaptive and safe values. The results obtained have a high level of statistical significance. This proved the sufficient validity of the author's scientific and practical development. The data presented in the article are distinguished by novelty and practical applicability, which makes it possible to recommend them for further use in the practice of specialists in the clinic of internal diseases

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Direct-Acting Oral Anticoagulants (DOACs) in Cirrhosis and Cirrhosis-Associated Portal Vein Thrombosis

Seminars in Liver Disease ◽

10.1055/s-0039-1679934 ◽

2019 ◽

Vol 39 (02) ◽

pp. 195-208 ◽

Cited By ~ 9

Author(s):

Ethan Weinberg ◽

Julia Palecki ◽

K. Reddy

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Treatment Guidelines ◽

Oral Anticoagulants ◽

Primary Prophylaxis ◽

Current Treatment ◽

Vein Thrombosis ◽

Increased Risk ◽

Direct Acting ◽

Direct Acting Oral Anticoagulants

AbstractDirect-acting oral anticoagulants (DOACs) have provided benefit in patients requiring anticoagulation for certain diseases by decreasing the burden of subcutaneous injections and the requirement for frequent monitoring through regular blood tests, to ensure adequacy of the therapeutic doses. Studies have demonstrated DOACs to be as safe, and in some instance safer, compared with traditional anticoagulants in the general population. However, the studies evaluating DOACs excluded patients with cirrhosis, a condition associated with an increased risk of developing portal vein thrombosis (PVT). Warfarin or low-molecular weight heparin are the standard-of-care treatment for acute PVT in cirrhosis, although there is enthusiasm in a paradigm shift switching to DOACs for the treatment of acute PVT in cirrhosis, particularly since the release of DOAC antidotes. This article reviews the current Food and Drug Administration-approved DOACs, hepatic metabolism of DOACs, pharmacokinetics of DOACs in patients with cirrhosis, safety of DOACs (including bleeding, hepatotoxicity, and pregnancy), current treatment guidelines for PVT in cirrhosis, and studies evaluating the use of DOACs in cirrhosis and for the treatment of PVT in cirrhosis. The potential use of DOACs for PVT primary prophylaxis in at-risk patients with cirrhosis and the possible antifibrotic effects of DOACs are also discussed.

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Incidence of venous thromboembolic disease (VTE) in a cohort of patients with colorectal cancer (CRC) according to KRAS, NRAS and BRAF status.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15136 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15136-e15136

Author(s):

Pilar Garcia-Alfonso ◽

Laura Ortega Morán ◽

Iria Gallego Gallego ◽

Gonzalo García González ◽

Gabriela Torres Pérez-Solero ◽

...

Keyword(s):

High Risk ◽

Predictive Model ◽

Metastatic Disease ◽

Statistical Significance ◽

Univariate Analysis ◽

Low Risk ◽

Intermediate Risk ◽

Vein Thrombosis ◽

Increased Risk ◽

Cancer Associated Thrombosis

e15136 Background: A recent study has suggested that KRAS mutation could increase the risk of VTE in patients with CRC. The role of others biomarkers, such as BRAF, in this setting is unknown. The aim of this study is to analyze the incidence of cancer-associated thrombosis in a cohort of patients with CRC based on KRAS, NRAS and BRAF status. Methods: We performed a retrospective review of patients with metastatic CRC and KRAS/NRAS/BRAF status known, attended in the Medical Oncology Department of the Hospital General Universitario Gregorio Marañón (Madrid, Spain) between January 2010 and January 2018. Results: 194 patients were identified and included in the analysis. The median age was 64 years (18-86). Most were metastatic at diagnosis (58.1%). Khorana’s predictive model: low-risk 67.7%, intermediate-risk 31.0%, high-risk 2.3%. The median follow-up was 35 months (2-240). 41 patients (21.1%) experienced VTE (11 pulmonary embolism, 15 lower extremity deep-vein thrombosis, 12 visceral vein thrombosis, 2 catheter-related thrombosis, 1 unknown). Most had metastatic disease at the moment of VTE (90.2%). 40% of the events occurred at the time of diagnosis or within the first 6 months. 65% were incidental events. Khorana’s predictive model in VTE patients: low-risk 63.4%, intermediate-risk 24.5%, high-risk 7.3%. According to biomarkers, the incidence was 19.1% (13/68) in KRAS/NRAS mutated patients, 28.6% (6/21) in BRAF mutated patients and 21% (22/105) in triple-wild-type patients. 6/38 patients (15.8%) developed recurrent thrombosis. In the univariate analysis, the presence of chronic kidney disease (p = 0.022), ECOG ≥ 2 (p = 0.038) and high-risk Khorana score (p = 0.011) were significantly associated with increased risk of VTE. Metastatic disease showed a trend towards the statistical significance (p = 0.053). In the multivariate model, including this variables, age, sex and biomarkers, only ECOG ≥ 2 remained independent predictor of VTE (OR 8.73; CI 95% 1.32-57.82; p = 0.025). Conclusions: The biomarkers have not been associated with the risk of VTE. We have observed a high incidence of VTE in BRAF mutated patients that should be investigated in further studies.

