Protocol of patient treatment undergoing invasive procedures and

The review takes into consideration the diagnostic significance of the main screening coagulologic tests under the light of modern views on the role of vessel wall, plasma proteins and blood cells in the dynamics of thrombin formation and its activities regulation.

В статье на основании данных проспективного наблюдения за больными, получающими терапию варфарином, проанализированы основные факторы, определяющие безопасность подбора поддерживающей дозы препарата. Выявлено, что достижение первого значения МНО ≥2,0 на 3–5-е сут. начала терапии варфарином достоверно связано с развитием чрезмерной гипокоагуляции (МНО ≥4,0). На основании оценки генотипа выявлена зависимость темпов насыщения варфарином от носительства аллельных вариантов CYP2C9 и VKORC1. Показано, что быстрые темпы достижения антикоагулянтного эффекта в подавляющем большинстве случаев связаны с носительством «неблагоприятного генотипа» (аллельных вариантов CYP2C9 *2/*2, или *3/*3, или 2/*3, или аллельного варианта АА VKORC1, или одновременного носительства двух гетерозиготных полиморфизмов CYP2C9 и VKORC1). Учитывая полученные результаты, авторами сделан вывод о высокой практической значимости проведения исследования крови на МНО на 3–5-е сут. от начала терапии. На основании проведенного дискриминантного анализа выявлен клинический предиктор развития чрезмерной гипокоагуляции, обусловленной передозировкой варфарина, — терапия амиодароном. Полученные данные легли в основу модификации существующего алгоритма подбора дозы варфарина.

В работе представлен анализ связи уровня фибриногена и Д-димера со степенью тяжести АГ в популяции взрослого неорганизованного населения Томска, выполненный в рамках проекта ЭССЕ-РФ — 2012. Показано, что уже у больных с АГ 1-й степени тяжести уровень фибриногена достоверно выше, чем у лиц с нормальным АД. Среди больных, принимавших гипотензивные препараты, целевые уровни АД были достигнуты только у 38,8%. Уровень фибриногена в этой подгруппе был достоверно ниже, чем у лиц, не достигавших целевого значения АД. По уровню Д-димера достоверно от лиц с нормальным АД отличались только больные с АГ 3-й степени тяжести. Достоверных различий в содержании Д-димера в группах, сформированных в зависимости от достижения целевых значений АД, не выявлено.

Активация тромбоцитов имеет большое значение в патогенезе развития тром-ботических осложнений атеросклероза. Применение антитромбоцитарных препаратов у пациентов с различными клиническими проявлениями атеросклероза при отсутствии противопоказания является нормальной практикой. Ацетилсалициловая кислота (АСК) рассматривается в качестве «золотого стандарта» ан-титромботической терапии. Однако эффективность АСК у различных больных неодинакова. Частота выявления этого феномена варьирует от 5 до 65%. К возможным механизмам, способным влиять на клинический эффект АСК, относится «остаточная реактивность тромбоцитов», которая может быть ассоциирована с повышенным риском развития сердечно-сосудистых осложнений. В публикации приведены результаты изучения динамики показателей агрегации тромбоцитов и содержания 11-дегидротромбоксана В2 в моче и определения значения «остаточной реактивности тромбоцитов» у больных стабильной ИБС, получающих длительную терапию АСК.

Aim. To study the factors associated with elevated D-dimer levels in patients with acute venous thromboembolic events (VTEE). material and methods. The study included 111 patients (76 men and 35 women aged 18–76 years) with a first or repeat episode of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the last 2 months. The majority of the patients (n=80) received unfractionated heparin (UFH) for at least 5 days, followed by warfarin (international normalized ratio (INR) control at least once a month; target INR 2,0–3,0). Some patients (n=31) received therapeutic doses of enoxaparin (1 mg/kg subcutaneously, every 12 hours) for at least 30 days, followed by warfarin treatment. D-dimer levels (norm ® D-DI” reagents (Diagnostica Stago). Results. D-dimer levels varied from 0,02 to 9,96 mkg/ml (median 1,05 mkg/ml, interquartile range 0,49–1,99 mkg/ml) and exceeded the upper norm limit in 74% of the patients. There was a positive association between D-dimer levels and thrombus “size” (r=0,304; p < 28 days, and thrombus “size” < 6 points were independent predictors of D-dimer elevation in the acute period of DVT/PE. Conclusion. D-dimer levels, measured 32 (23–44) days after the development of DVT/PE symptoms, were elevated in 74% of the patients. D-dimer elevation in the acute period of VTEE was associated with female gender, CHF, “age” and “size” of the thrombus.

On the basis of earlier executed studies of hypotensive effect of dinitrosyl iron complexes (DNIC) with glutathione, the drug has been created in industrial conditions named oxacom. Preliminary pharmacological studies of oxacom have not revealed negative qualities. The drug has been now tested in 14 healthy men in whom at single intravenous introduction it caused typical response a decrease of diastolic as well as systolic arterial preassure on 24-27 mmHg through 3-4 min with subsequent very slow restoration in 8-10 hours. The heart rate after initial rise was quickly normalized. Echocardiography revealed unaltered cardiac output in spite of reduced cardiac filling by 28%. The multilateral analysis of clinical and biochemical data has revealed an absence of essential alterations which could lead to pathological consequences. The drug is recommended for carrying out of the second phase of clinical trial. The comparative study of the efficiency of hypotensive action of oxacom, S-nitrosoglutathione (GS-NO) and sodium nitrite (NO2) in rats has shown that the duration of effect was the greatest at oxacom action.

