[Determination of anti-Xa activity in cancer patients].

Low molecular-weight heparins (clexan, fraxiparin, fragmin) were used in cancer patients to prevent hemostatic system disorders and related complications. The adequacy and safety of therapy were assessed measuring plasma anti-Xa activity in 239 patients. When the prophylactic doses of the low molecular-weight heparins clexan, fraxiparin, and fragmin were given, their anticoagulative effect was similar as judged from anti-Xa activity. Clexan exhibited the maximum anti-Xa activity when the therapeutic doses of the low molecular-weight heparins were used.

[Low molecular-weight heparin (clexane) in the prevention of thrombotic events in patients with malignancies].

The basic links of the hemostatic system and the markers of intravascular thrombogenesis were studied, by using an automatic STA Compact analyzer in 80 patients with locomotor tumors. The patients were divided into 2 groups: 1) 50 patients received clexane, 40 mg, 12 hours before and within 7-18 days after surgery (a study group); 2) 30 patients underwent only nonspecific prevention of thrombotic events (a control group). Postoperatively, hypercoagulation was shown to persist long (up to 18 days) in patients with locomotor tumors. Clexane used in the pre- and postoperative periods within 18-20 days was effective in reducing the rate of intravascular blood coagulation, preventing thrombotic events, and failing to cause hemorrhages.

[The clinical value of D-dimer in the diagnosis and treatment of thromboembolic complications and DIC syndrome in cancer patients].

The content of D-dimer was studied in 130 patients with cancer at various sites. Twenty-five patients were diagnosed as having pulmonary thromboembolism (PTE), 30 had venous thromboses, and 35 patients had acute and subacute disseminated intravascular coagulation (DIC) syndrome. A control group included 40 patients without thrombotic complications. The studies were performed on an automatic STA COMPACT analyzing device. It has been shown that there is a drastic (10-15-fold) increase in the content of D-dimer as compared with the controls. The highest level of D-Dimer was observed in patients with acute DIC who have significant clinical symptomss. The level of D-dimer was to a lesser extent increased in patients with multiple organ deficiency. The content of D-dimer decreased during therapy anticoagulant therapy. When PTE, venous thrombosis, or DIS are suspected, it is advisable to include the study of D-dimer into a coagulogram.

[Intraoperative infusion-transfusion therapy in pediatric surgical oncology]. / Intraoperatsionnaia infuzionno-transfuzionnaia terapiia pri operatsiiakh v detskoi onkologii.

Modern concept of intraoperative blood loss compensation differs crucially from the old rule to compensate the blood loss by donor blood in the same volume, which is explained by serious risks associated with blood transfusions. The parameters of infusion/transfusion therapy with 6% Infucol GEK are presented. The drug was used with good results in adults and children. Volemic parameters are presented and dynamic changes in the blood clotting system after transfusion of infucol GEK and Russian colloid preparation polygluquine are analyzed. Infucol GEK improved vascular blood filing and decreased the volume of other preparations used for blood loss compensation.

[Results of a phase I clinical trial of "theraphthal + ascorbic acid" catalytic system]. / Rezul'taty I fazy klinicheskogo izucheniia kataliticheskoi sistemy "teraftal + askorbinovaia kislota".

Phase-I clinical studies of teraphtal and a "teraphtal + ascorbic acid" catalytic system have been completed. The dose-limiting toxicity and maximum tolerable dose were not reached even at the end of maximal dose trials. No side-effects characteristic of antitumor cytostatic drugs were registered. The gravest side-effect ever recorded was a collapse which could not be linked to teraphtal dosage and was probably caused by hypersensitivity to the drug. The drug was recommended for phase II trials.

[Effects of theraphthal-Lio on hemostasis in experimental animals]. / Vliianie teraftala-Lio na gemostaz zhivotnykh.

Teraphtal-Lio (Tph) exerted a toxic dose-dependent effect on the hemostatic system. Treatment of experimental animals with maximum tolerated and highly toxic doses was followed by acute DVS syndrome formation involving a hemophilic condition, soaring activated partial prothrombin time, absence of fibrinogen, sharp rise in fibrinogen degradation product and D-dimer matched by fall in thrombocyte count. No toxic influence on the hemostatic system was registered when Tph doses recommended for humans in the course of phase II clinical trials were administered to animals.

[Hemostasis disorders in cancer patients with massive intraoperative blood loss]. / Narusheniia sistemy gemostaza u onkologicheskikh bol'nykh s massivnoi intraoperatsionnoi krovopoterei.

The hemostasis system was examined before, during, and after surgery in 130 patients with blood loss from 50 to more than 200% total circulatory volume. Blood loss caused deep changes in the hemostasis system, presenting as acute and subacute syndrome of different hypocoagulation degree in parallel with fibrinolysis activation of different intensity, or as hemodilution coagulopathy, or combination of both. Laboratory signs of acute DIC syndrome anticipate its clinical manifestation, which allows rapid correction of the detected disorders and prevention of severe hemorrhages. A complex of methods for rapid diagnosis of coagulopathic hemorrhages is developed. Various approaches to the treatment of DIC syndrome during and after surgery were used in patients with massive blood loss.

[The effect of Clexane (low-molecular-weight heparin) on the hemostatic system and on the incidence of postoperative thrombotic complications in gynecological cancer patients]. / Vliianie kleksana (nizkomolekuliarnogo geparina) na sistemu gemostaza i chastotu posleoperatsionnykh tromboticheskikh oslozhnenii u onkoginekologicheskikh bol'nykh.

