[Enoxaparin sodium for pharmacological prevention of postoperative venous thromboembolic complications in urological patients].

INTRODUCTION: Currently, there are paucity of reports on the success of medical prevention of venous thromboembolic complications after urological procedures. AIM: To evaluate the efficiency of enoxaparin sodium for prevention of postoperative venous thromboembolic complications in urological patients. MATERIALS AND METHODS: According to the medical records of 151 men and women aged 22 to 92 years old who were undergone to elective surgical treatment in April 2021, the results of the thrombin generation assay and ultrasound study of the inferior vena cava were retrospectively analyzed. All patients were divided into 6 study groups depending on the degree of risk of postoperative venous thromboembolism (very low, low, moderate, high, very high and extremely high). The data obtained during the thrombin generation assay in patients from different groups were compared with those in healthy volunteers (n=30, control group) and evaluated in dynamics. In addition, intergroup comparison was done. RESULTS: All study participants prior to surgery had a significant increase in peak thrombin and endogenous thrombin potential (ETP) by 5-26% and 13.5-21.5%, respectively. The postoperative findings were as following: 1) one hour after the procedure, a significant (by 9-28.6%) decrease in the normal bleeding time (Lag time); 2) a significant increase in the peak thrombin by 4.8-10.6% 1 hour after surgery and by 11-40.2% at the end of the first postoperative week; 3) reducing the time to peak thrombin (ttPeak) by 13-15%; 4) increase in ETP. According to the ultrasonic data, all study participants had no signs of thrombosis of the inferior vena cava system. CONCLUSION: In urological patients requiring surgical treatment, before and after procedure, there is almost always a shift in the hemostasis towards the predominance of the blood coagulation system. Under such conditions, to prevent the development of postoperative VTE, it is expedient and pathogenetically justified to use enoxaparin sodium in a single dose of 0.4 ml or 4000 anti-Xa IU administered once a day s/c 24 hours before the procedure and till full activation of a patient.

[Evaluation of the results of sodium fumarate, furosemide, and mannitol on the initiation and outcome of renal warm ischemia in an experimental study].

While performing surgical treatment of the localized form of renal cell cancer by means of open or laparoscopic partial nephrectomy, renal warm ischemia is an important issue. Using renal warm ischemia allows to prevent parenchymal bleeding, to optimize conditions for resection of the tumor and to increase significantly the efficiency of hemostasis. However, an important problem is the probability of ischemic hypoxic damage of the remaining part of the kidney tissue during renal warm ischemia and renal functional impairment in the postoperative period. AIM: To compare nephroprotective activity of sodium fumarate, mannitol and furosemide using experimental model of 30- and 60-minute renal warm ischemia in rabbits. MATERIALS AND METHODS: The experiments were carried out on 360 conventional male-rabbits of the "Chinchilla" breed weighed 2,6+/-0,3 kg which were allocated into 10 groups. The control group No1 included intact animals, the control group No2 included the rabbits in which renal artery was not clamped. For the animals from the trial groups (No3-No10) the experimental model of 30- and 60-minute renal warm ischemia was used. In groups No3 and No4 no drugs were provided. Other rabbits undergone renal warm ischemia with a protection by sodium fumarate (groups No5 and No6 - 1,5 ml/kg IV), lasix (groups No7 and No8 - 3,0 mg/kg IV) and mannitol (No9 and No10 - 1,0 g/kg IV). The influence of renal warm ischemia on the renal tissue ultrastructure and the levels of NGAL, Cystatin-C and creatinine in blood and urine were studied. RESULTS: During experimental pharmacologically uncorrected 30-minute renal warm ischemia in animals, edema of the terminal part of microvilli of the proximal tubules epithelium, an increase of lysosome number in the hyaloplasm of epithelial cells, appearance of flaky content of medium electronic density in the lumens of distal tubules and collecting tubules, as well as sharp peak-like increase of NGAL and cystatin-C in blood and urine were observed. Increasing the time of ischemia up to 60 minutes was accompanied by more severe disturbances. In groups where sodium fumarate, lasix and mannitol were used the observed ultrastructural disturbances were expressed to lesser extent, whereas sodium fumarate demonstrated the best nephroprotective activity. After using mannitol the severity of disturbances was less than in the groups where mannitol, lasix or sodium fumarate were not given. Lasix and sodium salt of fumaric acid showed a higher nephroprotective activity. The best results were received in the animals received sodium fumarate. CONCLUSIONS: The studied drugs provided a nephroprotective effect regarding ischemia of rabbit kidney. The effect of sodium fumarate was the most pronounced, followed by furosemide and, to a lesser extent, mannitol. Use of sodium fumarate allows to protect and stimulate the kidney tissue effectively during oxygen deprivation under ischemic state.