PURPOSE:To study the factors associated with an elevated content of D-dimer in patients diagnosed as having cardiovascular diseases (CVD) with no apparent thromboembolic complications. MATERIAL AND METHODS:A retrospective analysis of 1,000 case histories of patients (624 men and 376 women) aged from 19 to 93 years and undergoing treatment at the Institute of Cardiology named after A.L. Myasnikov in 2009. The sole criterion for inclusion into the study was the fact of hospitalization for any CVD and an altered content of D-dimer. The D-dimer levels were determined by latex agglutination using reagent kits «ST ALIATES® D-DF» (Diagnostica Stago). The upper limit of the normal distribution of the D-dimer amounted to 0.5 μg/ml. RESULTS:Thromboembolic complications were encountered in 13% of patients. Search for increased D-dimer predictors was carried out amongst a total of 867 CVD patients with no manifest thromboembolic complications. The D-dimer levels ranged widely from 0.01 to 16.97 (median 0.32, interquartile range 0.20-0.63) mg/ml and exceeded the upper limit of the normal distribution in 32% of the patients. Based on the findings of the univariate analysis we selected 14 parameters with the level of significance P<0.05, associated with an elevated D-dimer content. These parameters included but were not limited to: female gender, age >68 years, a history of venous thromboembolic events, no cardiac angina, the presence of ciliary arrhythmia and functional class III-IV chronic cardiac insufficiency (CCI), decompensated CCI, the presence of a permanent artificial pacemaker, an acute inflammatory process, chronic obstructive pulmonary disease, active cancer, pulmonary hypertension, and dilatational cardiomyopathy. The subsequent multivariate analysis showed that female gender, age >68 years, an acute inflammatory process, pulmonary hypertension, and decompensated CCI were independent predictors of an elevated D-dimer level in patients with CVD without apparent thromboembolic complications. CONCLUSIONS:The D-dimer level exceeded the upper limit of the normal distribution in 32% of CVD patients without manifest thromboembolic complications. Independent predictors of elevated D-dimer in CVD patients with no visible thromboses are as follows: female gender, age >68 years, acute inflammation, pulmonary hypertension, and decompensation of CCI.

Aim: to study the prevalence of various risk factors (RF) for venous thromboembolic events (VTEE) and their association with D-dimer levels. Subjects and methods. The clinical, demographic, anthropometric, anamnestic, and laboratory data were analyzed in 106 patients (73 men and 33 women) aged 18 to 78 years admitted to hospital with the first or recurrent episode of VTEE. Results. RF and VTEE-associated diseases were identified in all patients. Over 90% of the patients had more 2 RFs. The most common RFs were the age above 40 years (85%) and overweight (82%), including obesity (42%). There was a preponderance of cardiovascular diseases in the pattern of VTEE-associated diseases. The direct causes (precipitating factors) of thrombosis were revealed in 57% of cases; the thrombotic episode was classified as idiopathic in 43%. Elevated D-dimer levels were found in 74% of the patients. Higher D-dimer content was seen in women, non-smokers, patients operated on for thrombosis, those who had 2 precipitating factors or more, and those who had a less than 30-day history of thrombosis. There was an inverse correlation between the elevated level of D-dimer and the duration of thrombosis by the moment of its identification (thrombus age). Conclusion. All patients who have experienced a venous thrombotic episode have various RFs for VTEE. The content of D-dimer exceeds the normal value in most patients with VTEE. Among the RFs studied, thrombus age is the most important factor associated with elevated D-dimer levels in patients with VTEE.

Aim. To identify the factors determining homocysteine (HMC) levels in Russian patients with stable coronary heart disease (CHD). Material and methods. The study included 506 patients (388 men; mean age 59,4±12,2 years) with stable CHD. Classical risk factors (RFs) of cardiovascular disease (CVD), renal function (creatinine clearance by Cockroft-Gault formula), and atherosclerotic pathology of other localizations were assessed. The levels of plasma HMC, folate, and cobalamin were measured. Genetic analysis was performed using the real-time polymerase chain reaction method. Results. In 432 patients (85,4 %), hyperhomocysteinemia was diagnosed. The mean HMC level was 14,3±4,6 mkmol/l. According to multifactor analysis results, HMC level was independently associated with folate level (beta coefficient -3,86, p<0,0001), cobalamin level (beta -5,73, p<0,0001), and MTRR 66AA genotype (beta 10,71, p<0,0005). In addition, HMC concentration was linked to the following combinations: MTRR 66G allele + folate level (beta 1,12, p<0,0001), MTRR 66AA allele + cobalamin level (beta 0,012, p<0,0001), TCN 776G allele + cobalamin level (beta -0,03, p<0,0001), TCN 776G allele + folate level (beta 0,58, p<0,0009), MTR 2756G allele + cobalamin level (beta 0,004, p<0,002), MTRR 66G allele + creatinine clearance <90 ml/min (beta 0,08, p<0,001), and TCN 776G allele + creatinine clearance <90 ml/min (beta 0,07, p<0,0007). Conclusion. In Russian patients with stable CHD, HMC level was associated with folate and cobalamin concentrations and MTRR 66AA genotype, as well as with MTR 2756G, MTRR 66G, and TCN 776G alleles combined with vitamin concentrations and renal function.