medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2018-19-106-112medsovet-2756Research ArticleПоддерживающая терапия в онкологииSupportive care in oncologyСовременные низкомолекулярные гепарины в профилактике и лечении венозных тромбо эмболических осложнений у онкоурологических больныхModern low-molecular-weight heparins in the prevention and treatment of venous thromboembolic complications in oncourologic patientsВоробьевН. В.VorobyevN. V.

к.м.н., заведующий урологическим отделением отдела опухолей репродуктивных и мочевыводящих органов МНИОИ им. П.А. Герцена – филиала ФГБУ «НМИЦ радиологии» Минздрава России, Москва

ПоповС. В.PopovS. V.

д.м.н., профессор кафедры общей врачебной практики Медицинского института ФГАОУ ВО «Российский университет дружбы народов», врач-уролог, Москва

ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России, МоскваРоссияFederal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of Russia, MoscowRussian FederationМедицинский институт ФГАОУ ВО «Российский университет дружбы народов», МоскваРоссияMedical Institute of the Russian Peoples’ Friendship University, MoscowRussian Federation201811112018019106112Copyright © Воробьев Н.В., Попов С.В., 20182018Воробьев Н.В., Попов С.В.Vorobyev N.V., Popov S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2756

Онкоурологические заболевания сопровождаются риском развития венозных тромбоэмболических осложнений и относятся к числу наиболее опасных в плане тромбогенного эффекта. В статье представлен обзор результатов клинических исследований эффективности и безопасности, а также опыта применения в клинической практике современных низкомолекуля рных гепаринов – препаратов выбора для профилактики венозных тромбоэмболических осложнений у онкологических больных. Особое внимание уделено бемипарину – низкомолекулярному гепарину второго поколения с выраженным антитромботическим действием и улучшенными фармакологическими показателями, позволяющими успешно применять его в онкоурологической практике у больных с нарушениями функции почек.

Oncourologic diseases are accompanied by a risk for subsequent venous thromboembolic complications, which are rated the most dangerous in terms of thrombogenic effect. The article presents a review of the clinical studies of efficacy and safety, and the experience in using of modern low-molecular-weight heparins in clinical practice - drugs of choice for the prevention of venous thromboembolic complications in cancer patients. Particular attention is paid to Bemiparin - a new second-generation low-molecular-weight heparin with a significant antithrombotic effect and improved pharmacological parameters that allow it to be successfully used in patients with impaired renal function in oncourological practice.

