Репозиторий Университета

© 2020 The Author(s) Patients with cancer undergoing chemotherapy are at risk of thrombocytopenia. The co-incidence of cancer-associated venous thromboembolism (VTE) and thrombocytopenia is a frequent complication in patients with cancer. Especially in certain tumour entities at high VTE risk, chemotherapeutic agents with myelosuppressive effects are part of the standard of care. The management of cancer-associated VTE in the setting of chemotherapy-induced thrombocytopenia is challenging, in the absence of evidence from high-quality studies. Thrombocytopenia is associated with both increased risk of recurrent VTE and risk of bleeding during anticoagulation. In this case-based concise review, we aimed at summarizing available literature and expert consensus guidance on the treatment of cancer-associated VTE in patients with chemotherapy-induced thrombocytopenia.

© 2018 Media Sphera Publishing Group. All Rights Reserved. Aim - the objective of the present work was to analyze the data obtained in a study involving a group of patients presenting with recurrent deep vein thrombosis and/or bleeding who had been treated with the use of vitamin K antagonists. Material and methods. A total of 116 patients presenting either with recurrent deep vein thrombosis (n=10) or bleeding that developed while patients had been on the therapy with vitamin K antagonists were enrolled in the study. We performed clinical and instrumental examination as well as laboratory testing of the hemostatic system. All the patients received warfarin during 6 months or longer with 32 of them taking this medication to prevent deep vein thrombosis and the remaining 84 for the treatment of various cardiac diseases. The results of the clinical, instrumental, and laboratory studies provided a basis for the choice of the treatment strategies. Results. Sixty seven of the 116 patients were treated non-surgically while 27 patients were operated (25 urgently and two within 2 days after the admission to the hospital). 20 patients underwent endoscopic hemostasis, in two others the hematoma was punctured under ultrasound guidance. Eight patients presenting with recurrent deep vein thrombosis received the conservative treatment reduced to the correction of anticoagulation therapy (they were first switched from warfarin to heparins with the subsequent resumption of warfarin treatment using the individually adjusted doses of the drug). Two patients with free-floating thrombi in the main veins required the surgical intervention to prevent pulmonary embolism. The conservative treatment of the patients with bleedings included the withdrawal of warfarin together with the simultaneous administration of vitamin K1, fresh frozen plasma, and prothrombin complex concentrate in different combinations taking into consideration the results of clinical examination and laboratory testing. The conservative treatment was successful in all the cases. No severe complications, life-threatening conditions or death were documented. Conclusion. The patients receiving vitamin K antagonists are at enhanced risk of both a relapse of venous thromboembolism and bleedings. The timely started and appropriate management can prevent the severe complications.

© 2018 Sychev et al. Background: Non-vitamin K oral anticoagulants (NOACs) are commonly used for prophylaxis of venous thromboembolism (VTE) in orthopedic patients. Despite known safety and high potency of NOACs, potential interactions of NOACs with genetic polymorphisms are poorly understood. Dabigatran etexilate is one of the most commonly prescribed direct thrombin inhibitors for the prevention of VTE. The objectives of this study were to assess the effect of ABCB1 (rs1045642 and rs4148738) and CES1 (rs2244613) polymorphisms on dabigatran pharmacokinetics in patients after total knee arthroplasty. Patients and methods: A total of 60 patients, aged 37–81 years, who underwent surgery for knee replacement have been included in the study. VTE prophylaxis was conducted via administration of dabigatran etexilate 220 mg once daily. Genotyping for carrier state of polymorphic variants such as rs1045642 and rs4148738 of the ABCB1 gene and rs2244613 of the CES1 gene was carried out using real-time polymerase chain reaction (PCR). We also measured the peak and trough concentrations of plasma dabigatran by using high-performance liquid chromatography (HPLC). Results: Our study revealed that TT genotype of rs1045642 polymorphism of the ABCB1 gene was associated with higher dabigatran equilibrium peak concentrations and the higher risk of bleeding than the presence of CC genotype (p<0.008). There was no statistically significant genotype-dependent difference in the trough concentrations between rs1045642 and rs4148738 of the ABCB1 gene and rs2244613 of the CES1 gene. Conclusion: Our findings indicate that the polymorphisms of ABCB1 rs1045642 may have a prominent contribution to the safety of dabigatran in patients after knee surgery. Moreover, TT genotype may be associated with the higher risk of hemorrhagic complications in this population. There were no influence of polymorphism of ABCB1 rs4148738 and CES1 rs2244613 on dabigatran peak and through concentrations. Larger studies are needed to confirm our observations.