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A Systematic Review and Meta-Analysis of Safety and Efficacy for Pre-Procedural Use of Thrombopoietin Receptor Agonists in Hepatic Cirrhosis Patients

Blood ◽

10.1182/blood-2019-132063 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1094-1094

Author(s):

Kunhwa Kim ◽

Faustine Ong ◽

Gabor Varadi ◽

Sorab Gupta ◽

Vinicius Machado Jorge

Keyword(s):

Liver Cirrhosis ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Risk Ratio ◽

Meta Analysis ◽

Statistical Significance ◽

P Value ◽

Receptor Agonists ◽

Vein Thrombosis ◽

Increased Risk

Introduction Thrombocytopenia is common in liver cirrhosis patients, which often complicates with patients' frequent issue with gastrointestinal bleeding and procedural needs. Based on biologic understanding of decreased thrombopoietin(TPO) level in liver cirrhosis patients, use of TPO agonists in liver cirrhosis have been actively studied. Over the period of time, new studies have come out about 2 FDA-approved TPO agonists, Avatrombopag and Lusutrombopag, for prophylaxis before procedure in liver cirrhosis patients with thrombocytopenia. In the past, there have raised concerns of increased risk of portal vein thrombosis and other thrombotic risks in other agents. In our study, we aimed to study the effectiveness and safety of TPO receptor agonists for pre-procedural use in patients with liver cirrhosis. Study design Study was conducted from August 2018 to July 2019. Previous studies were identified through database searching MEDLINE, CENTRAL, Clinicaltrial.gov and google search. Randomized clinical trials with active treatment arm with TPO receptor agonists in the use of liver cirrhosis patients, with intention of pre-procedural prophylaxis, and having placebo for direct comparisons were included. One of the major exclusions was TPO receptor agonists to increase platelet counts for anti-viral treatment in cirrhosis patients. 14 studies were identified. Studies were reviewed and eligibility was determined by two independent clinically trained researchers. 5 duplicated studies were removed, and in total of 7 studies were included for quantitative and qualitative analysis. Details of studies were collected by 2 independent researchers and compared. When there is a discrepancy, repeat review of the study was conducted. Studies were conducted or published from 2012 to 2018. 1 trial from Eltrombopag, 3 trials from Avatrombopag, and 3 trials from Lusutrombopag were included. Result Characteristics of included studies are summarized in table 1. Our studies found that 5.5(95% CI : 4.35-7.15) times higher risk ratio(RR) of reaching platelet target before procedure compared to placebo. Target platelet number goal was 50,000 to 80,000 depending on the study. Studies showed homogenous result with I-squared was 30.8% and q-statistics of p-value 0.193.(Figure 1) Subgroup analysis by FDA-approved medication of Avatrombopag and Lusutrombopag showed statistically significant higher risk ratio of 4.74(3.36-6.68) and of 5.52(3.65-8.34) each compared to placebo. Risk ratio for preventing platelet transfusion was not able to be calculated with heterogeneity of study with I-square higher than 90%. Lusutrombopag study showed significant benefits (RR 6.33, 95% CI 2.95-13.58) with heterogeneity inside the same medications, which might be explained with different doses in studies. No statistical significance in risk ratio in a study with Avatrombopag. Subgroup analysis limited to phase 3 studies showed risk ratio of preventing transfusion of 2.87(95% CI 2.15-3.82) but heterogeneity with q-statistics of p-value at 0.029. Relative risk for adverse event related to portal vein thrombosis was not statistically significant with RR of 0.99(95% CI : 0.35-2.85) in total of 1,229 patients.(Figure 2) Study result was homogenous result by I-square 0%, q-statistics of p-value 0.794. Other severe adverse events, major bleeding risk, overall thrombosis risk were not statistically significant. Only increased risk without statistical significance was reported in trail with Eltrombopag which was early terminated. Conclusion Our meta-analysis of pre-procedural use of TPO agonist in liver cirrhosis patients showed statistically significant benefit of reaching platelet count goal by 5.58 times with risk ratio, but no benefit of preventing transfusion. Compared to prior studies including use of TPO agonists for Interferon-Ribavirin treatment, meta-analysis limited to pre-procedural use did not show statistically significant increase in portal vein thrombosis. Serious adverse events including thrombosis events and bleeding risk were not statistically significant. Most studies described that portal-vein thrombosis events were often related to high platelet counts about 200,000 and longer use of TPO agonist. In current era with lesser use of Interferon and Ribavirin as an anti-viral therapy, TPO agonists use in setting of pre-procedure mostly with lower platelet targets can be safely used. Disclosures No relevant conflicts of interest to declare.

