Conference "School of phlebology. Thrombosis and thrombophilia in the practice of a phlebologist ", Moscow, 15.03.2018.
On March 15, 2018, at the N.I. Pirogov held a scientific-practical conference from the cycle: "School of phlebologists", which was called "Thrombosis and thrombophilia in the practice of a phlebologist."
Presidium of the conference "School of Phlebologists"
The event was opened by Evgeny Arkadievich Ilyukhin, Ph.D., member of the executive board of the Association of Phlebologists of Russia, vice-president of the St. Petersburg Association of Phlebologists with a report "Classification and clinical significance of thrombophilia".
Speaker Ilyukhin E.A.
Thrombophilia is a pathological condition characterized by impaired blood clotting with a high probability of thrombosis. The main types of thrombophilia:
- Deficiency of a natural anticoagulant: Protein C protein, protein S, antithrombin.
- Genetic polymorphisms: polymorphism of gene V of the factor Leiden (FVL), polymorphism G20210A of gene II factor, prothrombin (FII).
- Antiphospholipid syndrome - antibodies: lupus anticoagulant, antibodies to cardiolipin, antibodies to β2-glycoprotein.
To acquired thrombophilic conditions in addition to APS are: cancer, myeloproliferative diseases. The clinical significance of thrombophilia is not equal, if the Leiden mutation and factor II polymorphism increases the probability of thrombosis by about 2 times (less influence of the blood group), then severe forms of thrombophilia increase it to 10 times. How and to whom to define laboratory markers of thrombophilia? There is no definitive answer, since thrombophilia often causes the first episode of thrombosis. But to determine the markers of thrombophilia to all in a row is economically inexpedient. Screening can be useful:
- With the ineffectiveness of anticoagulant therapy (thrombosis).
- When planning pregnancy in women with additional risk factors (obesity, age over 35 years, etc.).
- Before the beginning of taking combined oral contraceptives (if there is a family history of VTEO, the presence of risk factors).
- In young people with unprovoked (or had a weak provocation) thrombosis.
- In thrombosis of unusual localization (cerebral sinuses, veins of internal organs).
Assol Sergeevna Andreeva, candidate of chemical sciences, representative of the Werfen corporation in Russia, presented a report on the topic "Antiphospholipid syndrome: laboratory and clinical aspects".
Speaker Andreeva AS
Antiphospholipid syndrome is an autoimmune disease in which antibodies to phospholipids appear and is complicated by thrombosis and / or complications during pregnancy. APS - clinical and laboratory diagnosis. According to the laboratory criteria adopted in Sydney in 2005, patients with APS are distributed as follows:
- I: there is more than an 1 laboratory test (in any combination).
- IIa: only lupus anticoagulants.
- IIc: only antibodies to cardiolipins.
- IIc: Anti-β2glycoprotein-I antibodies only.
To assign a patient to a particular risk group, it is necessary to perform all three laboratory tests from one tube and confirm the result in 12 a week.
Antiphospholipid antibodies are recommended to be detected in the following cases:
- Young people (less than 50 years).
- In cases of idiopathic thromboembolism and chronic thromboembolic pulmonary hypertension.
- Thrombosis of atypical localization.
- In the association of thrombosis with autoimmune diseases.
- Cryptogenic stroke.
- Unexplained repeated thrombosis.
- An unexplained prolongation of APTT in healthy patients.
It is necessary to take into account the effect on drug tests, therefore, you should: cancel warfarin 1-2 weeks before the examination, low molecular weight heparin - 12 hours before the examination.
Olga Vadimovna Jenina, PhD, addressed such an important topic as "Drug therapy for thrombophilia in pregnant women."
Appears Jenina O.V.
Pregnancy in itself is a physiological thrombophilia. During this period, the following processes occur in the woman's body:
- The activity and quantity of factors of blood coagulation increase.
- The processes of fibrinolysis decrease.
- Vessels are dilated and the tone of their walls is reduced.
- The trunk veins are squeezed by the pregnant uterus.
Similarly, pregnancy can act as a trigger factor for the emergence of primary and secondary thrombophilia. During pregnancy, the risk of venous thrombosis rises in 5-7 times. Even higher in the first 6-8 weeks of the postpartum period, when the risk of VTEO is higher in 10-15 times. Olga Vadimovna described in detail the patterns of drug therapy for various types of thrombophilia, taking into account additional risk factors (somatic gestational, family).
Kirill Viktorovich Lobastov, Ph.D., presented a report on "Risk assessment, diagnosis of recurrent venous thromboembolic complications and ways to prevent them."
Lobastov K.V. is speaking.
In his report, Kirill presented the results of studies that demonstrate the advantages of using new oral anticoagulants in patients with verified thrombophilia.
Mikhail Nikolaevich Zamyatin, professor, presented a report on the topic "Thrombosis in oncology, features of treatment and prevention of relapse."
Speaker Zamyatin M.N.
In his lecture, Mikhail Nikolaevich told about the nuances of screening for cancer in patients with VTEO, the treatment of cancer-associated thrombosis, and the prospects for using new oral anticoagulants.
Evgeny Igorevich Seliverstov, Ph.D., presented on the topic "Peculiarities of surgical treatment of patients receiving anticoagulants for a long time."
Speaker Seliverstov EI.
In this report, Yevgeny Igorevich disclosed the features of the approach (therapeutic and surgical), the nuances of using anticoagulant drugs in the perioperative period in this category of patients.
Victor Evgenievich Barinov, Doctor of Medical Sciences, presented a report on the topic "Difficult choice: benefits and risks of prolonged prevention of recurrent venous thromboembolic complications."
Speakers Barinov V.E.
The prolongation of anticoagulation is often the only way to avoid recurrence of thrombosis, but carries the inevitable risks of bleeding. In this regard, this issue has been and remains the subject of discussion, the search for a balance of benefit and risk.
Igor Nikolaevich Sonkin, Candidate of Medical Sciences, member of the Russian Association of Vascular Surgeons, presented a report on the topic "The effectiveness of various options for conservative treatment of deep vein thrombosis of the lower extremities."
Speaker Sonkin IN
The effectiveness of modern standard treatment methods (regimen, anticoagulation, compression) has been proved, but it is still not enough. Even with the above mentioned methods, a high percentage of development of post-thrombotic disease, venous lameness, trophic ulcers remains. In this context, Igor Nikolayevich turned to the technique of variable pneumocompression. Her role in the treatment of deep vein thrombosis remains underestimated and little studied.
Yuri Mikhailovich Stoyko, Professor, President of the Association of Phlebologists of Russia, presented a report on the topic "Duration of anticoagulant therapy for venous thromboembolic complications in patients with high hemorrhagic risk."
Speaker Stoyko Yu.M.
In modern clinical practice, there are excellent tools for quantifying the risk of recurrence of venous thromboembolic complications, and many scales have been developed. But with the system of calculating the threat of hemorrhagic complication in patients who have experienced VTEO, things are somewhat worse, the choice here is not so great. In this context, it is possible to use the scale (or online calculator) of HAS-BLED, developed by a group of scientists at the University of Maastricht in 2010. Yuri Mikhailovich told about the global trends in anticoagulation therapy. 4-6 February 2018 year in Melbourne (Australia) was the World Congress of phlebology. New oral anticoagulants occupy new niches and increasingly replace not only vitamin K antagonists, but also low-molecular heparins. In cases of increased risk of bleeding, preference is given to sulodexide.