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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">lvrach</journal-id><journal-title-group><journal-title xml:lang="ru">Лечащий Врач</journal-title><trans-title-group xml:lang="en"><trans-title>Lechaschi Vrach</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1560-5175</issn><issn pub-type="epub">2687-1181</issn><publisher><publisher-name>ООО «Издательство "Открытые системы"»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.51793/OS.2021.24.11.012</article-id><article-id custom-type="elpub" pub-id-type="custom">lvrach-842</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>АКТУАЛЬНАЯ ТЕМА</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>TOPICAL THEME</subject></subj-group></article-categories><title-group><article-title>Влияние сопутствующей патологии на систему гемостаза в периоперационном периоде при некардиальной хирургии</article-title><trans-title-group xml:lang="en"><trans-title>Effect of concomitant diseases on the hemostasis system in the perioperative period of non-cardiac surgery</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0951-1475</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пряхин</surname><given-names>И. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Pryakhin</surname><given-names>I. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Пряхин Иван Сергеевич, аспирант; врач анестезиолог-реаниматолог</p><p>121359, Россия, Москва, ул. Маршала Тимошенко, 19, стр. 1А</p><p>119285, Россия, Москва, Мичуринский пр., 6, стр. 1</p></bio><bio xml:lang="en"><p>Ivan S. Pryakhin, PhD student; anaesthesiologist and intensivist</p><p>19 b. 1A Marshal Timoshenko str., Moscow, 121359, Russia</p><p>6 b. 1 Michurinsky ave., Moscow, 119285, Russia</p></bio><email xlink:type="simple">vanja.prjakhin@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7124-1918</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мурашко</surname><given-names>С. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Murashko</surname><given-names>S. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мурашко Светлана Степановна, к. м. н., доцент кафедры анестезиологии и реаниматологии; заместитель главного врача</p><p>121359, Россия, Москва, ул. Маршала Тимошенко, 19, стр. 1А</p><p>119285, Россия, Москва, Мичуринский пр., 6, стр. 1</p></bio><bio xml:lang="en"><p>Svetlana S. Murashko, MD, Associate professor of department of Anesthesiology and Intensive Care; Deputy chief physician</p><p>19 b. 1A Marshal Timoshenko str., Moscow, 121359, Russia</p><p>6 b. 1 Michurinsky ave., Moscow, 119285, Russia</p></bio><email xlink:type="simple">murashkos@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1002-1895</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бернс</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Berns</surname><given-names>S. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бернс Светлана Александровна, д. м. н., профессор кафедры терапии и общей врачебной практики</p><p>101990, Россия, Москва, Петроверигский пер., 10</p></bio><bio xml:lang="en"><p>Svetlana A. Berns, Dr. of Sci. (Med.), Рrofessor at the Department of Therapy and General Medical Practice</p><p>10 Petroverigsky Lane, Moscow, 101990, Russia</p></bio><email xlink:type="simple">svberns@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8121-4160</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пасечник</surname><given-names>И. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Pasechnik</surname><given-names>I. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Пасечник Игорь Николаевич, д. м. н., профессор, заведующий кафедрой анестезиологии и реаниматологии</p><p>121359, Россия, Москва, ул. Маршала Тимошенко, 19, стр. 1А</p></bio><bio xml:lang="en"><p>Igor N. Pasechnik, Dr. of Sci. (Med.), Professor, Head of department of Anesthesiology and Intensive Care</p><p>19 b. 1A Marshal Timoshenko str., Moscow, 121359, Russia</p></bio><email xlink:type="simple">pasigor@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ ДПО ЦГМА УДП РФ; ФГБУ Объединенная больница с поликлиникой УДП РФ</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Central State Medical Academy of the Administrative Department of the President of the Russian Federation; Joint Hospital with Polyclinic of the Administrative Department of the President of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБУ НМИЦ ТПМ Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Institution National Medical Research Center for therapy and Preventive Medicine of the Ministry of Healthcare of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБУ ДПО ЦГМА УДП РФ</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Central State Medical Academy of the Administrative Department of the President of the Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2021</year></pub-date><pub-date pub-type="epub"><day>18</day><month>12</month><year>2021</year></pub-date><volume>1</volume><issue>11</issue><fpage>73</fpage><lpage>78</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Пряхин И.