Вы находитесь на странице: 1из 7

ISSN 1818$5398 . 2013. 4. . 8187.

616-089.8-005.3-08:616.151.5 -084:615.273

. . , . .

.
. 90 , ,
. 1- () (n = 30)
() 5000 2 5000 2 7 ,
2- (n = 30) 2500 2 2500 1 7 , 3-
(n = 30) (2500 ) 6 , 2500 1
7 . : (), (),
(), , - , III (-III), - (), D- ,
1- 5- .
. - ( ), (, , , , - ), (
-III, ) ( D-) ,
. 11,8 %, . , , 5-
. 1-

. .
. 5-
. -
. , , - .

: , , , .


.

[9, 14, 17]. ,
c

.

[4]. ,
[5, 8, 13,

, . . ., ., .
E-mail: kligunenko@yandex.ua
. . , . . , 2013
30 2013 .

81

4 2013

25]. /
,
, .

(2011) ()
,
, ,
[1, 3, 7, 9, 14, 16, 18].
, II .
12 500,
8 [22].
()
.
,

[10, 12, 15, 18, 20, 21, 24].
,

--, , ,
(TFPI), . ,

FLEBUS , , , TFPI [23]. ,
,
,
I [11, 12]. , ,
, ( MEDENOX,
PREVENT, ARTEMIS .).
,
[23].
, () 3 (0,3 %)
() [26].
,
, ,
[12, 15, 20, 23, 2628]. , 82

. . , . .

0,4 %, 2,6 %
( ).

29,3 % ,
[12]. () , .

.

90 ,


. (4 5 /),
(4 5 / ). (5 / 3 /
). (200 / ) (45 15) .

1. 40 65 .
2. 20 35 /2.
3.

.
4.

Wells.
5. .

1. 39 65 .
2. 20 35 /2.
3. .
4. Wells.
5.
.
6. .


. 1- () (n = 30) 5000
2 5000 2
7 , 2-
(n = 30) 2500 2
2500 1 7

4 2013

. . , . .

, 3- (n = 30) (2500 ) 6 ,
2500 1 7 .
, (), (), (),
, -- , III (-III),
, -
(), D- . ,
, , , BFT-2 Analyzer (Dadebehring,
) -
( 2.1; 68331; 37,4 ;
80 ; 220 ).
-- ,
-III, ,
-, Pr/FV,
- , - ().
D-
Roshe (KobasIntegra 400+) .
: , 1- 5-
.
MS Excel. ( < 0,05). < 0,05 .

- ( ), (, , , ,
-- ), (-III, ) (D-)
, .
11,8 %,
.
(. 1)

,
- , 5-
25 %
. 1-
8 %

.
- 15
17 % . ,
(
13 % ) -III. D-
( 78 % ) ( 10 %).
5- (. . 1)
-

1-

5-

243,00 31,57

236,00 11,80

249,50 22,60

294,10 17,54

11,56 0,38

12,00 0,21

12,96 0,31

11,90 0,22

, . .

1,01 0,03

1,02 0,09

1,04 0,04

1,03 0,02

28,12 0,74

28,50 1,25

29,03 0,94

29,59 0,99

, /

2,75 0,19

2,78 0,14

3,21 0,19

3,57 0,21

-- , /

0,30 0,03

0,30 0,04

0,35 0,02

0,25 0,03

III, %

92,20 7,33

92,50 3,84

105,00 3,78

107,88 2,55

, . .

0,87 0,03

0,87 0,07

0,82 0,03

0,83 0,03

D-, /

< 0,5

0,46 0,04

0,82 0,03

2,34 0,52

, . .

3,48 0,12

3,89 0,19

4,29 0,15

4,36 0,23

, /

83

4 2013

. . , . .

(
4 % ).
28 %
- 17 %
.

-III
D- ( 408,6 %
185 % 1- . ,
,
5- .
,
(. 2),
1- 24 % ,
- .

. , 10 % , 15 %,
. : -- 1- ,
25 % . .
15 %, D-

20 % , . , 1-

.
5- .

: 30 %
15 % 1-

( 17,8 % 7 % ). -
,

--
. -III 18 % ( < 0,05). D- 80 % 50 % 1-
, 20 %,


(. . 2). ,
- ,
,
-

1-

5-

243,00 31,57

253,63 23,71

192,25 16,39

264,17 30,32

11,56 0,38

12,38 0,22

13,65 0,42

16,11 0,41

, . .

1,01 0,03

1,01 0,03

1,12 0,04

1,07 0,04

28,12 0,74

30,73 1,10

32,38 1,07

33,11 1,74

, /

2,75 0,19

2,74 0,21

2,05 0,10

2,16 0,10

-- , /

0,30 0,03

0,30 0,03

0,35 0,03

0,24 0,04

III, %

92,20 7,33

92,83 1,75

095,20 4,5

100,27 3,65

, . .

0,87 0,03

0,87 0,07

0,79 0,02

0,71 0,03

D-, /

< 0,5

0,55 0,06

0,66 0,08

0,99 0,11

, . .

