[Sulodexide in treatment of chronic venous insufficiency. Results of the All-Russian multicenter programme ACVEDUCT]. / Sulodeksid v lechenii khronicheskoi venoznoi nedostatochnosti. Itogi Vserossiiskoi mul'titsentrovoi programmy ACVEDUCT.

INTRODUCTION: Pharmacotherapy occupies one of the leading places in comprehensive treatment of lower-limb chronic venous diseases (CVD) and their complications. At the same time, there are not so many therapeutic agents intended for treatment of CVD and possessing evidence-based efficacy. Sulodexide (registered in Russia as Vessel Due F) is a drug with a confirmed therapeutic effect in patients with a moderately severe course of chronic venous disease or its late stages. However, the experience of using it in Russia for treatment of patients presenting with initial manifestations of chronic venous insufficiency (CVI) is still scarce. PATIENTS AND METHODS: The data concerning the use of Vessel Due F in the routine practice of treating CVD in Russian patients were collected and assessed within the framework of the ACVEDUCT programme. This observational prospective non-controlled multicentre programme included patients routinely prescribed by their attending physician Vessel Due F as a solution for injections and/or soft capsules in accordance with the registered in the Russian Federation instruction for use. A total of 2,263 patients took part in the programme. RESULTS: The majority of the patients prescribed sulodexide were diagnosed as having CEAP class C3 (38.4%) and class C4 (35.6%) CVD. Treatment was accompanied and followed by a decrease in the symptoms' severity observed in 56.4% of patients and a decrease in the number of symptoms in 42.8% of patients (thus positive dynamics was totally noted in 99.2%), with the effect of taking the drug commencing to manifest itself in patients as early as on day 15-20 of treatment. The highest rate of regression of symptoms of CVD was observed in 30-to-40-year-old patients. A statistically significant positive correlation was revealed between efficacy and the duration of treatment, the use of capsules during the term of follow up, with a negative correlation revealed between efficacy of treatment and the patient's age at which the diagnosis had been made, the stage according the CEAP classification, the total number of symptoms, a combination of risk factors. CONCLUSIONS: Sulodexide proved to be an effective, safe, well-tolerated and pathogenetically substantiated pharmacological agent for treatment of patients presenting with lower-limb CVI and should therefore be recommended for patients at early stages of formation of CVD. Patients suffering from venous trophic ulcers require higher doses and prolonged administration of the drug.

[Clinical experience with the use of rivaroxaban in the treatment of cancer patients with venous thrombosis]. / Klinicheskii opyt primeneniia rivaroksabana v lechenii patsientov s ostrymi venoznymi trombozami na fone onkopatologii.

The urgency of the problem. The incidence of various thromboembolic complications in patients with oncopathology reaches 5-12%. When treating VTE in patients with oncology it is necessary to choose between two generally recognized alternatives. The recommended two-component scheme of the initiating phase of anticoagulant therapy with subsequent long-term admission of VKA is fraught with the development of clinically significant bleeding during the initial selection of the dose of warfarin and an increased risk of recurrence of VTE. Long-term parenteral use of LMWH is often negatively treated by patients and adversely affects compliance. For these reasons, enteral administration of new oral anticoagulants is promising for prolonged anticoagulant therapy in this category of patients. The paper cites three clinical cases of treatment of patients with acute venous thrombosis of deep veins against a background of different oncological processes. In the first case - the operated previously for cancer, in the second case - to be treated over oncological process and in the third case - in the primary cancer detection. DISCUSSION: The results of the studies of EINSTEIN-DVT and EINSTEIN-PE allow us to consider the use of rivaroxaban in the treatment of patients with VTE on the background of oncopathology. The possibility of its use from the first day, in our opinion, is a significant advantage, since it allows us to reveal the clinical effectiveness of anticoagulant therapy already during the first stage of treatment, since NOAKs does not imply the possibility of laboratory monitoring.