венозные тромбоэмболические осложненияонкологические больныеонкоурологические заболеванияпрофилактиканизкомолекулярные гепариныбемипаринэффективностьбезопасностьvenous thromboembolic complicationsoncological patientsoncourological diseasespreventionlow-molecular-weight heparinsbemiparinefficacysafetyReferencesБокерия Л.А., Затевахин И.И., Кириенко А.И. и др. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО). Флебология, 2015, 9(4), вып. 2. 52 с.Bokeria LA, Zatevakhin II, Kirienko AI et al. The Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Flebologiya, 2015, 9 (4), No. 2. 52 p.Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA, 2005, 293(6): 715-722.Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA, 2005, 293(6): 715-722.Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancerpatients undergoing chemotherapy in the United States. Cancer, 2013, 119(3): 648-655.Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancerpatients undergoing chemotherapy in the United States. Cancer, 2013, 119(3): 648-655.Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost, 2006, 4(3): 529-535.Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost, 2006, 4(3): 529-535.Чернышев И.В., Перепечин Д.В. Комплексная профилактика тромбоэмболических осложнений у урологических больных. Экспериментальная и клиническая урология, 2012, 1: 57-62.Chernyshev IV, Perepechin DV. Complex prophylaxis of thromboembolic complications in urological patients. Eksperimentalnaya i Klinicheskaya Urologiya, 2012, 1: 57-62.Cedervall J, Hamidi A, Olsson A-K. Platelets, NETs and cancer. Thrombosis Research, 2018, 164(Suppl.1): 48-52.Cedervall J, Hamidi A, Olsson A-K. Platelets, NETs and cancer. Thrombosis Research, 2018, 164(Suppl.1): 48-52.Сомонова О.В., Елизарова А.Л., Нестерова Ю.А., Борисенко Н.Н., Корнюшенко У.А. Возможности применения бемипарина в профилактике и лечении тромбозов в онкологии. Медицинский совет, 2018, 10: 103-106.Somonova OV, Elizarova AL, Nesterova YuA, Borisenko NN, Korniushenko UA. Possibilities of using bemiparin in the prevention and treatment of thrombosis in oncology. Meditsinsky Sovet, 2018, 10: 103-106.Connolly GC, Khorana AA. Emerging risk stratification approaches to cancerassociated thrombosis: risk factors, biomarkers and a risk score. Thromb Res, 2010, Apr, 125(Suppl. 2): S1.Connolly GC, Khorana AA. Emerging risk stratification approaches to cancerassociated thrombosis: risk factors, biomarkers and a risk score. Thromb Res, 2010, Apr, 125(Suppl. 2): S1.Khalil J, Bensaid B, Elkacemi H. Venous thromboembolism in cancer patients: an underestimated major health problem. World J Surg Oncol, 2015, 13: 204.Khalil J, Bensaid B, Elkacemi H. Venous thromboembolism in cancer patients: an underestimated major health problem. World J Surg Oncol, 2015, 13: 204.Robin P, Carrier M. Revisiting occult cancer screening in patients with unprovoked venous thromboembolism. Thrombosis Research, 2018, 164(Suppl.1): 7-11.Robin P, Carrier M. Revisiting occult cancer screening in patients with unprovoked venous thromboembolism. Thrombosis Research, 2018, 164(Suppl.1): 7-11.Agnelli G, Bolis G, Capussotti L et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @ RISTOS project. Ann Surg, 2006, 243(1): 89-95.Agnelli G, Bolis G, Capussotti L et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @ RISTOS project. Ann Surg, 2006, 243(1): 89-95.Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med, 2006, 166(4): 458-464.Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med, 2006, 166(4): 458-464.Состояние онкологической помощи населению России в 2017 году. Под редакцией Каприна А.Д., Старинского В.В., Петровой Г.В. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2018. 236 с.2017 status of oncological care provided to the population of Russia. Edited by Kaprin AD, Starinsky VV, Petrova GV. Moscow: Herzen Medical Research Cancer Institute, a branch of National Medical Research Center of Radiology of the Ministry of Health of Russia, 2018. 236 p.Варламов С.А., Лубенников В.А., Рассоха А.В., Тачалов М.А. Профилактика послеоперационных венозных тромбоэмболических осложнений у больных местно-распространенным раком почки. Актуальные вопросы онкоурологии и онкогинекологии. Материалы межрегиональной научно-практической конференции с международным участием, 5-6 июня 2002, Барнаул. С. 32.Varlamov SA, Lubennikov VA, Rassokha AV, Tachalov MA. Prevention of postoperative venous thromboembolic complications in patients with locally advanced kidney cancer. Actual questions of oncourology and oncogynecology. Materials of the Interregional Scientific and Practical Conference with international participation, June 5-6, 2002, Barnaul. p. 32.Duivenvoorden WC, Daneshmand S, Canter D, Lotan Y, Black PC, Abdi H et al. Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant Chemotherapy. J Urol, 2016, 196(6): 1627-1633.Duivenvoorden WC, Daneshmand S, Canter D, Lotan Y, Black PC, Abdi H et al. Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant Chemotherapy. J Urol, 2016, 196(6): 1627-1633.Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R et al. Cardiovascular Disease Educational and Research Trust, European Venous Forum, North American Thrombosis Forum, International Union of Angiology and Union Internationale du Phlebologie. Patients With Cancer. Clin Appl Thromb Hemost, 2013, 19(2): 172-176.Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R et al. Cardiovascular Disease Educational and Research Trust, European Venous Forum, North American Thrombosis Forum, International Union of Angiology and Union Internationale du Phlebologie. Patients With Cancer. Clin Appl Thromb Hemost, 2013, 19(2): 172-176.Kakkar AK, Haas S, Wolf H, Encke A. Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost, 2005, 94(4): 867-871.Kakkar AK, Haas S, Wolf H, Encke A. Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost, 2005, 94(4): 867-871.Lyman GH, Bohlke K, Khorana AA, American Society of Clinical Oncology. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014. J Clin Oncol, 2015, 33(6): 654-656.Lyman GH, Bohlke K, Khorana AA, American Society of Clinical Oncology. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014. J Clin Oncol, 2015, 33(6): 654-656.Величко Э.В., Хачукаева А.С., Хабадзе З.С., Аксенова Е.М., Стуров Н.В., Прокофьева Е.Б., Тедорадзе Р.В., Бериша А. Место бемипарина в современной клинической практике. Трудный пациент, 2017, 15(10-11): 11-14.Velichko EV, Khachukaeva AS, Khabadze ZS, Aksenova EM, Sturov NV, Prokofieva EB, Tedoradze RV, Berisha A. The role of Bemiparin in modern clinical practice. Trudny patsient, 2017, 15 (10-11): 11-14.Planès A. Review of bemiparin sodium a new second-generation low molecular weight heparin and its applications in venous thromboembolism. Expert Opin Pharmacother, 2003, 4(9): 1551-1561.Planès A. Review of bemiparin sodium a new second-generation low molecular weight heparin and its applications in venous thromboembolism. Expert Opin Pharmacother, 2003, 4(9): 1551-1561.Rico S, Antonijoan R-M, Ballester MR et al. Pharmacodynamics assessment of Bemiparin after multiple prophylactic and single therapeutic doses in adult and elderly healthy volunteers and in subjects with varying degrees of renal impairment. Thromb Res, 2014, 133 (6): 1029-1038.Rico S, Antonijoan R-M, Ballester MR et al. Pharmacodynamics assessment of Bemiparin after multiple prophylactic and single therapeutic doses in adult and elderly healthy volunteers and in subjects with varying degrees of renal impairment. Thromb Res, 2014, 133 (6): 1029-1038.Atiq F, van den Bemt PM, Leebeek FW et al. A systematic review on the accumulation of prophylactic dosages of low-molecularweight heparins (LMWHs) in patients with renal insufficiency. Eur J Clin Pharmacol, 2015, 71(8): 921-929.Atiq F, van den Bemt PM, Leebeek FW et al. A systematic review on the accumulation of prophylactic dosages of low-molecularweight heparins (LMWHs) in patients with renal insufficiency. Eur J Clin Pharmacol, 2015, 71(8): 921-929.Falkon L, Sáenz-Campos D, Antonijoan R et al. Bioavailability and pharmacokinetics of a new low molecular weight heparin (RO11)-a three way cross-over study in healthy volunteers. Thromb Res, 1995, 78(1): 77-86.Falkon L, Sáenz-Campos D, Antonijoan R et al. Bioavailability and pharmacokinetics of a new low molecular weight heparin (RO11)-a three way cross-over study in healthy volunteers. Thromb Res, 1995, 78(1): 77-86.Westmuckett AD, Kakkar VV, Hamuro T et al. Bemiparin and fluid flow modulate the expression, activity and release of tissue factor pathway inhibitor in human endothelial cells in vitro. Thromb Haemost, 2001, 86(6): 1547-1554.Westmuckett AD, Kakkar VV, Hamuro T et al. Bemiparin and fluid flow modulate the expression, activity and release of tissue factor pathway inhibitor in human endothelial cells in vitro. Thromb Haemost, 2001, 86(6): 1547-1554.Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg, 1988, 208(2): 227-240.Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg, 1988, 208(2): 227-240.Kakkar VV, Balibrea JL, Martinez-Gonzalez J, Prandoni P. Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBESURE randomized study. J Thromb Haemost, 2010, 8(6): 1223-1229.Kakkar VV, Balibrea JL, Martinez-Gonzalez J, Prandoni P. Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBESURE randomized study. J Thromb Haemost, 2010, 8(6): 1223-1229.Стуров Н.В., Медянцева Д.А. Использование бемипарина в качестве средства профилактики венозных тромбозов в общей хирургии и оперативной онкологии. Трудный пациент, 2012, 10(12): 24-28.Sturov NV, Medyantseva DA. The use of bemiparin in the prevention of venous thrombosis in general surgery and operational oncology. Trudny Patsient, 2012, 10 (12): 24-28.Ozaslan E, Ozkan M, Cicin I, Benekli M, Kocer M, Uysal M et al. Effectiveness and Safety of LMWH Treatment in Patients With Cancer Diagnosed With Non-High-Risk Venous Thromboembolism: Turkish Observational Study (TREBECA). Clin Appl Thromb Hemost, 2018, 24(6): 973-979.Ozaslan E, Ozkan M, Cicin I, Benekli M, Kocer M, Uysal M et al. Effectiveness and Safety of LMWH Treatment in Patients With Cancer Diagnosed With Non-High-Risk Venous Thromboembolism: Turkish Observational Study (TREBECA). Clin Appl Thromb Hemost, 2018, 24(6): 973-979.

The authors declare that there are no conflicts of interest present.