[The monitoring of application of dabigatran as a remedy of prevention of thromboembolic complications after hip joint arthroplasty].

The analysis was applied to the indicators of hemostasis system under application of new anticoagulant, dabigatran etexilat, after hip joint arthroplasty. It is established that among the coagulation methods analysis the most specific to the effect of dabigatran is the testing of thrombin and echitox time of coagulation. Considering low sensitivity of the echitox to anticoagulation effect of D-dimer the echitox test is optimal for laboratory monitoring of application of dabigatran after orthopedic intervention.

[Use of recombinant factor VIIa to reduce transfusional load in hemorrhaging patients after surgery for malignant tumors].

Often expanded surgical interventions in patients with malignant tumors are accompanied by huge bleeding and require transfusion of big mass of medications prepared from donor blood that may develop different complications. It is showed that with the aim of treatment of hemorrhagic complications the use of recombination factor VIIa allows reducing the surgical blood loss, as well as diminishing hemotransfusional load after surgery especially in patients with malignancies of urogenital system and malignant tumors of the colon and lung.

[Laboratory monitoring of recombinant factor VIIA effects].

Recombinant activated factor Vll originally proposed to prevent and arrest bleedings in patients with the inhibitory form of hemophilia has been shown to be a universal hemostatic agent that is effective in arresting and preventing a broad spectrum of spontaneous and postoperative hemorrhages. Procedures for monitoring the action of this agent on the hemostatic system have not been studied so far. The paper presents the results of a study of various parameters of the hemostatic system in patients with profuse hemorrhages before and after the use of recombinant activated factor VII. It has been ascertained that monitoring of the pharmacokinetics of the agent can be achieved when the prothrombin test with bovine thromboplastin is carried out.

[Phlebothrombosis and pulmonary thromboembolism in patients with thrombophilia].

A study was made of the course of phlebothrombosis ana pulmonary thromboembolism in 54 patients with thrombophilia. Of these, 23 patients had factor la resistance to protein C, 15 presented with antiphospholipid syndrome, four with protein C deficit, one with protein S deficit, three with antithrombin III deficiency, and three patients with hyperhomocysteinemia. Five patients presented with the following combined forms of thrombophilia: thrombophilia due to protein C deficit and antiphospholipid syndrome; protein C deficit and hyperhomocysteinemia; protein C and antithrombin III deficit; factor Va resistance to protein C and hyperhomocysteinemia; antiphospholipid syndrome and hyperhomocysteinemia. Thrombosis of the inferior vena cava (IVC) was present in 52 and PTE in 27 patients, The recurrence of phlebothrombosis was recorded in 40 (76.9%), that of PTE in 12 (44.4%) patients. The time elapsed between disease exacerbations accounted for one month to nine years, the number of recurrences constituted two to 6. Initially, thrombosis in three patients was located in lower limb saphenous veins, in 18 in the tibial and femoral veins, in 29 in the femoral and iliac veins; two patients presented with femoroiliocaval phlebothrombosis. The recent control examination revealed thrombosis of the saphenous veins in two patients. In ten patients, thrombosis was located in the tibiofemoral segment, in 19 patients, it was discovered in the femoroiliac and in two cases, in the femoroiliocaval segment. During observation period, venous thrombosis in the previously intact lower limb developed in nine (16.7%) patients. Thrombosis of other vessels inclusive of the organ ones was present in 14 (25.9%) patients. Of these, seven patients had thrombosis of the arteries of the upper and lower limbs: in four cases, it was located in the system of the IVC and in two cases, in the mesenterial arteries; ischemic stroke was recorded in two cases, thrombosis of the portal vein in one, and myocardial infarction was also marked in one case. In view of different hemostatic changes underlying the development of venous thromboses and PTE, we carried out differentiated therapy applying anticoagulants, platelet inhibitors, and transfusions of quickfrozed plasma. In acute femoroiliac and caval thromboses and PTE, 40 patients were provided implantation into the IVC of the cava filter <>. After cava filter implantation 16 patients developed tnrombosis of the IVC. Embolism to the cava filter occurred in seven patients. In three cases, it terminated in occlusion of the IVC and in the remaining cases, in its recanalization. Over the period one to six years, occlusive thrombi of the IVC underwent recanalization in 11 patients. Analysis of the course of phiebothrombosis and PTE in patients with thrombophilia made it possible to define situations that require its goal-oriented search. It is demonstrated that it is advisable to implant the cava filter <> to the permanent position in thromboses of the femoral, iliac veins and of the IVC as well as in PTE.

