Consilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum9505710.26442/2075-1753_2018.6.53-56Review ArticlePrevention of thromboembolism. Rational approach of maintaining patients in the postoperative period (review)PestrikovaT. Yutyp50@rambler.ruYurasovaE. Aurasovaea@yandex.ruYurasovI. V-KnyazevaT. Pk_t_2002@mail.ruTkachenkoV. Aya.vik.tka@icloud.comFar Eastern State Medical University of the Ministry of Health of the Russian Federation15062018206535628122021Copyright © 2018, Consilium Medicum2018Problems of prevention and treatment of thromboses and thromboembolism are a relevant clinical situation. According to a number of researchers, most often thrombosis arises after surgeries. thromboembolism of a pulmonary artery (TEPA) - is one of the most frequent reasons of maternal mortality. To some extent it is promoted by increase the number of operations of Cesarean - section after which a risk of specific complications is 10-15 times higher. After gynecologic operations complications after TEPA arise at 19% of the operated women, and the massive thromboembolism is diagnosed during autopsy - for 11.2% of the dead in gynecologic hospitals. TEPA should consider as the preventable reason of hospital mortality of patients. When carrying out the prevention of TEPA, by means of low-molecular heparins, indicators of frequency of thromboembolism multiply decrease. Among all low-molecular heparins used for treatment and prevention of venous thromboembolism and TEPA attracts attention Bemiparin. The feature of a bemiparin is the only low-molecular heparin which can be used for the prevention of TEPA, both in to- and in the postoperative period. Usual use of low-molecular heparins at daily operations in obstetrics and gynecology will allow not only to reduce mortality in hospitals at gynecological patients, but also to eliminate cases of maternal mortality and cases of near - miss from such complications as thromboembolism and TEPA.thromboembolismthromboembolism of a pulmonary arterylow-molecular heparinsbemiparinтромбоэмболиитромбоэмболия легочной артериинизкомолекулярные гепариныбемипарин[Неотложные состояния в акушерстве. Рук-во для врачей. Под ред. В.Н.Серова, Г.Т.Сухих, И.И.Баранова и др. М.: ГЭОТАР-Медиа, 2011.][Акушерство. Национальное рук-во. Под ред. Г.М.Савельевой, Г.Т.Сухих, В.Н.Серова, В.Е.Радзинского. Изд. 2-е, перераб. и доп. М.: ГЭОТАР-Медиа, 2015.][Причины и резервы снижения материнской смертности на современном этапе. Рук-во для врачей. Изд. 2-е, доп. Под ред. А.П.Милованова, И.О.Буштыревой. М.: МДВ, 2014][Пестрикова Т.Ю. Мониторирование основных показателей работы акушерско-гинекологической службы Дальневосточного Федерального округа в 2017 г. Сб.: Новые технологии в акушерстве и гинекологии. Хабаровск: Изд-во ДГМУ, 2018; с. 10-52.][Рагимова Р.И. Комплексная профилактика ранних тромбоэмболических осложнений с использованием перфторуглеродных соединений у больных после гинекологических операций. Совр. проблемы науки и образования. 2016; 2: 165][Guidelines on the diagnosis and management of acute pulmonary embolism. The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology. Eur Heart J 2008; 29: 2276-315.][Chapman N.H, Brighton T, Harris M.F et al. Venous thromboembolism - management in general practice. Aust Fam Physician 2009; 38 (1-2): 36-40.][Cohen A.T, Agnelli G, Anderson F.A et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (4): 756-64.][Cohen A.T, Tapson V.F, Bergmann J.F et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371 (9610): 387-94.][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; 133: 381-453.][Kearon C, Akl E.A, Comerota A.J et al. Antithrombotic therapy for venous thromboembolic disease: antithrombotic therapy and prevention of thrombosis. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Ed.). Chest 2012; 141: 419-94.][Макацария А.Д., Бицадзе В.О., Акиньшина С.В. Тромбозы и тромбоэмболии в акушерско-гинекологической практике. Молекулярно-генетические механизмы и стратегия профилактики тромбоэмболических осложнений: Рук-во для врачей. М.: Медицинское информационное агентство, 2007][Heit J.A. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thrombos Thrombol 2006; 21: 23-9.][Серов В.Н., Пасман Н.М., Стуров В.Г., Дробинская А.Н. Наследственные и приобретенные тромбофилические состояния в акушерско-гинекологической практике. Клинические аспекты, диагностика, тактика ведения, подходы к терапии. Рук-во для врачей. Новосибирск: Сова, 2011.][Ряженов В.В., Горохова С.Г. Клинико-экономический анализ применения низкомолекулярных гепаринов в рутинной клинической практике. Трудный пациент. 2012; 10 (6): 12-5.][Scottish Intercollegiate Guidelines Netword (SIGN), Prevention and Management of Venous Thromboembolism, A National Clinical Guideline, 2010.][Abad J.I, Gomez-Outes A, Martinez-Gonzalez J, Rocha E. 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 2007; 127 (8): 665-70.][Vavken P, Lunzer A, Grohs J.G. A prospective cohort study on the effectiveness of 3500 IU versus 5000 IU bemiparin in the prophylaxis of postoperative thrombotic events in obese patients undergoing orthopedic surgery. Wien Klin Wochenschr 2009; 121 (13-14): 454-8.][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; 30 (5): 337-45.][Planes A. Review on bemiparin sodium - a new second generation low-molecular-weight heparin and its applications in venous thromboembolism. Expert Opin Pharmacother 2003; 4: 1551-61.][Abad Rico J.I, Lozano Sánchez F.S, Rocha E. Clinical experience with bemiparin. Drugs 2010; 70 (Suppl. 2): 25-33.][Gómez-Outes A, Rocha E, Martínez-González J, Kakkar W. Cost effectiveness of bemiparin sodium versus unfractionated heparin and oral anticoagulants in the acute and long-term treatment of deep vein thrombosis. Pharmacoeconomics 2006; 24 (1): 81-92.][Kahn S.R, Panju A, Geerts W et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 2007; 119 (2): 145-55.][Abad J.I, Gómez-Outes A, Martínez-González J, Rocha E. A prospective observational study on the effectiveness and safety of bemiparin, first dose administered 6h after knee or hip replacement surgery. Arch Orthop Trauma Surg 2007; 127 (8): 665-70.][Kakkar W, Balibrea J.L, Martínez-González J, Prandoni P. Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBE-SURE randomized study. J Thromb Haemost 2010; 8 (6): 1223-9.][Constans M, Santamaria A, Mateo J et al. Low-molecular-weight heparin as bridging therapy during interruption of oral anticoagulation in patients undergoing colonoscopy or gastroscopy. Int J Clin Pract 2007; 61: 212-7.][Lecumberri R, Rosario E, Pacho J, Rocha E. Fixed-dose low-molecular-weight heparin, bemiparin, in the long-term treatment of venous thromboembolism in patients with transient risk factors in standard clinical practice: the FLEBUS study. J Thromb Haemost 2006; 4: 2504-8.][Amin A, Stemkowski S, Lin J, Yang G. Thromboprophylaxis rates in US medical centers: success or failure? J Thromb Haemost 2007; 5 (8): 1610-6.][Cohen A.T, Tapson V.F, Bergmann J.F et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371 (9610): 387-94.][Инструкция по применению препарата Цибор. http://medside.ru/tsibor]