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Does COVID-19 infection increase the risk of pulmonary embolism in ambulatory patients with deep vein thrombosis

Vascular ◽

10.1177/17085381211052207 ◽

2021 ◽

pp. 170853812110522

Author(s):

Salih Salihi ◽

Bilal Perçin ◽

Halil Ibrahim Erkengel ◽

Bilhan Özalp ◽

Hakan Saçlı ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Statistical Significance ◽

Survival Rates ◽

Vein Thrombosis ◽

Significant Difference ◽

Prophylactic Drug ◽

Ambulatory Patients ◽

Thrombotic Complications ◽

Deep Vein

Objectives Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications including venous thromboembolism. This study compares the development of pulmonary embolism, post-thrombotic syndrome, and clinical outcomes of COVID-19 and non-COVID-19 patients with deep vein thrombosis (DVT). Methods One hundred and eight patients diagnosed with acute deep vein thrombosis (DVT) between June 2020 and February 2021 in our institution were included in this retrospective study. Thirty-nine patients had been previously diagnosed with COVID-19 and specified as the COVID-19 group. Sixty-nine patients did not have COVID-19 and specified as the non-COVID-19 group. Mean ages of both groups were 64.3 ± 15.8 and 60.1 ± 19.7 years, respectively ( p = .37). Results The median duration from the onset of the COVID-19 to diagnosis of DVT was 22 (2–120) days in the COVID-19 group. The patients of two groups were mostly treated outpatient at rates of 94.9% vs 94.2%, respectively ( p = .88). Pulmonary embolism was seen in six patients (15.4%) in the COVID-19 group and in three patients (4.3%) in the non-COVID-19 group ( p = .04). Kaplan–Meir curves showed that patients with COVİD-19 had significantly higher pulmonary embolism than those without COVID-19 ( p = .015). The recurrence rate of DVT was 2.6% in the COVID-19 group ( n = 1), and 4.3% in the non-COVID-19 group ( n = 3), indicating no statistically significant difference ( p = .63). Mortality was seen in six patients (15.4%) in the COVİD-19 group, and in seven patients (10.1%) in the non-COVID-19 group. According to the Kaplan–Meir method, 10 months survival rates were 73.9 ± 10% in the COVID-19 group, and 66.3 ± 12.8% in the non-COVID-19 group with no statistical significance ( p = .218). Conclusions Our data draw attention to the fact that deep vein thrombosis should not be considered a safe and self-limited condition. Efficient preventive measures such as mobilization and prophylactic drug use should be considered to prevent DVT during the management of COVID-19.

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Changing physicians’ attitudes regarding anticoagulant therapy for novel coronavirus infection in 2021.

Тромбоз, гемостаз и реология ◽

10.25555/thr.2021.4.0997 ◽

2021 ◽

Author(s):

Е.В. Ройтман ◽

С.М. Маркин ◽

П.Ф. Кравцов ◽

К.В. Мазайшвили

Keyword(s):

