medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-4S-87-93medsovet-6214Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHЭноксапарин натрия – препарат выбора для лечения тромбозов в онкологииEnoxaparin sodium as a drug of choice for the treatment of thrombosis in oncologyhttps://orcid.org/0000-0003-4706-2439СомоноваО. В.SomonovaО. V.

Сомонова Оксана Васильевна, д.м.н., ведущий научный сотрудник

115478, Москва, Каширское шоссе, д. 24

Oxana V. Somonova, Dr. Sci. (Med.), Leading Research Associate

24, Kashirskoye Shosse, Moscow, 115478

somonova@mail.ruhttps://orcid.org/0000-0001-6975-4562ЕлизароваА. Л.ElizarovaА. L.

Елизарова Анна Львовна, к.б.н., старший научный сотрудник

115478, Москва, Каширское шоссе, д. 24

Anna L. Elizarova, Cand. Sci. (Biol.), Senior Research Associate

24, Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-5769-3114ДавыдоваТ. В.DavydovaТ. V.

Давыдова Татьяна Владимировна, к.б.н., заведующая клинико- диагностической лабораторией

115478, Москва, Каширское шоссе, д. 24

Tatiana V. Davydova, Cand. Sci. (Biol.), Head of Clinical Diagnostic Laboratory, 

24, Kashirskoye Shosse, Moscow, 115478

Национальный медицинский исследовательский центр онкологии имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии  имени Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии им. Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian Federation20211206202104S8793Copyright © Сомонова О.В., Елизарова А.Л., Давыдова Т.В., 20212021Сомонова О.В., Елизарова А.Л., Давыдова Т.В.Somonova О.V., Elizarova А.L., Davydova Т.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/6214Введение

Введение. Тромбоэмболические осложнения часто развиваются у больных злокачественными новообразованиями, а возникновение тромбоза осложняет противоопухолевое лечение и  ухудшает выживаемость онкологических пациентов. Низкомолекулярные гепарины (НМГ) являются препаратами первого выбора для лечения рак-ассоциированных тромбозов, т. к. в настоящее время имеется обширная доказательная база по эффективности и безопасности применения НМГ у онкологических пациентов.

Цель

Цель. Оценить эффективность и безопасность применения эноксапарина натрия для лечения тромбозов у онкологических больных.

Материалы и методы

Материалы и методы. Под нашим наблюдением находилось 190 онкологических больных на различных этапах комплексного лечения. Из них 70 пациентов с острыми тромбозами и тромбоэмболией легочной артерии (ТЭЛА). Больные с тромбозами получали лечебные дозы эноксапарина натрия. Оценка показателей гемостаза была проведена с использованием автоматического анализатора. Больным проводилось дуплексное ангиосканирование сосудов нижних конечностей.

Результаты и обсуждение

Результаты и обсуждение. У онкологических больных с тромбозами по сравнению с больными без тромбозов имела место выраженная гиперкоагуляция с признаками активного внутрисосудистого свертывания крови. Применение эноксапарина натрия у онкологических больных с тромбозами уменьшало интенсивность внутрисосудистого свертывания крови со снижением концентрации фибриногена и маркеров внутрисосудистого свертывания крови. По данным УЗ-исследования венозные тромбозы не  определялись, либо наступала реканализация просвета сосуда, ни  в  одном случае не  развивалась ТЭЛА. У 8 пациентов сохранялся высокий уровень Д-димера (> 2 мкг/мл) и фактора Виллебранда, что явилось неблагоприятными прогностическими признаками. У этих больных наблюдалиcь рецидивы венозных тромбозов, что требовало более длительного и упорного лечения тромботических осложнений.

Выводы

Выводы. Эноксапарин натрия является эффективным и безопасным препаратом для лечения тромбозов в онкологии.

Introduction

Introduction. Patients with cancer are more likely to develop thromboembolic complications, and the occurrence of thrombosis complicates the course of anticancer treatment and worsens the survival rate of cancer patients. Low molecular weight heparins (LMWH) is the first choice for the treatment of cancer-associated thrombosis, as there is extensive evidence on the efficacy and safety of LMWH in cancer patients based on current knowledge.

Materials and methods

Materials and methods. There were 190 cancer patients under our supervision at various stages of complex treatment. Of these, 70  patients with acute thrombosis and pulmonary embolism  (PE) who received therapeutic doses of  enoxaparin  sodium. Assessment of hemostasis parameters was carried out using an automatic analyzer. The patients underwent duplex angioscanning of the vessels of the lower extremities.

Results and discussion

Results and discussion. The use of enoxaparin sodium in cancer patients with thrombosis reduced the intensity of intravascular coagulation with a decrease in the concentration of fibrinogen and markers of intravascular coagulation. According to the ultrasound study, venous thrombosis was not detected, or recanalization of the vessel lumen occurred, in no case did PE develop. Eight patients retained high levels of D-dimer (> 2 μg/ml) and von Willebrand factor, which were unfavorable prognostic signs. In these patients, recurrence of venous thrombosis was observed, which required a more prolonged and persistent treatment of thrombotic complications.

Conclusion

Conclusion. Enoxaparin sodium is an effective and safe drug for the treatment of thrombosis in oncology. 

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