С., Мурашко С.С., Бернс С.А., Пасечник И.Н., 2021</copyright-statement><copyright-year>2021</copyright-year><copyright-holder xml:lang="ru">Пряхин И.С., Мурашко С.С., Бернс С.А., Пасечник И.Н.</copyright-holder><copyright-holder xml:lang="en">Pryakhin I.S., Murashko S.S., Berns S.A., Pasechnik I.N.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://journal.lvrach.ru/jour/article/view/842">https://journal.lvrach.ru/jour/article/view/842</self-uri><abstract><p>В данном исследовании изучалось влияние клинических факторов и антитромботической терапии на свертывающую систему крови пациентов в периоперационном периоде. В исследование включено 80 пациентов, которым проводилось плановое некардиальное хирургическое вмешательство. Лабораторный контроль осуществлялся с использованием рутинных методов исследования гемостаза (АЧТВ, МНО) и глобального теста исследования гемостаза (тест тромбодинамики). Использование теста тромбодинамики в данном исследовании оказалось более чувствительным методом по сравнению с рутинными тестами и позволило выявить клинические факторы, ассоциированные с гиперкоагуляционными состояниями и снижением эффективности низкомолекулярных гепаринов в послеоперационном периоде: возраст старше 60 лет, фибрилляция предсердий, хроническая ишемическая болезнь сердца, стентирование коронарных артерий в анамнезе, предшествующий прием антитромботической терапии до оперативного вмешательства. У больных с тромбозом глубоких вен нижних конечностей отмечалась гиперкоагуляция в первые сутки после проведения операции по сравнению с остальными пациентами. Использование теста тромбодинамики за сутки до оперативного вмешательства позволило спрогнозировать увеличение объема интраоперационной кровопотери. Назначение периоперационной мост-терапии низкомолекулярными гепаринами у больных с высоким тромботическим риском достоверно ассоциировалось с увеличением трансфузии эритромассы практически в 2 раза по сравнению с остальными пациентами и было связано с повышением риска геморрагических осложнений. Результаты исследования показали, что тест тромбодинамики потенциально может быть применен в дальнейших исследованиях с целью персонификации ведения пациентов в периоперационном периоде при некардиальной хирургии, а также способен прогнозировать возникновение геморрагических и тромботических осложнений.</p></abstract><trans-abstract xml:lang="en"><p>This study examined the effect of clinical factors and antithrombotic therapy on the blood coagulation system of patients in the perioperative period. The study included 80 patients who underwent elective noncardiac surgery. Laboratory control of hemostasis was carried out using routine tests for studying hemostasis (APTT, INR) and a global test for hemostasis (thrombodynamics test). Usage of the thrombodynamics test in this study was more sensitive compared to routine tests and made it possible to identify clinical factors associated with hypercoagulable states and «decreasing in the effectiveness» of low molecular weight heparins in the postoperative period. These factors are: age over 60 years, chronic ischemic heart disease, a history of coronary artery stenting, prior antithrombotic therapy before surgery. Hypercoagulability was found on the first day after surgery in patients with deep vein thrombosis of the lower extremities compared to other patients. The use of a thrombodynamics test a day before surgery allowed to predict an increase of intraoperative blood loss volume. Perioperative bridge therapy with low molecular weight heparins in high thrombotic risk patients was significantly associated with an increase in packed red blood cells transfusion of almost two times compared with other patients and is associated with an increased risk of hemorrhagic complications. The results of the study showed that thrombodynamics test can potentially be used further with the aim of personalizing patients’ management in the non-cardiac surgery perioperative period. It also helps to predict the occurrence of hemorrhagic and thrombotic complications.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>некардиальная хирургия</kwd><kwd>ишемическая болезнь сердца</kwd><kwd>антикоагулянты</kwd><kwd>тромбодинамика</kwd></kwd-group><kwd-group xml:lang="en"><kwd>non-cardiac surgery</kwd><kwd>coronary heart disease</kwd><kwd>anticoagulants</kwd><kwd>thrombodynamic</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Любошевский П. А., Овечкин А. М. Возможности оценки и коррекции хирургического стресс-ответа при операциях высокой травматичности // Регионарная анестезия и лечение острой боли. 2014; 8 (4): 5-21.</mixed-citation><mixed-citation xml:lang="en">Lyuboshevskiy P. A., Ovechkin A. M. 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