3,48 0,12

3,78 0,20

4,34 0,36

4,55 0,38

, /

84

4 2013

. . , . .

1-

5-

243,00 31,57

248,45 16,04

253,90 18,10

334,80 36,29

11,56 0,38

12,38 0,22

16,29 0,34

15,62 0,40

, . .

1,01 0,03

1,05 0,02

1,02 0,03

0,99 0,03

28,12 0,74

31,83 1,29

32,09 1,13

31,98 0,86

, /

2,75 0,19

2,68 0,14

2,09 0,12

2,24 0,15

-- , /

0,30 0,03

0,30 0,04

0,37 0,04

0,30 0,02

III, %

92,20 7,33

92,10 3,47

101,60 4,49

101,40 5,62

, . .

0,87 0,03

0,86 0,07

0,78 0,02

0,79 0,04

D-, /

< 0,5

0,55 0,06

0,52 0,06

1,22 0,11

, . .

3,48 0,12

3,78 0,18

4,39 0,37

4,7 0,45

, /

5-
.

(. 3) ,
1- .
31 %

14 %. , . D-
,
16 % ( < 0,05),
.
5-
- (
35 %
27 % 2- ).

. , , 2- ,
1- .
D- 110 % .
24 %. -

,
. ,
-


.



5-
.

- ,

5-
.
, ,
- .

85

4 2013

 . ., . ., . . .


.
. ., 2008. . 28 30.
 . . ()
// Consilium medicum. . 2011. 1. . 3 6.
 . ., . ., . . .
: , , :
. ., 2011.
 . ., . / . .
. . . . .: , 2008. . 509 521.
 . ., . ., . ., ..

II
//
. 2010. 3 (28).
 . ., . .
. , , : .
. , 2008. . 46.
 329 15.06.2007 .

,
, . ., 2007.
 / .
.. : . . .: -, 2006.
. 775.
 .
: // . 2012.
20 (297). . 18 20.
 . .
.
//
. 2010. 5 (234). . 16 17.
 . .
// . 2007. 15 (5). . 210.
 Abad J. I., Gomez-Outes A., Martinez-Gonzalez J. et al. A prospective observational study on the effectiveness and safety of bemiparin,
first dose administered 6-h after knee or hip replacement surgery //
Arch. Orthop. Trauma Surg. Repub. 2006. Nov 7.
 Allman K. G., Wilson I. H. Oxford handbook of anesthesiology.
2nd ed. Oxford University Press, 2007. 36 p.
 Bates S. M., Greer I. A., Pabinger I. et al. Venous thromboembolism,
thrombophilia, antithrombotic therapy, and pregnancy: American
college of chest physicians evidence-based clinical practice guidelines
(8th ed.) // Chest. 2008. Vol. 33. P. 844 886.
 Chapman T. M., Goa K. L. Bemiparin: a review of its use in the prevention of venous thromboembolism and treatment of deep vein
thrombosis // Drugs. 2003. Vol. 63 (21). P. 2357 2377.
 Douketis J. D., Berger P. B., Dunn A. S. et al. The perioperative management of antithrombotic therapy. American college of chest physi-

. . , . .























30.

cians evidence-based clinical practice guidelines (8th ed.) // Chest.


