Журнал "Амбулаторная хирургия" №1, 2018
М.Р. Кузнецов1,2, И.П. Марченко2 , Е.Е. Федоров2,1, Российский национальный исследовательский медицинский университет им. Н.И. Пирогова 2 ГКБ №29 им. Н.Э. Баумана
В статье разбираются эпидемиологические данные о частоте венозных тромбоэмболических осложнений (ВТЭО) в хирургии. Представлены группы риска в зависимости от клинических характеристик пациента, видов хирургических операций, основные меры первичной профилактики данного осложнения. Обсуждаются методы стимуляции венозного кровотока в нижних конечностях, различные возможные антикоагулянты, которые могут использоваться для этих целей. Показывается большая антитромботическая эффективность и безопасность низкомолекулярных гепаринов (НМГ) по сравнению с нефракционированным гепарином (НФГ), преимущество низкомолекулярных гепаринов с максимально низкой массой. Обсуждается длительность первичной профилактики, в т. ч. у онкологических больных. Приводятся данные о возможности применения НМГ с наименьшей массой - бемипарина у пациентов со спинальной анальгезией и его положительное влияние на общую выживаемость при онкологических заболеваниях.
M.R. Kuznetsova1,2, I.P. Marchenko2 , E.E. Fedorov2,1, N.I. Pirogov Russian National Research Medical University 2 N.E.Bauman City Clinical Hospital No 29
Prevention of venous thromboneembolic events in surgery
The article deals with epidemiological data on the incidence of venous thromboembolic events (VTEE) in surgery. The risk groups are presented depending on clinical characteristics of a patient, types of surgical operations, main primary measures taken for preventing the complication. The article discusses methods for stimulating venous blood flow in the lower extremities, various possible anticoagulants that can be used for these purposes. It shows great antithrombotic efficacy and safety of low molecular weight heparins (LMWH) in comparison with unfractionated heparin (NFH), the advantage of low molecular weight heparins with the lowest possible mass. The duration of primary prophylaxis, including that in oncologic patients, is discussed. It also provides data on the possibility of using LMWH with the lowest mass – bumparin in patients with spinal analgesia and its positive effect on overall survival in oncological diseases.
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