Scientific and practical conference: "Thromboembolic complications in surgical practice", Moscow, 7 June 2018.
7 June, 2018, the Scientific and Practical Conference "Thromboembolic complications in surgical practice" was held at the Clinical Hospital No. 1 of the Administrative Department of the President of the Russian Federation.
Leading specialist of the phlebology center "MIFTS", surgeon-phlebologist, lymphologist Aleksey Mikhailovich Malakhov took part in the conference.
Surgeon-phlebologist "MIFTS", lymphologist Malakhov A.M.
Viktor Evgenievich Barinov, professor of the department of surgery with courses of endoscopy and pediatric surgery at the State Medical Faculty of the Administration of the President of the Russian Federation, presented a lecture: "A multidisciplinary surgical hospital is a territory for safety from venous thromboembolic complications".
Speaker Professor Barinov V.E.
In the message, Viktor Evgenevich told about a sharp increase in the risk of venous thromboembolic (VTEO) complications in treatment conditions under stationary conditions. In Europe and the United States, the trend towards a maximum reduction in the length of stay of patients in the hospital is more than one decade. And it is caused not only by concern for patients, but also by economic expediency. In our country, the same stationary substitution technologies have been developing dynamically in the last 20 years. Nevertheless, the treatment of certain pathologies still require stationary conditions. To reduce the risk of VTEO in hospital patients, the following is effective:
- Use the scale or the online calculator Caprini.
- More individual selection of doses of anticoagulant drugs, laboratory monitoring of their effectiveness.
- Application of methods of active acceleration of blood flow (intermittent pneumatic compression, electromyostimulation).
Ilya Veniaminovich Schastlivtsev, Candidate of Medical Sciences, Associate Professor "RNIMU im. N.I. Pirogov "presented the report:" Venous thrombosis and pulmonary embolism: quickly suspect and inexpensively verify. "
Speech of Dr. Schastlivtsev I.V.
Dr. Schastlivtsev presented the optimal algorithms for diagnosing deep vein thrombosis. The main, most accessible, but no less informative method, is duplex ultrasound scanning. Additional techniques (MRI, CT and phlebography) should be used when:
- Diagnosis of vein thrombosis of the pelvis and abdominal cavity.
- Planning operations for the disruption of the venous bed.
Ilya Veniaminovich told about the nuances of diagnosing such a serious complication as pulmonary embolism. Nonspecific symptoms, often their non-expression on the background of the general condition, make verifying PE is a rather difficult task. For this purpose, various instrumental and laboratory methods are used in hospitals. Dr. Schastlivtsev outlined the most effective algorithm for the diagnosis of PE, which included scales of the clinical probability of venous thromboembolic complications and a test for D-dimer. Ilya Veniaminovich also noted the high information content of the following methods:
- CT angiopulmonography.
- Determination of the level of troponin and natriuretic blood peptide.
Early diagnosis of PE allows for more timely initiation of anticoagulant therapy, which significantly increases the chances of survival of such patients.
Elena Nikolaevna Perets, Candidate of Medical Sciences, Scientific Leader of the Center for Restorative Medicine, Head of the Department of PTO and LFK, The Clinical Hospital №1 of the Presidential Administration of the Russian Federation read the lecture: "Early rehabilitation of patients is a pledge to prevent relapse of VTEO and an important stage in the treatment of venous thrombosis."
Speaker Dr. Perets EN
Elena Nikolaevna revealed the advantages of applying methods of active acceleration of blood flow and early activation of patients after acute venous thrombosis. Dr. Peretz introduced the Center of Reconstructive Medicine of Volyn Hospital and spoke about the nuances of the rehabilitation of patients with venous obstruction.
Narek Vardanovich Zakaryan, MD, scientific adviser on cardiovascular surgery, The Clinical Hospital №1 of the Administrative Department of the President of the Russian Federation presented the message: "Features of stenting of veins in postthrombophlebitic syndrome".
Speaker is Dr. med. Zakaryan N.V.
Having uncovered the nuances of operations for venous obstruction, Narek Vardanovich turned to ambiguous situations, for example, to the complexity of choosing tactics for obstruction of the femoral venous segment. Dr. Zakaryan talked about the benefits of venous nitinol stents with higher radial stability and flexibility, spoke about the hybrid stents "Sinus-Obliqus" specialized for interventions in the Mei-Turner syndrome.
Alexey S. Pankov, Ph.D., doctor of X-ray and endovascular diagnostics and treatment, FGBU "Clinical Hospital №1" of the Presidential Administration of the Russian Federation presented the report: "Catheter-guided thrombolysis: the secrets of skill".
Speaker Ph.D. Pankov A.S.
Despite the fact that modern Russian and most of the western recommendations for the treatment of deep vein thrombosis postulate the appointment of anticoagulant therapy, the incidence of postthrombotic disease (PTB) in the next two years in these patients reaches 20-40%. About what these figures say: annually in Russia is registered from 45 to 112 thousand new patients with PTB. When using catheter thrombolysis, the probability of post-thrombotic disease is significantly reduced. Aleksei Sergeevich told about the indications and contraindications to this procedure, the drugs used, the technical aspects of implementation, the postoperative management of patients. Catheter-guided thrombolysis is an effective and safe method of treating patients with acute deep vein thrombosis, which allows to significantly reduce the incidence of post-thrombotic disease. Wide introduction in medical practice is hampered by the high cost of the procedure.
Viktor Barinov concluded the event with the message: "Anticoagulants ... Are they all equally useful?" It's no secret that new oral anticoagulants (rivaroxaban, apixaban, dabigatran) have a number of significant advantages:
- High profile of efficiency and safety.
- Ease of use for patients.
- No need for laboratory monitoring.
At the same time, preparations of antagonists of vitamin K for anticoagulation have no alternative in the following patients:
- Presence of an artificial heart valve.
- Valvular form of atrial fibrillation.
- The glomerular filtration rate is less than 15 ml / min.
Anticoagulant therapy in patients with oncology should be performed with drugs of the group of low molecular weight heparins, since they have the best profile of efficacy and safety in this situation.