Научно-практическая конференция в рамках программы: «Школа тромбоза», Москва, 29.11.2016г.
29 November 2016 in the framework of the conference "First Aid and Emergency Medicine in a Modern Multi-Purpose Hospital" a scientific and practical event "School of Thrombosis" was held. The venue for the event was the Moscow Government Building on Novy Arbat.
The building of the government of Moscow, where the conference was held
Speakers were: Lobastov KV, Ph.D., surgeon-phlebologist, member of the European Venous Forum, International Union of Angiology; Barinov VE, MD, professor of the Department of Surgery, Central State Medical Academy, Department of Affairs of the President of the Russian Federation, Associate Professor of the Surgery Department of the RNMU named after. N.I. Pirogova, member of the European Venous Forum, author of 77 scientific works; Schastlivtsev IV, MD, associate professor of the Surgery Department of the RNMU named after. N.I. Pirogov.
Participants of the conference "School of thrombosis"
The conference was attended by the employee of the phlebology center "MIFTS", the leading specialist in the treatment of thrombosis and trophic ulcers Alexei Malakhov.
The certificate of the participant of the conference Malakhov A.M.
Термин «венозные тромбоэмболические осложнения» (ВТЭО), объединяет ряд патологических состояний, таких как тромбофлебит поверхностных вен, тромбоз глубоких вен, тромбоэмболию лёгочной артерии (ТЭЛА). Согласно мировой статистике частота ВТЭО составляют 1-1,92; острого венозного тромбоза — 0,48-1,24; ТЭЛА — 0,5-0,69 на тысячу человек в год. Официально, в РФ (2011-2012 гг.) частота венозных тромбозов составляет 1,6 случаев на тысячу человек в год, что выше общемировых показателей.
Report by Barinov VE: "Acute venous thrombosis: modern approaches and the dangers of anticoagulant therapy"
The treatment is aimed at the following pathophysiological factors: stopping the development of thrombosis, preventing the development of complications, restoring the patency of the vein, preventing relapse. The therapy of VTEO according to the time factor can be conditionally divided into the following stages (phases): initial (7 days), long (3 months), prolonged (indefinitely).
Both for prophylaxis and for treatment of VTEh, the following medicines are mainly used: unfractionated heparin preparations, low molecular weight heparins, Fondaparinux, PLA, vitamin K antagonists, disaggregants, heparinoids. The unfractionated heparin, the pioneer of the anticoagulant market, was first synthesized in 1916. At the heart of the action is the inactivation by the antithrombin lll of coagulation factors ll, lX, X, Xl, Xll. Despite the appearance of more advanced LMWH, has a number of qualities that leave it in the arsenal of the hospital doctor. Due to the high molecular weight, it practically does not penetrate the hemato-placental barrier, which makes its use possible in pregnant women. The short half-life period makes it extremely urgent not only in obstetrics, but also in emergency surgery. At the same time, nonselectivity of the effect (suppresses several factors of coagulation) makes it less manageable, carries a high risk of bleeding. Heparin-induced thrombocytopenia, a condition that complicates the use of any heparin, but more often unfractionated, has facilitated the search for new drugs. Currently, UFH is gradually replaced by low molecular weight heparins (derivatives of UFH with a molecular mass from 2 to 10 thousand Dalton). At the moment, the most popular low molecular weight heparins on the territory of the Russian Federation are: Enoxoparin (Clexane), Nadroparin (Fraksiparin), Dalteparin (Fragmin). In comparison with UFH, LMWHs have a more selective effect on coagulation (which made the administration more manageable), a longer half-life (less frequent administration), require less frequent control of the coagulogram, and much less cause heparin-induced thrombocytopenia. The above characteristics made it possible to use LMWH in outpatient practice. K.W. Lobastov presented an interesting article on the role of inflammation of the vascular wall in the pathogenesis of thrombosis. In fact, the process of thrombosis accompanies all the same symptoms as in any inflammatory process. That is, developing, this condition provokes further damage to the venous wall, and as a consequence, the growth of the thrombus. Given that heparins have the ability to suppress inflammatory reactions that accompany thrombogenesis, they are an essential component of thrombosis therapy. For longer anticoagulant therapy, attention should be paid to the following classes of drugs: PLAA, acetylsalicylic acid preparations, sulodexide. Currently, the following new oral anticoagulants are on the Russian market: Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixaban (Elikvis).
Report of Lobastov K.V. "The role of inflammation of the vascular wall in the genesis of venous thrombosis and the possibility of its correction"
In a number of clinical studies, such as REMEDY and RESONATE (Dabigatran) and several others, PLA (new oral coagulants) have proved their clinical effectiveness and comparative safety. With long-term use, a good hypocoagulation effect is achieved with less risk of bleeding (compared with heparins and warfarin). Nevertheless, the risk of hemorrhages with prolonged use remains significant. Before a doctor who prescribes long-term therapy with anticoagulants, it is not an easy choice, as preventing thrombosis, it is easy to cause bleeding. At high risks of hemorrhage, one should think about the use of drugs of acetylsalicylic acid and sulodexide. A vitamin K antagonist (Warfarin) blocking the synthesis of all K-dependent factors of coagulation in the liver (ll, Vll, lX X), has not only an excellent hypocoagulation effect, but also a high risk of bleeding. AVK therapy remains relevant in patients after the transplantation of PE with the development of chronic postembolic pulmonary hypertension. Due to the high risk of relapse and lethality associated with VTEO, he is shown life-long use of AVC with the target INN 2,0-3,0, as there is no data on the use of PLA in these clinical situations.