[Surgical treatment of COVID-19 patients during the pandemic]. / Opyt khirurgicheskogo lecheniya patsientov s COVID-19 v period pandemii.

OBJECTIVE: To analyze the results of emergency surgery in COVID-19 patients with viral pneumonia. MATERIAL AND METHODS: A retrospective study included 75 COVID-19 patients who underwent emergency surgical interventions. Comorbidities included cardiac diseases, nonspecific lung diseases, type 2 diabetes, kidney diseases, overweight, and cancer. Various combinations of these diseases were also noted. RESULTS: We carried out emergency surgeries for abdominal, thoracic, soft tissue and venous diseases. Postoperative mortality was 42.6%. The best results were obtained after minimally invasive interventions without mechanical ventilation. Extended surgery with mechanical ventilation was followed by fast progression of pneumonia according to clinical and CT data. CONCLUSION: Surgical interventions undoubtedly worsen prognosis of treatment in patients with COVID-19. Emergency minimally invasive surgery without mechanical ventilation can reduce the risk of unfavorable outcomes in patients with viral pneumonia, especially in case of concomitant cancer and other severe comorbidities.

[Management of surgical complications following prolonged warfarin therapy in a general surgical hospital]. / Lechenie khirurgicheskikh oslozhnenii prolongirovannoi terapiei varfarinom v obshchekhirurgicheskom statsionare.

OBJECTIVE: To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. MATERIAL AND METHODS: The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). RESULTS: Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. CONCLUSION: The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.

[Coagulological aspects of treatment of complications of prolonged therapy with warfarin]. / Koagulologicheskie aspekty lecheniia oslozhnenii prolongirovannoi terapii varfarinom.

The authors analysed the results of treating a total of 116 patients (68 men and 48 women aged from 20 to 84 years, mean age 59.5±15.5 years) presenting with various complications of prolonged therapy with warfarin. Prescription of prolonged therapy with warfarin had been caused by various cardiac diseases and lower extremity deep vein thromboses. The duration of anticoagulant therapy at the time of onset of complications was different and depended on the underlying disease. The majority of patients included into the study had been taking warfarin for one year and more, with nearly half of patients (48.1%) - for more than 5 years. Examination of patients included clinical, instrumental and laboratory studies, among which we determined standard laboratory parameters of haemostasis [activated partial thromboplastin time (APTT), international normalised ratio (INR), prothrombin index, prothrombin time, thrombin time, fibrinogen, etc.] and global tests (the thrombodynamics test and thromboelastogram). Amongst complications of prolonged warfarin therapy, 10 patients were found to have various thrombotic complications and 106 patients were diagnosed as having various by localisation and intensity haemorrhage. The obtained results of the study have demonstrated that the appearance of any thrombotic complications takes place occurs on the background of insufficient hypocoagulation and often require only correction of warfarin therapy. Whereas floating thrombi developing on the background of inadequate warfarin therapy require surgical management. Once haemorrhagic complications have developed, beside appropriate correction of warfarin therapy it is necessary to carry out correction of coagulopathies, which is done by means of different drugs and therapeutic regimens, whose choice should be based on assessing the clinical findings (localization and severity of haemorrhage) and laboratory indices, the main of which are local coagulologic tests, as well as global tests. The thrombodynamics test proved highly efficient for assessing the state of plasma haemostasis and predicting danger of the development of venous thromboembolic complications in patients with lower extremity deep vein thrombosis on the background of hyper- and hypocoagulation.

[Criteria for efficacy of anticoagulant therapy in patients with thromboses of deep veins of lower limbs].

The authors analysed the results of a prospective study of dynamics of laboratory indices of plasma haemostasis on the background of anticoagulant therapy in a total of 60 patients (23 women and 37 men) presenting with idiopathic thromboses of deep veins of lower limbs in order to work out criteria for its efficacy and safety. Anticoagulant therapy was carried out using nonfractionated heparin according to the standard regimens. The patients' mean age amounted to 57.4±13.6 years. Studying the system of haemostasis along with generally known standard laboratory indices (activated partial prothrombin time, D-dimer, fibrinogen, prothrombin level, INR, PTI) included one of the global coagulogical tests - a method of thrombodynamics whose main parameter was Vs (stationary clot growth rate). The results of anticoagulant therapy were assessed by dynamics of clinical symptomatology, the findings of ultrasonographic angioscanning, and by the dynamics of laboratory parameters of plasma haemostasis. The obtained findings demonstrated that anticoagulant therapy with nonfractionated heparin followed by switching to warfarin is an effective method of conservative treatment of patients with idiopathic thromboses, making it possible to attain laboratory confirmed hypocoagulation accompanied by both clinical and US-controlled improvements. The results of the thrombodynamics assay by the dynamics of a decrease in the D-dimer level made it possible to statistically significantly single out a group with no effect of heparin (no effect of hypocoagulation) and high sensitivity in singling out groups of ineffective therapy with warfarin, which on the background of normo- or hypercoagulation is a marker of increased fibrinogenesis and, consequently, of high risk for the development of recurrent thrombosis in such patients.