[Optimization of anticoagulation therapy for venous thromboembolism]. / Optimizatsiia antikoaguliantnoi terapii venoznogo tromboémbolizma.

OBJECTIVE: To optimize anticoagulation therapy for venous thromboembolism by means of dabigatran etexilate. MATERIAL AND METHODS: From 2006 to 2012, within the framework of the international trials RE-COVER and RE-COVER II aimed at evaluating efficacy and safety of dabigatran etexilate compared to warfarin, a total of 95 patients meeting the inclusion and exclusion criteria were enrolled in our study. As part of the RE-COVER trial, we carried out analysis of comprehensive examination and treatment of 55 patients with venous thromboembolism (VTE), who were randomly divided into two groups. Group I (Control Group) consisted of 30 patients receiving initial therapy with heparin for seven days followed by taking warfarin for six months. Group II (Study Group) comprised 25 patients taking dabigatran etexilate instead of warfarin. RESULTS: There were no cases of recurrent VTE in the Control Group, and one (4%) patient of the Study Group was found to have a relapse of the disease owing to resistance to anticoagulation therapy and congenital thrombophilia. Undesirable events of anticoagulation therapy developed in 20% of the Control Group patients an in 16% of the Study Group patients. In two Control Group patients and one Study Group patient anticoagulation therapy was discontinued due to the development of complications. After 2 years, 36.7% of the Control Group patients and 40% of the Study Group patients had no manifestations of chronic venous insufficiency (CVI). The degree of CVI was similar in the both groups. CONCLUSION: Dabigatran proved non-inferior to warfarin regarding efficacy, possessing, however, a series of advantages: it has a predictable anticoagulant effect, requires neither monitoring of the haemostasis system, nor dose adjustment, and is administered at standard dosages.

[Efficiency of meldonium in the complex therapy of acute coronary syndrome].

We examined 140 patients (mean age 54.8±3.1 years) with ST elevation acute coronary syndrome resulting in Q-wave myocardial infarction of the left ventricle. From the first hours complex therapy of these patients comprised meldonium (1 g/day intravenously for 2 weeks then orally until 1.5 months). Therapy with meldonium accelerated restoration of left ventricular diastolic function what was in agreement with lowering of NT-proBNT concentration in blood. It was established that administration of meldonium led to reduction of number of high grade ventricular extrasystoles during first 6 hours after thrombolysis, to lowering of blood concentration of lipoperoxide degradation products. Early use of meldonium decreases probability of emergence of fatal arrhythmias and improves prognosis of hospital stage of rehabilitation of patients with acute coronary syndrome resulting in Q-wave myocardial infarction.

[Application of coenzyme Q(10) in combination therapy of arterial hypertension].

We studied effect of coenzyme Q(10) on 24-hour blood pressure profile and function of vascular endothelium in patients with essential hypertension. Coenzyme Q(10) was used as a component of combination therapy comprising angiotensin converting enzyme inhibitor enalapril. Administration of coenzyme Q(10) in combination with traditional antihypertensive therapy promoted normalization of vascular endothelial function and more effective correction of 24-hour blood pressure profile. These findings allow to consider the use of coenzyme Q(10) as promising component of combination therapy of arterial hypertension.

[Efficiency of combined therapy with myocardial cytoprotector mexicor in hypertensive patients with acute cerebrovascular disturbances].

Sixty hypertensive patients (mean age 64.9 +/- 1.5) with acute ischemic stroke were randomized into 2 groups. Both groups received conventional therapy (Aspirin Cardio, Trental, Prestarium, Arifon), which in the test group was added by Mexicor (0.3 gper day for 3 weeks). Circadian blood pressure (BP) and its variability were monitored in all patients at 1, 5, 10, 14, and 21 days after the stroke. NIH Stroke Scale, the Barthel ADL Index, Rankin Scale, Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) were used for the neurological status assessment. Mexicor was shown to accelerate the systolic and diastolic BP lowering, reduction of BP variability (mainly nocturnal) and improvement of circadian BP profile (more patients showed dipper type hypertension and less - non-dipper, over-dipper and night-peaker patterns, compared with the control group). Mexicor had a positive effect on neurological status, cognitive function and focal neurological deficit severity.