[Evaluation of the effectiveness and safety of compression hosiery «Mediven Plus¼ in the treatment of elderly patients with chronic venous diseases of the lower extremities].

This publication presents the results of a study aimed at assessing the justification of the use of compression hosiery «Mediven Plus¼ among patients in the older age group on the basis of demographic, anthropometric data (gender, age, weight of the patient; the volume of the lower leg, upper thigh), clinical examination, data of instrumental examination (duplex ultrasound, volumetry, legometry), data of laboratory tests (fibrinogen, soluble fibrin-monomer complexes). The effectiveness of therapeutic effects of compression underwear is proved for all parameters.

[Treatment of purulent wounds with wound dressing on a foamy basis with Hydrofiber technology]. / Lechenie gnoinykh ran s primeneniem ranevykh pokrytii na pennoi osnove s tekhnologiei Gidrofaiber.

AIM: to evaluate the effectiveness of modern approaches to the treatment of purulent wounds with the use of foam-based wound coatings with the Hydrofiber technology in comparison with the traditional method of wounds. MATERIAL AND METHODS: An analysis of the results of treatment of 34 patients with purulent wounds of various etiologies was performed. Patients were divided into two groups: control and basic. In the main group, local treatment of wounds was carried out using a foam-based wound coating with Hydrofiber technology. In the control group, local treatment of wounds was carried out using traditional methods with the use of gauze bandages. RESULTS: With the use of foam-based wound coatings with Hydrofiber® technology, the inflammation process in the wound and surrounding tissues is more rapidly eliminated, the periods of purification and microbial decontamination in the purulent focus are reduced.

[The treatment of elderly and senile patients with venous trophic ulcers and type 2 diabetes mellitus.]

The effectiveness of the inclusion of sulodexide in the pharmacotherapy of complex treatment of patients (n=52) elderly and senile with a combination of chronic diseases of the veins complicated by refractory trophic ulcers of the lower extremities, and type 2 diabetes mellitus was studied. Patients were randomly randomized in the 1st (n=26) and the 2nd (n=26) groups, the statistical differences between them in age (t1-2=0,2, p1-2=0,833), sex (χ21-2=0,008, p1-2=0,991), nosology (χ21-2=0,004, р1-2=0,993); the anamnesis of chronic diseases of veins (t1-2=0,14, p1-2=0,893); duration of trophic ulcers (t1-2=0,21, p1-2=0,827); planimetric parameters of trophic ulcers (t1-2=0,18, p1-2=0,865) were not recorded. Patients of the 1st group received treatment with sulodexide according to the standard schedule for 50 days. The primary outcome of the study is the complete closure of the trophic ulcer after 1 month. Secondary outcomes are epithelization after 2 months and dynamic planimetric indices within 12 months. The effectiveness of the use of sulodexide was assessed according to the VCSS scale, dynamic changes in the malleolar volume and changes in planimetric parameters. A statistically significant improvement in the overall VSCC score was observed in both the 1st (p=0,002) and the 2nd (p=0,0016) groups in all study outcomes. At the same time, a statistically significant improvement in the VSCC scores was more pronounced in the 1st group (p<0,05). After 2 and 6 months, a statistically significant decrease in the malleolar volume of the affected lower extremity was recorded both in the 1st (t=4,17, p=0,001) and in the 2nd (t=2,4, p=0,37) groups. Clinically and statistically significant decrease in malleolar volume was more pronounced in the 1st group (p<0,05). After 30 days, trophic ulcers were closed in 9 (34,6%) cases in the 1st group and in 5 (19,2%) patients in the 2nd group (p<0,05). On day 60 epithelization was achieved in 22 (84,6%) and 12 (46,1%) patients, respectively. The time of complete epithelization in patients of the 1st and the 2nd groups was 51,2±1,6 and 78,4±2,6 days (p<0,05). The conclusion is made that sulodexide is an effective and pathogenetically grounded pharmacological preparation for the treatment of patients of elderly and senile age with chronic clinical disease C6 of clinical class and type 2 diabetes mellitus.

