The hemostasis system was studied in 35 cancer patients with comorbid terminal chronic renal failure (tCFR) before and after program hemodialysis (HD) at different stages of treatment. All patients underwent bicarbonate HD using equipment 4008 S ("Fresenius", Germany). Appropriate anticoagulation was performed according to the following scheme: at the beginning of the procedure, 1000-3000 units of sodium heparin were injected into the extracorporeal system; further in the process of extracorporeal hemocorrection operation the dose of sodium heparin was from 5 to 15 U/kg of body weight per hour. Hypercoagulability with signs of activation of intravascular blood coagulation, combined with impaired synthesis of individual coagulation factors, occurred in cancer patients with tCFR before the start of renal replacement therapy (RRT). All patients underwent HD procedure 3 times a week. After completion of the programmed HD procedure, multidirectional changes in the hemostasis system were observed. On the one hand, significant hypercoagulability with signs of intravascular coagulation activation remained, which increases the risk of thrombotic complications, on the other hand — prolongation of activated partial thromboplastin time (APTT), decreased activity of prothrombin complex factors and platelet aggregation ability increased the risk of hemorrhagic complications, which dictates the need for a cautious, balanced approach to the prescription of anticoagulants. According to Doppler ultrasonography (DU) in duplex mode of paired vessels (arteries or veins), no signs of thrombosis were detected. The mean hemoglobin level and platelet count before and after the programmed HD procedure did not differ. The use of programmed HD in cancer patients with tCFR, taking into account blood parameters, allows for adequate antitumor treatment, improves the quality and prognosis of life of cancer patients.

Венозные тромбоэмболические осложнения (ВТЭО) — собирательное понятие, объединяющее тромбоз поверхностных вен, тромбоз глубоких вен, венозную гангрену и тромбоэмболию легочной артерии. ВТЭО развиваются у 10–20% онкологических больных при жизни и выявляются при аутопсии в 30–50% случаев.

The data on the diagnostic levels of sepsis markers in blood plasma in 117 patients with oncological diseases at the age from 1 to 18 years are presented. The patients were divided into 4 groups depending on the outcome of the clinical course of the inflammatory process or infectious complications: group 1 - patients with no complications of anticancer treatment (n = 13/11.1%), group 2 - the presence of a systemic inflammatory response in patients (n = 64/54.7%), group 3 - patients with sepsis (n = 27/23.1%), group 4 - patients with septic shock (n = 13/11.1%). The threshold level of presepsin between groups 1 and 2 was 202 pg/ml, 371 pg/ml between groups 1 and 3, 604 pg/ml between groups 2 and 3 and 1500 pg/ml between groups 3 and 4. For procalcitonin, the threshold level between groups 1and 2 was 0.23 ng/ml, 0.48 ng/ml between groups 1 and 3, 0.51 ng/ml between groups 2 and 3 and 3.9 ng/ml between groups 3 and 4. The threshold value of C-reactive protein in patients with solid tumors was 12.6 g/l between groups 1 and 2. In patients with oncohematological diseases, the threshold level of C-reactive protein was 43.4 g / L between groups 2 and 3, 77.1 g / L between groups 2 and 4. According to the ROC analysis, presepsin was superior to procalcitonin and C-reactive protein in the diagnosis of septic complications.

The purpose of the review is to highlight the current possibilities for the prevention and treatment of venous thrombotic complications in patients with cancer.The data of 52 scientific sources published in the Russian and foreign press in 1997–2020 are considered.Cancer patients are at high risk of thrombotic complications, which worsen the outcome of anticancer treatment and are one of the leading causes of death. Thrombosis in an oncological patient increases the risk of death by 30 times, which is associated with fatal thromboembolism and a more aggressive course of the disease. The leading role in the pathogenesis of thrombotic complications is played by disorders in the hemostasis system caused both by the tumor itself and by therapy. Low molecular weight heparins are considered the basis for specific prophylaxis of thromboembolic complications in cancer patients. The use of low molecular weight heparins after surgery and during chemotherapy effectively reduces the incidence of venous thrombosis. Direct oral anticoagulants are promising drugs for oral administration and are indicated as one of the treatment options for patients with tumor-associated thrombosis with a low risk of bleeding and no drug interactions with ongoing systemic chemotherapy.

Introduction. Patients with cancer are more likely to develop thromboembolic complications, and the occurrence of thrombosis complicates the course of anticancer treatment and worsens the survival rate of cancer patients. Low molecular weight heparins (LMWH) is the first choice for the treatment of cancer-associated thrombosis, as there is extensive evidence on the efficacy and safety of LMWH in cancer patients based on current knowledge.Materials and methods. There were 190 cancer patients under our supervision at various stages of complex treatment. Of these, 70 patients with acute thrombosis and pulmonary embolism (PE) who received therapeutic doses of enoxaparin sodium. Assessment of hemostasis parameters was carried out using an automatic analyzer. The patients underwent duplex angioscanning of the vessels of the lower extremities.Results and discussion. The use of enoxaparin sodium in cancer patients with thrombosis reduced the intensity of intravascular coagulation with a decrease in the concentration of fibrinogen and markers of intravascular coagulation. According to the ultrasound study, venous thrombosis was not detected, or recanalization of the vessel lumen occurred, in no case did PE develop. Eight patients retained high levels of D-dimer (> 2 μg/ml) and von Willebrand factor, which were unfavorable prognostic signs. In these patients, recurrence of venous thrombosis was observed, which required a more prolonged and persistent treatment of thrombotic complications.Conclusion. Enoxaparin sodium is an effective and safe drug for the treatment of thrombosis in oncology.