Anticoagulant Therapy ◽

Process Development ◽

Oral Anticoagulants ◽

Vascular Diseases ◽

Medical Community ◽

Treatment And Prevention ◽

Increased Risk ◽

Venous Thromboembolic ◽

Thrombotic Complications ◽

Novel Coronavirus

Введение. Несмотря на комплекс противоэпидемических мероприятий, включающих и массовую вакцинацию, распространение COVID-19-инфекции во второй половине 2021 г. продолжается. Отчасти это обусловлено появлением новых, более агрессивных штаммов. Так или иначе, поступление вируса SARS-CoV-2 в организм человека по-прежнему сопровождается развитием COVID-19-ассоциированной коагулопатии, реализующейся в различных тромботических осложнениях. Актуальные клинические рекомендации уже 12-го пересмотра описывают основные подходы к лечению и профилактике венозных тромбоэмболических осложнений, однако реализация их не всегда представляется возможной. Несмотря на растущую информированность клиницистов относительно патогенетических аспектов развития инфекционного процесса, в реальной практике все также имеет место значительное количество отклонений и нарушений, в том числе носящих системный характер, во многом связанных с избыточным желанием предотвратить отдельные из них. Цель исследования: изучение изменения состояния реальной клинической практики в области лечения и профилактики развития тромботических осложнений у пациентов, страдающих новой COVID-19-инфекцией. Материалы и методы. В основе работы – 2 анонимных опроса, проведенных в феврале и августе 2021 г., в которых приняли участие врачи-специалисты (соответственно, 223 и 131), занимающиеся лечением пациентов с хроническими и острыми заболеваниями сосудов. В опросник было включено 17 вопросов, описывающих отношение врачей к проблеме, касающихся выбора тактики лечения, применения фармацевтических препаратов и методов контроля системы гемостаза. Результаты. Результаты опросов выявили сохраняющуюся высокую степень информированности медицинского сообщества об увеличении риска тромботических осложнений при COVID-19 и необходимости коррекции COVID-19-ассоциированной коагулопатии путем назначения адекватной антикоагулянтной терапии (АКТ). Максимальную степень доверия среди респондентов при АКТ в условиях стационара сохраняют низкомолекулярные гепарины (НМГ), хотя растет количество врачей, рекомендующих новые (прямые) оральные антикоагулянты (НОАК/ПОАК), несмотря на отсутствие качественных рандомизированных исследований, подтверждающих их эффективность. Зафиксирован рост информированности респондентов в вопросах, касающихся лабораторного контроля за системой гемостаза. Заключение. Полученные результаты свидетельствуют о необходимости продолжения информационной кампании в отношении профилактики COVID-19-ассоциированной коагулопатии среди медицинских работников. Background. Despite a set of anti-epidemic measures, including mass vaccination, the spread of COVID-19-infection in the second half of 2021 continues. This is largely due to the emergence of new, more aggressive strains. One way or another, entry of SARS-CoV-2 virus into human body is still accompanied by development of COVID-19-associated coagulopathy realized in various thrombotic complications. Current clinical guidelines, already the 12th revision, describe the main approaches to treatment and prevention of venous thromboembolic complications, but their implementation is not always possible. Despite the increasing awareness of clinicians concerning pathogenetic aspects of infectious process development, a significant number of deviations and disorders, including those of systemic nature, still occur in real practice largely due to excessive desire to prevent some of them. Objectives: to study real clinical practice changes in treatment and prevention of thrombotic complications in patients with new COVID-19-infection. Materials/Methods. The work was based on two anonymous surveys conducted in February and August 2021 with the participation of 223 and 131 physicians treating patients with chronic and acute vascular diseases, respectively. The questionnaires included 17 questions describing physicians’ attitudes regarding treatment choices, use of pharmaceuticals, and methods of hemostasis monitoring. Results. The results of the questionnaires revealed a continuing high degree of awareness among the medical community about the increased risk of thrombotic complications in COVID-19 and the need to correct coagulopathy by prescribing adequate anticoagulant therapy (ACT). Low molecular weight heparins (LMWHs) retain the highest degree of confidence among respondents in inpatient ACT, although the number of physicians recommending new oral anticoagulants (NOACs) is increasing, despite the lack of high-quality randomized trials confirming their effectiveness. There has been an increase in respondents’ awareness of issues related to hemostasis laboratory control. Conclusions. The results obtained indicate the need to continue the information campaign regarding the prevention of COVID-19-coagulopathy among healthcare workers.

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Sclerotherapy of varicose veins in patients with documented thrombophilia: a prospective controlled randomized study of 105 cases

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.008081 ◽

2009 ◽

Vol 24 (4) ◽

pp. 176-182 ◽

Cited By ~ 23

Author(s):

C M Hamel-Desnos ◽

J-L Gillet ◽

P R Desnos ◽

F A Allaert

Keyword(s):

Varicose Veins ◽

Randomized Study ◽

Factor V Leiden ◽

Factor V ◽

Factor V Leiden Mutation ◽

Vein Thrombosis ◽

Ultrasound Monitoring ◽

Thrombotic Complications ◽

High Level ◽

Deep Vein

Objectives The aim of this study was to assess thrombotic complications following sclerotherapy in thrombophilic patients in combination with thromboprophylaxis, in two randomized arms using low molecular weight heparin (LMWH) or warfarin. Patients and methods This study received approval from the Ethics Committee. A total of 105 patients (81 females, 24 males) ranging in age from 20 to 82 years (mean 50) were selected: 75 with Factor V Leiden mutation, 18 with prothrombin 20210A mutation, 7 with high level of Factor VIII, 5 combinations of these. After randomization, 51 and 54 patients received warfarin and LMWH, respectively. A total of 199 sclerotherapy sessions were performed. Foam was used in 160 treatments. Results No episodes of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) occurred; no instances of DVT were revealed by ultrasound-monitoring. Conclusions This study suggests that in the three most common forms of thrombophilia, sclerotherapy, in combination with thromboprophylaxis, can be performed safely. Prophylaxis with LMWH is easier to use than warfarin.

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