[Significance of endothelial protection in treatment of patients with class c6 chronic venous disease and type 2 diabetes mellitus].

The authors studied efficacy of using sulodexide (Vessel Due F) in treatment of patients with clinical class C6 chronic venous disease (CVD) and type 2 diabetes mellitus (DM). The study included a total of sixty-two 18-to-75-year-old patients of both sexes suffering from class C6 CVD and type 2 DM. The patients were randomly assigned to either the Study Group (Group I) and Control Group (Group II) in the ratio of 1:1. The Study Group patients received treatment with sulodexide according to the standard regimen during 50 days. The study included taking case history, examination by a phlebologist and endocrinologist, measuring the malleolar volume, body weight, ultrasound examination of lower-limb vessels, clinical and biochemical blood analyses, coagulogram, planimetry of trophic ulcers, microbiological and cytological study. The primary end point was epithelialization of trophic ulcers after 1 month. Secondary endpoints were ulcer healing after 2 months and dynamic alterations during epithelialization. The Study Group patients as compared to the Control Group patients were found to have statistically significant improvement of the composite index of clinical assessment of VSCC severity, decrease in the malleolar volume, positive dynamics of speed velocity parameters of venous outflow and improvement of quality of life according to the SF-36 questionnaire. After 30 days, epithelialization was achieved in 11 (33.5%) cases in the Study Group and in 6 (19.4%) cases in the Control Group (p<0.05). After 60 days, epithelialization was achieved in 27 (87.1%) and 15 (48.4%) patients of the Study and Control Groups, respectively. The time to complete epithelialization in Group I and II patients amounted to 49.8 ± 1.4 and 76.6 ± 2.4 days, respectively (p<0.05). A conclusion was drawn that administration of sulodexide (Vessel Due F) is effective and pathogenetically substantiated in treatment of patients presenting with class C6 CVD and type 2 DM.

[Improvement of rehabilitation efficiency in patients with chronic venous insufficiency of the lower extremities].

The relationship between functional incompetence, development and severity of chronic venous insufficiency of the lower extremities was investigated by the method of clinical analysis of locomotor activity. Results of the study may be used to choose an optimal therapeutic modality and assess dynamics of its efficiency. It was shown that the treatment of chronic venous insufficiency in the majority of the patients is inefficient unless functional activity of the lower extremities is recovered. Stimulation of the muscular-venous pump improves the outcome of postoperative rehabilitation, permits to reduce its duration, and improves quality of life of the patients.

[Modern aspects of conservative treatment of patients with lymphovenous insufficiency of lower extremities].

The main aspects of diagnosis and complex treatment of chronic lymphovenous insufficiency of lower extremities are elucidated. Modern methods of physiotherapeutic and rehabilitation measures are described with reference to clinical manifestations and results of different methods of examining patients. The effectiveness of using magnetic fields, laser irradiation and biomechanical pneumovibration stimulation in complex treatment of patients is shown. The individual strategy necessary in treatment of each patient allows improvement of quality of life of patients and effectiveness of medico-social rehabilitation.

[Biomechanical air-vibration stimulation in the medical rehabilitation of patients with chronic venous insufficiency of the lower extremities]. / Biomekhanicheskaia pnevmovibratsionnaia stimuliatsiia pri meditsinskoi reabilitatsii bol'nykh s khronicheskoi venoznoi nedostatochnost'iu nizhnikh konechnostei.

Biomechanical pneumo-vibration stimulation of lower extremities was used in 146 patients with different forms and stages of chronic venous insufficiency of lower extremities during conservative treatment in preoperative preparation and the following early rehabilitation, in 106 patients with consequences of the trauma and diseases of the spinal cord as well as in 35 healthy people. The biomechanical pneumo-vibration stimulation is thought by the authors to be a promising noninvasive conservative method of medical rehabilitation. It can be recommended for clinical use with due regard for contraindications.