[Risk factors for venous thromboembolic complications and their association with D-dimer level].

AIM: to study the prevalence of various risk factors (RF) for venous thromboembolic events (VTEE) and their association with D-dimer levels. SUBJECTS AND METHODS: The clinical, demographic, anthropometric, anamnestic, and laboratory data were analyzed in 106 patients (73 men and 33 women) aged 18 to 78 years admitted to hospital with the first or recurrent episode of VTEE. RESULTS: RF and VTEE-associated diseases were identified in all patients. Over 90% of the patients had more 2 RFs. The most common RFs were the age above 40 years (85%) and overweight (82%), including obesity (42%). There was a preponderance of cardiovascular diseases in the pattern of VTEE-associated diseases. The direct causes (precipitating factors) of thrombosis were revealed in 57% of cases; the thrombotic episode was classified as idiopathic in 43%. Elevated D-dimer levels were found in 74% of the patients. Higher D-dimer content was seen in women, non-smokers, patients operated on for thrombosis, those who had 2 precipitating factors or more, and those who had a less than 30-day history of thrombosis. There was an inverse correlation between the elevated level of D-dimer and the duration of thrombosis by the moment of its identification (thrombus age). CONCLUSION: All patients who have experienced a venous thrombotic episode have various RFs for VTEE The content of D-dimer exceeds the normal value in most patients with VTEE. Among the RFs studied, thrombus age is the most important factor associated with elevated D-dimer levels in patients with VTEE

The importance of D-dimer for the diagnosis of venous thromboses in clinical cardiology.

The aim of the study was to analyze the importance of the rapid assay for D-dimer in the diagnosis of venous thromboses (VT). The study accrued 82 patients. There were 57 (70%) men and 25 (30%) women aged 16 to 86 years. Fifty-three patients were suspected of deep venous thrombosis (DVT) and 29 of pulmonary thromboembolism (PTE). In 49 of the 82 patients, the use of USD, isotope phlebography, x-ray and ventilation-perfusion scintigraphy of the lungs made it possible to verify the diagnosis of VT. In one case, it was verified on autopsy. In 33 patients, the suspicions were rejected. The blood assay for D-dimer was performed using the kit Roche/Diagnostika Stago. The method is based on agglutination of latex particles covered by monoclonal antibodies to D-dimer. Among the 49 patients with a verified diagnosis of VT, D-dimer was positive in 44 (89.8%) and negative in 5 (11.4%) patients. In the group of the 33 patients, in whom the diagnosis of VT was rejected, D-dimer was negative in 26 (78.8%) and positive in 7 (21.8%) patients. Thus, the sensitivity of the assay for D-dimer constituted 89.8% and the specificity 78,8%. The high sensitivity of the assay provides an opportunity of using D-dimer measurement as a screening method in patients suspected of VT. Negative D-dimer is helpful in excluding VT. If D-dimer is positive, the diagnosis should be confirmed by other methods.

[Antiischemic efficacy of trimetazidine in patients with ischemic heart disease, stable angina pectoris and disturbances of carbohydrate metabolism]. / Antiishemicheskaia éffektivnost' trimetazidina u bol'nykh ishemicheskoi bolezn'iu serdtsa, stabil'noi stenokardiei i narusheniiami uglevodnogo obmena.

AIM: To compare antiischemic effects of trimetazidine in patients with stable angina pectoris with and without disturbances of carbohydrate metabolism. MATERIAL: Patients with ischemic heart disease, stable class II-III angina pectoris and reproducible positive results of on-treatment exercise tests (n=40, mean age 56.7-/+1.95 years, 37 men) with normal carbohydrate metabolism (group 1, n=20) and with disturbances of carbohydrate metabolism (group 2, n=20). METHODS: All patients in addition to individually selected antianginal therapy were given trimetazidine (60 mg/day) for 2 months. Bicycle exercise tests were repeated after 1 and 2 months. Patient's diaries were used for registration of anginal attacks and nitroglycerine consumption. RESULTS: Addition of trimetazidine was associated with significant (p<0.005) prolongation of exercise duration until 1 mm-ST depression in both groups. Exercise duration was 553-/+10.5 and 555-/+10.2 s (p>0.05) at baseline, 657-/+15.3 and 695-/+10.1 s (p<0.05) after 2 months in groups 1 and 2, respectively. Other effects of trimetazidine in groups 1 and 2 included increases of total work performed during exercise test (by 14 and 22%, respectively), decreases in numbers of patients with ST depression (by 40, p<0.05, and 50%, p<0.05, respectively), numbers of anginal attacks (by 30, p<0.001, and 43%, p<0.001, respectively) and nitroglycerine pills (by 13%, p<0.001 and 51%, p<0.001, respectively). The decrease in supplemental nitroglycerine consumption was significantly more pronounced in group 2 (p<0.0001). There was no significant increment in double product in both groups. CONCLUSION: Antiischemic effect of trimetazidine was greater in patients with angina pectoris and disturbances of carbohydrate metabolism than in similar patients without such disturbances. KEY WORDS. trimetazidine; diabetes, type II, ischemic heart disease; angina pectoris.