Гипофибринолиз как основной фактор риска тромбоэмболических осложненийу онкологических пациентов

Гипофибринолиз как основной фактор риска тромбоэмболических осложненийу онкологических пациентов

Автор: Петрова О.Ю., Суханов В.А., Левит Д.А.

Журнал: Злокачественные опухоли @malignanttumors

Рубрика: Медицинские науки

Статья в выпуске: 3 (10), 2014 года.

Бесплатный доступ

Введение: Частота венозных тромбоэмболических осложнений (ВТЭО) у онкологических пациентов (ОП) увеличивается на 10% во время химиотерапии (ХТ). Сочетание системной гиперкоагуляции крови и гипофибринолиза являются наиболее опасными рисками ВТЭО. Целью данного исследования было оценить параметры тромбоэластографии (ТЭГ) (гиперкоагуляция и гипофибринолиз) для оценки антитромботического эффекта низкомолекулярного гепарина (НМГ). Методы: Мы изучали 78 ОП (женщины - 47, средний возраст - 56 лет) с высоким риском ВТЭО по шкале Khorana до ХТ (≥3 балла). Исследования крови делали до и через 3-4 часа после инъекции НМГ (дальтепарин натрий 5000 МЕ в сутки). Изучали следующие ТЭГ параметры (TEG 5000, США): R - время начала реакции (наша модификация, патент РФ № 2015515, норма=660-970 с), фибринолиз (наша модификация, патент РФ № 2358657, норма=60-120%). Чтобы оценить комплексно взаимодействие этих двух параметров, мы решили ввести бальную оценку. Мы присвоили: 1 балл когда параметр R был менее 500 сек и 1 балл при фибринолизе менее 40%. В случае укорочения этих показателей ниже означенных значений начинали терапию НМГ. Результаты: До назначения НМГ в 38% ОП имели умеренную/выраженную гиперкоагуляцию крови (средний балл=0,5), и в 80% - умеренное/выраженное угнетение фибринолиза (средний балл = 0,95): общий балл (ОБ) составил 1,45. Следовательно, угнетение фибринолиза является ведущим фактором риска ВТЭО у ОП. На пике действия НМГ ОБ снизился на 64% (р

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Онкология, венозная тромбоэмболия, химиотерапия, тромбоэластография, низкомолекулярный гепарин

Короткий адрес: https://sciup.org/14045488

IDR: 14045488

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