2008. Vol. 133. P. 299 339.
Geerts W. H., Pineo G. F., Heit J. A. et al. Prevention of venous
thromboembolism. The Seventh ACCP Conference on Antithrombotic and Thrombolitic Therapy // Chest. 2004. Vol. 126.
P. 338S 400S.
Geerts W. H., Bergqvist D., Pineo G. F. et al. Prevention of venous
thromboembolism. American College of chest physicians evidence
based clinical practice guidelines (8th ed.) // Chest. 2008.
Vol. 133. P. 381 453.
Hirsh J., Guyatt G., Albers G. W. et al. American college of chest
physicians evidence-based clinical practice guidelines (8th ed.).
Executive Summary // Chest. 2008. Vol. 133. P. 71 109.
Kakkar V. V., Howes J., Sharma V., Kadziola Z. The Bemiparin
Assessment group. A comparative, double-blind, randomized trial of
a new second generation LMWH (Bemiparin) and UFH in the prevention of post-operative venous thromboembolism // Thromb.
Haemost. 2000. Vol. 83. P. 523 529.
Kearon C., Kahn S. R., Agnelli G. et al. Antithrombotic therapy for
venous thromboembolic disease: American college of chest physicians
evidence-based clinical practice guidelines (8th ed.) // Chest.
2008. Vol. 133. P. 454 545.
Kolde H. J. Haemostasis. Physiology, pathology, diagnostics. 2nd
ed. Basel: Pentapharm Ltd., 2004. P. 164.
Martinez-Gonzales J., Vila L., Rodrigues C. Bemiparin: second generation, low-molecular-weight heparin for treatment and prophylaxis
of venous thromboembolism // Exp. Rev. Cardiovas. Ther. 2008.
Vol. 6, N 6. P. 793 802.
Mismeti P., Laporte S., Darmon J. Y. et al. Meta-analysis of low
molecular weight heparin in prevention of thromboembolism in general surgery // Br. J. Surg. 2001. Vol. 88. P. 913 930.
Nicolaides A. N. Prevention of venous thromboembolism.
International Concensus Statement. Guidelines complied in accordance with the scientific evidence // Int. Angiol. 2001. Vol. 20.
P. 1 37.
Otero-Fernandez R., Gomez-Outes A., Martinez-Gonzalez J. et al.
Evaluation of the effectiveness and safety of bemiparin in a large
population of orthopedic patients in a normal clinical practice //
Clin. App. Thromb. Hemost. 2008. Vol. 14 (1). P. 75 83.
Planes A. Review of bemiparin sodium a new second generation
low molecular weight heparin and its applications in venous thromboebolism // Exp. Opin. Pharmacother. 2003. N 4 (9).
P. 1551 1561.
Righini M., Perrier A., De Moerloose P., Bounameaux H. D-Dimer
for venous thromboembolism diagnosis: 20 years later // J. Thromb.
Haemost. 2008. Vol. 6, N 7. P. 1058 1071.
Rodriguez-Manas L., Gomez-Huelgas R., Veiga-Fernandez F. et al.
Thromboprophylaxis with the low-molecular-weight heparin bemiparin sodium in elderly medical patients in usual clinical practice: the
ANCIANOS study // Clin. Drug Investig. 2010. Vol. 30 (5).
P. 337 345.
Turpie A. G., Bauer K. A., Caprini J. A. et al. Fondaparinux combined with intermittent pneumatic compression vs. intermittent
pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, doubleblind comparison // J. Thromb. Haemost. 2007. Vol. 5, N 9. P. 1855 1861.

. . , . .



.
. 90 ,

, . 1- ()
(n = 30) () 5000 2
5000 7 , 2- (n = 30) 2500 2
2500 1 7 , 3- (n = 30) (2500 ) 6

86

. . , . .

4 2013

, 2500 1 7 . : (),
(), (), , , III (-III), , - (),
D- , 1- 5- .
. - ( ),
(, , , , - ), ( -III, )
( D-) , .
11,8 %, .

, 5- .
1-
.
.
. 5-
. -
. , ,
.
: , , , .

. . Kligunenko, O. S. ozina
S Dnpropetrovsk Medical Academy of Ministry of Health of Ukraine

BEMIPARIN THROMBOPROPHYLAXIS EFFECT ON HEMOSTASIS


The aim to examine the bemiparin effects on hemostasis with different starting thromboprophylaxis in planned abdominal surgery.
Materials and methods. 90 patients who underwent abdominal surgery : laparoscopic cholecystectomy or large ventral hernia alloplasty during a total intravenous anesthesia with muscle relaxation and mechanical ventilation were prospectively divided into three
groups depending on the thromboprophylaxis type. In the 1st (control) group (n = 30) unfractionated heparin thromboprophylaxis
(UFH) was performed at a 5000 IU dose in 2 hours before surgery and 5000 IU twice daily for 7 days after surgery; in the 2nd group
(n = 30) bemiparin at a 2500 IU dose in 2 hours before surgery and 2500 units once daily for 7 days; in the 3rd group (n = 30) bemiparin
in first dose (2500 IU) was administered 6 h after surgery, followed by 2500 IU once daily for 7 days. Hemostatic parameters studied:
prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen level, factor Xa
activity, antithrombin III AT III), protein C, soluble fibrin-monomer complexes (SFMC), blood D-dimer content before surgery, on 1st
and 5th day after surgery.
Results and discussion. Before surgery, vascular platelet hemostasis parameters (platelet count), coagulation (PT, INR, APTT,
fibrinogen, factor Xa activity), anticoagulant (AT III, protein C) and indirectly fibrinolytic (D-dimer) systems were within normal
limits, the differences between groups was not. SFMC level was above normal at 11.8 %, indicating inhibition of the fibrinolytic system
and the risk of blood clots. UFH thromboprophylaxis does not prevent activation of extrinsic coagulation route and the threat of thromboembolic complications, especially on 5th post-operative day. In the case of pre-operative bemiparin thromboprophylaxis, the hemocoagulation balance normalized due to external and internal routes activation with little coagulation fibrinolytic systems activation to the
1st day end. Prevention with post-operative bemiparin start helped compensate for hypercoagulability due to stabilization of anticoagulant and APTT.
Conclusions. UFH thromboprophylaxis does not eliminate the thromboembolic complications risk with maximum threat to 5th
postoperative day. Pre and post-operative start of bemiparin thromboprophylaxis prevent hypercoagulability after surgery. Bemiparin that
is used in the mode of postoperative start, promotes vascular platelet hemostasis activation in the absence of extrinsic and total coagulation routes and relative fibrinolysis activation lack.
Key words: thromboprophylaxis, bemiparyn, hemostasis, planned abdominal surgery.

87