scholarly journals Anticoagulation in Patients with Liver Cirrhosis (Literature Review)

2019 ◽  
Vol 4 (2) ◽  
pp. 23-28
Author(s):  
E. S. Eniseeva
Keyword(s):  
Atrial Fibrillation ◽  
Molecular Weight ◽  
Liver Cirrhosis ◽  
Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Coagulation Cascade ◽  
Low Molecular Weight ◽  
Thromboembolic Complications ◽  
Low Molecular Weight Heparins ◽  
Increased Risk

Liver cirrhosis is accompanied by complex hemostatic disorders with an increase in the risk of both hemorrhagic and thrombotic complications. Reduced coagulation protein synthesis, such as factors II, VII, IX, X and thrombocytopenia are associated with an increased risk of bleeding. Reducing the synthesis of such anticoagulants as protein C, protein S, antithrombin III is accompanied by increased generation of thrombin, which leads to procoagulant status, increased risk of venous thrombosis, pulmonary embolism, and portal vein thrombosis. Activation of the coagulation cascade increases the risk of thrombosis, and also plays an important role in liver damage, contributing to the progression of fibrosis. Cirrhosis increases the risk of thromboembolic complications of atrial fibrillation.Anticoagulants are necessary for the prevention of thrombosis and thromboembolic complications. However, there are no large prospective studies. There is insufficient data on the safety of anticoagulant therapy in cirrhosis. There are difficulties in monitoring anticoagulation in the application of vitamin K antagonists and low molecular weight heparins.The review presents the available data on the use of warfarin, unfractionated heparin, low molecular weight heparins and direct oral anticoagulants in patients with liver cirrhosis, indicating the need for prevention of venous thrombosis in patients with risk factors, the possibility of preventing decompensation of cirrhosis, reducing the frequency of cardioembolic strokes in patients with atrial fibrillation.

scholarly journals Modern low-molecular-weight heparins in the prevention and treatment of venous thromboembolic complications in oncourologic patients

2018 ◽  
pp. 106-112
Author(s):  
N. V. Vorobyev ◽  
S. V. Popov
Keyword(s):  
Molecular Weight ◽  
Impaired Renal Function ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Antithrombotic Effect ◽  
Low Molecular Weight Heparins ◽  
Prevention And Treatment ◽  
Venous Thromboembolic

Oncourologic diseases are accompanied by a risk for subsequent venous thromboembolic complications, which are rated the most dangerous in terms of thrombogenic effect. The article presents a review of the clinical studies of efficacy and safety, and the experience in using of modern low-molecular-weight heparins in clinical practice - drugs of choice for the prevention of venous thromboembolic complications in cancer patients. Particular attention is paid to Bemiparin - a new second-generation low-molecular-weight heparin with a significant antithrombotic effect and improved pharmacological parameters that allow it to be successfully used in patients with impaired renal function in oncourological practice.

Effect of concomitant diseases on the hemostasis system in the perioperative period of non-cardiac surgery

2021 ◽  
Author(s):  
И.С. Пряхин ◽  
С.С. Мурашко ◽  
С.А. Бернс ◽  
И.Н. Пасечник
Keyword(s):  
Molecular Weight ◽  
Cardiac Surgery ◽  
Antithrombotic Therapy ◽  
Perioperative Period ◽  
Low Molecular Weight ◽  
Clinical Factors ◽  
Low Molecular Weight Heparins ◽  
Global Test ◽  
Thrombotic Risk ◽  
Increased Risk