Relevance. Neoplasms tend to increase among the firemen and military personnel, according to their medical and statistical indicators. People with hazardous occupation are at high risk of malignancies. Thus, the issues of diagnostics, prophylaxis and treatment of oncology diseases and their thrombotic complications are of essential importance for this category of patients. Intention. To analyze the literature data on the role of hemostatic system disorders, possible ways of prophylaxis and treatment of thrombotic complications in case of oncology diseases. Results. Thrombotic complications affect negatively the antineoplastic therapy outcomes and become one of the leading death causes. The thrombosis in oncology patients 30-fold increases death risk due to the fatal thromboembolism and more aggressive neoplastic process. Hemostasis system disorders are caused both by neoplasms and their treatment. Low molecular weight heparin (LMWH) is considered a basis for thromboembolism prevention in oncology patients. LMWH decreases effectively the venous thromboses after surgery and during chemotherapy. Direct oral anticoagulants are promising medications for oral administration; they are indicated for patients with tumor-associated thromboses in case of a low bleed risk and absence of drug interactions with system chemotherapy.

In experimental systems, interference with coagulation can affect tumor biology. Tumor-mediated activation of the hemostatic system has been implicated in both the formation of tumor stroma and the promotion of hematogenous metastasis. We emphasize that hypercoagulation is a frequent symptom in metastatic renal cell carcinoma (MRCC) patients and clinically correlates with progression of the disease. It has been suggested that hypercoagulation is a possible negative predictor for a response to immunotherapy in MRCC patients.

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.

Evaluation of anemic syndrome (AS) was performed in 79 patients with advanced stages of Hodgkin’s lymphoma (LH) at various stages of chemotherapy (CT) according to the EACOPP-14 scheme. Against the background of the treatment, the number of erythrocytes and, accordingly, the HCT indices decreased with each subsequent cycle of chemotherapy (CTC) and reached the maximum reduction to 5, 6 th CCT. Absolute iron deficiency (IDA), which was combined with a low level of EPO and an inadequate degree of anemia, was found in a few LH patients (5 people, 6.3%). Functional iron deficiency (FDZH) was diagnosed in 9 patients (11.4%), had the same morphological signs as IDA. Namely, microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes (RET-HE). In contrast to IDA, patients with FDZh concentration of FR, GP-25 and IL-6 were high. Despite the fairly large reserves of iron, the level of rRTF testified to the “iron hunger” of the erythrocariocytes of the bone marrow, its index exceeded the upper limit of the norm, while RET-HE was low. In 34 (43%) patients, LH revealed a deficiency of endogenous erythropoietin (EPO), which was observed not only in patients with AHZ, but also in patients with IDA. Lower levels of EPO were detected in patients with leukopenia and very low erythropoietic activity of the bone marrow.

A study of the clinical analysis of blood and major metabolites of ferrokinetics in 107 breast cancer patients before treatment was conducted. In 31 (28.9%) patients revealed anemic syndrome (AS). A feature of the AS is pronounced microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes. Most often (n = 22; 71%) there was iron deficiency (IDA), which was characterized by a low concentration of iron (F), ferritin (FR), hepcidin 25 (GP25), interleukin-6 (IL-6) and high - soluble transferrin receptors (rTFR), transferrin (TRF). In 9 (29%) patients with AS, on the basis of a high concentration of FR, GP25, IL-6, the anemia of chronic disease (AHZ) with functional iron deficiency (FDI) was established. In 23 (74.2%) patients with AS, the was a deficiency of erythropoietin (EPO), the lowest rates were found in the group of patients with a common tumor process and FDI, with less in patients with IDA.

Онкологические больные подвержены высокому риску тромботических осложнений, которые ухудшают исходы противоопухолевого лечения и занимают одно из лидирующих мест среди причин смерти. Тромбоз у онкологического пациента увеличивает риск смерти в 30 раз, что связано с развитием смертельной тромбоэмболии и более агрессивным течением опухолевого процесса. Ведущую роль в патогенезе тромботических осложнений играют нарушения в системе гемостаза, вызываемые как непосредственно опухолью, так и методами лечения. Низкомолекулярные гепарины (НМГ) являются основой специфической профилактики тромбоэмболических осложнений у онкологических больных. Применение низкомолекулярных гепаринов после операции и на фоне химиотерапии эффективно снижает частоту венозных тромбозов. НМГ являются препаратами первого выбора для лечения рак-ассоциированных тромбозов в течение первых 6 месяцев. Прямые оральные антикоагулянты (ПОАК) являются перспективными препаратами для приема внутрь и показаны для лечения и вторичной профилактики тромбозов у онкологических больных как приемлемая альтернатива.