The article is devoted to the discussion of modern approaches to the use of laboratory methods to improve the tactics of using direct oral anticoagulants (DOACs) therapy. Clinical situations in which ...it may be reasonable to use data on the blood concentration of DOACs are given, including very old age, a marked deviation from the norm of body weight or impaired renal function. Data on the role of measuring the blood level of DOACs are considered in cases of the development of diseases or complications in which information is required on the preservation of the anticoagulant effect of DOACs, for example, in the development of severe bleeding or the need for urgent surgical intervention. The advantages and limitations of modern laboratory methods for assessing the blood concentration of DOACs are discussed. It is emphasized that one of the main advantages of using DOACs is the absence of the need to monitor laboratory parameters in most patients. Data from pharmacological studies are presented that may be useful in explaining the mechanisms that determine the higher safety of some DOACs compared to others. Promising methods for assessing the blood level of DOACs, as well as the possibility of using less specific reagents for assessing the concentration of DOACs, are considered. The possibility of using less specific, but more accessible methods for assessing the blood concentration of factor Xa inhibitors, in particular, a reagent for assessing the level of the antifactor, which is used to determine the blood level of heparin, is being considered. The opinions of experts on the role of assessing the blood level of DOACs and the possibility of tactics for selecting doses of DOACs based on laboratory analysis data are given.
Modern teaching to young physicians has become increasingly limited because of rising clinical workload, due to the epidemiological situation, new requirements for medical documentation, the lack of ...a clear timetable of working hours and other educational features. Additionally, today’s residents expect that the training sessions will provide focused content integrated into their clinical workflow. One of the classical teaching methods that is ideally suited to meet these needs is a focused thematic training session, usually conducted with the help of simple but accessible visual aids and extensive audience participation. However, most listeners will benefit from structured content and guidance on the delivery of this content, also known as a learning scenario. A good learning scenario resident’s misconception, highlights a certain number of learning moments, uses strategies to engage students and provides a cognitive basis for teaching a topic that the teacher can improve over time. The proposed pedagogical concept of teaching sections of clinical hemostasiology for residents in the specialty "Therapy" orients the professional and cognitive interest of a young specialist against the background of constantly updated new knowledge in this field with the integration of scenarios of the content of training into clinical practice.
Modern professional education of internists is being updated at an intensive pace. This is primarily due to the fact that medicine and its technologies do not stand still, rushing into a high-tech ...future. In this regard, people have great hopes for highly effective conservative care, including for hematological diseases. Basic research on the mechanisms of blood clotting has greatly improved the knowledge of complex pathophysiology. These advances have led to a more complex decision-making process, which is reflected in the complex effect of hemostasis imbalance on the complement system, immunity and inflammation, and hence on the treatment of hemostasis disorders. Given this rapidly changing context, optimal educational activities are needed to disseminate knowledge among health professionals and develop their competencies in this field. Specialized professional associations can provide support and training offerings that facilitate access to relevant resources and tools to enable high-quality, up-todate basic and clinical research.
Introduction: to assess the influence of factors independently associated with arterial and venous thrombosis in women aged 18-44 years outside pregnancy.Material and methods. The case-control study ...included 319 women: the cases group included 134 patients with verified arterial and venous thrombosis, the control group included 185 patients without thrombosis. inclusion criteria: age 18-44 years; the presence of the first episode of instrumental^ verified arterial or venous thrombosis; consent to participate in the study. Exclusion criteria: pregnancy; the postpartum period up to 6 weeks at the time of thrombosis; mental disorders and mental illness. All women underwent clinical examination, collection of somatic and obstetric history, testing for biochemical parameters, hereditary and acquired thrombophilia. To quantify the independent relationships of risk factors with thrombotic events, the multiple logistic regression method was used.Results. In the group of cases, venous thrombosis was in 75% women, arterial thrombosis - in 25%. Ischemic strokes prevailed in the structure of arterial thrombosis. The most common trigger was the use of estrogen-progestin containing contraceptives in combination with other risk factors. In 23 cases (17.2%) the thrombosis were unprovoked. The proportion of women ≥ 40 years old, smoking intensity; family history of VTE in relatives up to 50 years of age, dyslipidemia, hyperfibrinogenemia, comorbidity, and the presence of thrombophilia met with a higher frequency in the group of cases. Independent factors associated with the development of arterial and venous thrombosis in young women were: the presence of diseases of the gallbladder (OR = 12,1 95% CI 2.5-67.5), cardiovascular diseases (OR = 10.2; 95% CI 3.6-29.1); total cholesterol level (OR = 7.7; 95% CI 4.4-13.5); respiratory diseases (OR = 3.7; 95% CI 1.0-11.5); the use of combined hormonal contraceptives (OR = 3.4; 95% CI 1.7-6.8); varicose veins of the lower extremities (OR = 2.5; 95% CI 1.0-4.9).Conclusion. The identification of the most important risk factors for arterial and venous thrombosis will expand the understanding of the common pathogenetic way of thrombosis in a population of women of childbearing age and improve their personalized prognosis and early prevention.
Aim.
To quantify the risk of venous thromboembolism (VTE) in hospitalized patients, depending on the severity of heart failure (HF).
Material and methods.
Current cross-sectional study included 132 ...patients hospitalized in the cardiology department in 2019. All participants were divided into 2 groups: group 1 (n=48) — patients with class I-II HF; group 2 (n=84) — patients with class III-IV HF. A total quantitative assessment of the VTE risk was carried out according to the Caprini risk scoring method.