[Comparative analysis of various methods of determination of fibrinogen in the plasma]. / Sravnitel'nyi analiz razlichnykh metodov opredeleniia fibrinogena v plazme krovi.

Fibrinogen was measured in the plasma of normal subjects and patients with various hemostasis disorders by gravimetric methods with thromboplastin coagulation and coagulation with Echis multisquamatus snake venom. Coagulation was assessed using optic Coag-Mate HM (Netherlands) and roll Amelung KC4A (Germany) coagulometers during coagulation with thrombin after Klauss and with the above venom. The results were compared with those of fibrinogen measurements by radial immunodiffusion using Behring antifibrinogen serum. The data of all methods coincided if the initial levels of fibrinogen were normal, whereas in manifest hypo- or hyperfibrinogenemia Klauss' method was the most accurate and informative.

[Initial experience in the diagnosis of thrombophilia due to activated protein C resistance]. / Pervyi opyt diagnostiki trombofilii, obuslovlennoi rezistentnost'iu k aktivirovannomu proteinu C.

The authors describe the first in Russia cases of thrombophilia caused by factor Va resistance to activated protein C. This abnormality was diagnosed in 6 of 25 patients (24%) with recurrent early thrombosis. The diagnosis was conducted according to a modified method implying the addition of protac (activator of protein C) to normal platelet poor plasma (PPP) free of factor V containing 100% of protein C. Protac dose was adjusted to increase the activated partial thromboplastin time (APTT) 2.4-2.8-fold in mixing PPP of the examinee with plasma containing activated protein C. The indices were estimated indicative of insufficient prolongation of APTT in response to activated protein C. Of 6 patients, 2 had apparent and 4 strong resistance to activated protein C. Treatment policy in this variant of thrombophilia is discussed.

[Prevalence, diagnosis and clinical significance of thrombophilia caused by Va factor resistance to activated C protein]. / Rasprostranennost', diagnostika i klinicheskoe znachenie trombofilii, obuslovlennoi rezistentnost'iu faktora Va k aktivirovannomu proteinu C.

Examining 26 patients with early recurrent venous thrombophilias and ischemic attacks revealed that 6 cases had Va factor resistance to activated C protein. The latter suggests that thrombophilia associated with hereditary C- protein resistance is recorded in the Russian population, among the residents of West Siberia in particular.

[The ability of low-molecular heparin (Fraxiparin) to overcome the action of exogenous coagulases--a fundamental difference from nonfractionated heparin]. / Sposobnost' nizkomolekuliarnogo geparina (fraksiparina) preodolevat' deistvie ékzogennykh koagulaz--fundamental'noe otlichie ot nefraktsionirovannogo geparina.

A new previously unknown activity of the low molecular-weight heparin Fraxiparin (Sanofi) has been discovered. This is its ability to reduce the plasma clotting action of snake venom coagulases at final concentration of more than 12.5 anti-Xa U/ml, while the unfractionated heparin does not possess this property. The experiments demonstrated that Fraxiparin the action of Echis carinatus prothrombin-activating venom to a greater degree and Agkistrodon halys halys thrombin-like coagulase to a lesser degree. Unlike the unfractionated heparin, Fraxiparan also prevents the death of white rats from acute toxic hemocoagulant shock caused by the intravenous injection of DL100 Echis carinatus venom.