В данном исследовании изучалось влияние клинических факторов и антитромботической терапии на свертывающую систему крови пациентов в периоперационном периоде. В исследование включено 80 пациентов, которым проводилось плановое некардиальное хирургическое вмешательство. Лабораторный контроль осуществлялся с использованием рутинных методов исследования гемостаза (АЧТВ, МНО) и глобального теста исследования гемостаза (тест тромбодинамики). Использование теста тромбодинамики в данном исследовании оказалось более чувствительным методом по сравнению с рутинными тестами и позволило выявить клинические факторы, ассоциированные с гиперкоагуляционными состояниями и снижением эффективности низкомолекулярных гепаринов в послеоперационном периоде: возраст старше 60 лет, фибрилляция предсердий, хроническая ишемическая болезнь сердца, стентирование коронарных артерий в анамнезе, предшествующий прием антитромботической терапии до оперативного вмешательства. У больных с тромбозом глубоких вен нижних конечностей отмечалась гиперкоагуляция в первые сутки после проведения операции по сравнению с остальными пациентами. Использование теста тромбодинамики за сутки до оперативного вмешательства позволило спрогнозировать увеличение объема интраоперационной кровопотери. Назначение периоперационной мост-терапии низкомолекулярными гепаринами у больных с высоким тромботическим риском достоверно ассоциировалось с увеличением трансфузии эритромассы практически в 2 раза по сравнению с остальными пациентами и было связано с повышением риска геморрагических осложнений. Результаты исследования показали, что тест тромбодинамики потенциально может быть применен в дальнейших исследованиях с целью персонификации ведения пациентов в периоперационном периоде при некардиальной хирургии, а также способен прогнозировать возникновение геморрагических и тромботических осложнений. This study examined the effect of clinical factors and antithrombotic therapy on the blood coagulation system of patients in the perioperative period. The study included 80 patients who underwent elective noncardiac surgery. Laboratory control of hemostasis was carried out using routine tests for studying hemostasis (APTT, INR) and a global test for hemostasis (thrombodynamics test). Usage of the thrombodynamics test in this study was more sensitive compared to routine tests and made it possible to identify clinical factors associated with hypercoagulable states and «decreasing in the effectiveness» of low molecular weight heparins in the postoperative period. These factors are: age over 60 years, chronic ischemic heart disease, a history of coronary artery stenting, prior antithrombotic therapy before surgery. Hypercoagulability was found on the first day after surgery in patients with deep vein thrombosis of the lower extremities compared to other patients. The use of a thrombodynamics test a day before surgery allowed to predict an increase of intraoperative blood loss volume. Perioperative bridge therapy with low molecular weight heparins in high thrombotic risk patients was significantly associated with an increase in packed red blood cells transfusion of almost two times compared with other patients and is associated with an increased risk of hemorrhagic complications. The results of the study showed that thrombodynamics test can potentially be used further with the aim of personalizing patients’ management in the non-cardiac surgery perioperative period. It also helps to predict the occurrence of hemorrhagic and thrombotic complications.

Low-Molecular-Weight Heparin in Cancer Patients: Overview and Indications

2019 ◽  
Vol 39 (01) ◽  
pp. 067-075 ◽  
Author(s):  
Minna Voigtlaender ◽  
Florian Langer
Keyword(s):  
Molecular Weight ◽  
Cancer Patients ◽  
Anticancer Agents ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Increased Risk

AbstractAlthough venous thromboembolism (VTE) is a well-known cause of death in patients with cancer, both its treatment and prevention remain a challenge in daily practice. Direct oral anticoagulants have emerged as safe and efficacious alternatives to vitamin K antagonists in the general population, and recent clinical trials also support their use in select patients with cancer-associated VTE. Despite this, low-molecular-weight heparins (LMWHs), a comparatively ancient class of antithrombotic drugs, remain the anticoagulants of choice in many indications relevant to modern haematology and oncology. In addition to the treatment of established VTE, these indications include VTE prophylaxis in surgical or acutely ill, hospitalized medical cancer patients as well as the prevention of VTE in high-risk patients undergoing ambulatory chemotherapy. In a constantly changing landscape of approved anticancer agents, this review article summarizes pivotal clinical trial data and guideline recommendations regarding the use of LMWH in haematological and oncological patients, who constitute a highly vulnerable patient population due to their increased risk for both bleeding and VTE recurrence.

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