Results.
All patients hospitalized in the cardiology department, regardless of HF class, had a moderate and high risk of VTE and required prophylactic anticoagulation. High VTE risk had 85% of patients with class I-II HF; 97,6% — patients with a class III-IV HF. Mean score of ≥10 was observed in every fifth patient. Atrial fibrillation requiring long-term anticoagulant therapy was observed in 51,5% of patients. There were no absolute contraindications for parenteral prophylactic anticoagulation at the time of hospitalization in the study population.
Conclusion.
All patients admitted to the cardiology department had a moderate and high according to the Caprini risk score, regardless of HF class. More than half of the patients had indications for long-term anticoagulant therapy. The remaining patients required the parenteral prophylactic anticoagulation.
Organization of anticoagulant therapy control plays a key role in ensuring the effectiveness and safety of anticoagulant use. Currently, several models of organization are successfully used in the ...Russian Federation, which cover more than 23000 patients at high risk for thromboembolic events. There are following common features of the models used: the maximum reduction in the time from the moment of international normalized ratio (INR) testing with a quick communication with a patient for the need to adjust the dose, the ability to sort patients depending on the degree of hypocoagulation and the risks of events with the creation of a personalized approach to treatment, the organization of a shared information space and maintaining a register of patients.
Prognostic value of central aortic pressure and peripheral blood pressure in relation to the development of pre-eclampsia was assessed in pregnant women with different forms of hypertension. It was ...shown that development of pre-eclampsia was associated with higher mean 24-hour systolic blood pressure (BP), time index of systolic BP, variability of diastolic BP, and pulse BP measured on weeks 16-22 of gestation. Pregnant women with hypertension, especially those with pre-eclampsia were characterized by absence of proper nocturnal BP lowering or BP elevation during night hours (non-dippers and night-peakers). Critical values for prediction of preeclampsia were daily average central (aortic) systolic BP higher than 115 mm Hg and a mean daily brachial systolic BP above 131 mm Hg.
To estimate central (aortic) blood pressure (BP) and arterial stiffness and their prognostic value in the development of preeclampsia (PE) in pregnant women with different forms of hypertension.
The ...study included 106 patients with chronic hypertension, 21 with the latter concurrent with PE, 63 with gestational hypertension, 10 with PE, and 100 without hypertension. All the women underwent 24-hour BP monitoring by an oscillometric method to estimatecentral (aortic) BP and arterial stiffness at 16-22 weeks' gestation.
The highest average daily central systolic and diastolic BP was in the pregnant women with PE. ROC analysis showed that the average daily aortic systolic BP greater than 115 mm Hg was most significant for the prediction of PE. The highest values of arterial stiffness (augmentation index, stiffness, maximum rate of blood pressure rise) were detected in the pregnant women with PE in the presence of chronic hypertension.
24-four BP monitoring inpregnant women can provide additional characteristics that reflect the stiffness of the aorta and peripheral arteries, which may be used to predict PE.
Aim.
To evaluate the influence of target BP achievement on clinical course and outcomes of pregnancy in pregnant women with arterial hypertension (AH).
Material and methods.
A cohort study with ...prospective cohort. Totally 300 pregnant women included; of those in to the 1st group 103 included with AH, who had not reached target BP; into the 2nd – 97 women with AH, who had reached target BP; control consisted of 100 women without AH. Women underwent clinical examination and observation, analysis of medical data, standard laboratory and instrumental investigation, genetic investigation by polymerase chain reaction.
Results.
Women who had not reached target BP pregnancy complicated more often with fetus development retardation and pre-eclampsy, and in pregancy outcomes there were preterm delivery and antenatal fetus death, newborns from this group had lower weight and height; also they had more often mutation of D-allele of ACE gene (I/D) and mutant C-allele of receptor 1 type angiotensine II gene (ATR11166 A/C) comparing to the group with achieved BP and with controls. By the result of logistic regression study the factor independently associated with total worse outcome, were premature deliveries in anamnesis - increase the risk almost 6 times (OR=5,93, 95% CI 1,83-19,2; p=0,003), pre-eclampsy during current preganancy – increases risk 3,7 times (OR=3,68, 95% CI 1,48-9,16; p=0,005), and target BP acievement (less than 140/90 mmHg) decreases the risk of total negative outcome 8 times (OR=0,12, 95% CI 0,05-0,28; p<0,001).
Conclusion.
Target BP achievement in pregnant women with AH might be an independent factor influencing the prevalence of obstetric complications and negative outcomes of pregnancy. A definite impact on target BP levels achievement make genetic polymorphisms of renin-angiotensin system genes.
Objective.
We performed a cross-sectional study of risk factors and biomarkers of cardiovascular diseases among young women with hypertensive disorders during pregnancy in comparison with women ...without hypertension during pregnancy.
Design and methods.
Altogether 117 women were enrolled, 33 were included in the group of hypertensive disorders during pregnancy, and 44 formed the group without hypertension during pregnancy. The control group consisted of 40 patients. The time interval after delivery was on average 5 to 19 years.
Results and conclusions.
Women with hypertension during pregnancy developed changes in carbohydrate and lipid metabolism associated with hypertension and abdominal obesity, which are the components of the cluster of the metabolic syndrome. These changes are also accompanied by insulin resistance, hyperinsulinemia, adipokine imbalance, changes in fbrinolysis and more pronounced remodeling of the heart and vessels as target organs in hypertension.
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