Clexane in a dose of 40 mg before and after surgery notably decreased the intensity of chronic intravascular blood coagulation during surgical treatment of oncogynecological patients. Only 3% patients developed thrombosis of deep veins of the lower limbs after Clexane, while in the group administered no Clexane, 20% developed this complication. Preventive administration of Clexane did not cause an increase of the operative blood loss. The incidence of wound hematomas in patients administered Clexane and nonfractionated heparin was negligible and virtually the same.

[The diagnosis and correction of hemostatic system disorders during surgical coagulopathic hemorrhages in cancer patients]. / Diagnostika i korrektsiia narushenii sistemy gemostaza vo vremia operatsionnykh koagulopaticheskikh krovotechenii u onkologicheskikh bol'nykh.

The hemostasis system was examined before surgery, during the principal stages of the operative intervention, and in the early postoperative period in 280 patients with various malignant tumors. The volume of intraoperative blood loss varied from 280 to 14,000 ml. The studies revealed that the main factor causing the most profound disorders in the hemostasis system which lead to the development of grave coagulopathic hemorrhages is blood loss due to surgical trauma. Coagulopathic bleedings most frequently develop in case of at least a 3000 ml blood loss and course as different variants and stages of the syndrome of disseminated intravascular coagulation (DIC) or hemodilution coagulopathy. Massive blood loss was found to involve primarily damage of the platelet component of the hemostasis system, thrombocytopenia being paralleled by a drastic reduction of the aggregability of these cells, this, in turn, increasing bleeding from small vessels. Laboratory signs of acute DIC diagnosed during surgery anticipate its clinical manifestation. Working classification of operative bleedings and rapid methods for their diagnosis have been developed.

[Coagulopathic hemorrhages in the surgical treatment of cancer patients]. / Koagulopaticheskie krovotecheniia pri khirurgicheskom lechenii onkologicheskikh bol'nykh.

The hemostasis system was examined before surgery, during the principle stages of the intervention, and in the immediate postoperative period in 280 patients with various malignant tumors. The volume of blood loss during the operation varied from 280 to 14,000 ml. The studies demonstrated that blood loss due to traumatic surgical interventions is the principal factor causing the most profound disorders in the hemostasis system leading to the development of grave coagulopathic hemorrhages in cancer patients. Coagulopathic bleedings most frequently develop at a blood loss of more than 3,000 ml and course as variants and stages of the disseminated intravascular coagulation (DIC) syndrome or hemodilution coagulopathy. A massive blood loss was found to be detrimental primarily for the platelet component of the hemostasis system; besides thrombocytopenia, the aggregability of these cells reduced, this being conducive to development of hemorrhages from the small vessels. Laboratory signs of acute DIC syndrome diagnosed during surgery were shown to anticipate its clinical manifestation. A working classification of surgical hemorrhages and rapid methods for their diagnosis have been developed.

[The diagnosis and prevention of hemostatic system disorders in the surgical treatment of patients with cancer of the large intestine]. / Diagnostika i profilaktika narushenii sistemy gemostaza pri khirurgicheskom lechenii bol'nykh rakom tolstoi kishki.

The hemostasis system was studied before, during, and after surgery in 40 patients with colonic cancer administered no pretreatment and in 30 ones administered depogen before the operation and its combination with heparin after surgery. Preoperative depogen had a positive impact on both the coagulation and platelet components of the hemostasis. Depogen in complex with heparin reduced the intensity of subacute chronic intravascular blood coagulation during and after the operation and was conducive to a decrease of the incidence of postoperative complications in patients with colonic cancer.

[Prevention of hemostatic disorders at different stages of surgical treatment in patients with colonic cancer]. / Profilaktika narushenii sistemy gemostaza na razlichnykh étapakh khirurgicheskogo lecheniia bol'nykh rakom tolstoi kishki.

The status of the hemostasis system was studied in 40 patients with colonic cancer before, during, and after surgery, who were administered no treatment before the operation, and in 30 ones administered depogen with heparin in the preoperative period. Preoperative treatment with depogen had a favorable effect on both coagulation and platelet components of the hemostasis system. Administration of depogen together with heparin reduced the intensity of subacute chronic intravascular blood coagulation during and after surgery in patients with colonic cancer and was conducive to a reduction of the incidence of postoperative complications.

[The effect of antioxidants on the hemostasis system in patients with cancer of the lung]. / Vliianie antioksidantov na sistemu gemostaza u bol'nykh rakom legkogo.

Addition of drugs improving blood viscosity to premedication with antioxidants promotes to normalization of platelet function, thus attenuating the intensity of chronic intravascular coagulation syndrome and improving the state of microcirculation in patients with lung cancer. The above premedication decreases the incidence of postoperative complications.

[Diagnosis of postoperative coagulopathic hemorrhage in oncology patients]. / Diagnostika operatsionnykh koagulopaticheskikh krovotechenii u onkologicheskikh bol'nykh.

The condition of the hemostatic system during operation and in the early postoperative period was studied in 288 oncological patients in blood loss of different volumes. A relation of changes in hemostasis to the amount of blood lost was found. The increase in the volume of blood loss was caused first of all by the traumatic character of the operation itself, i.e. surgical hemorrhages, while the coagulopathic hemorrhages were of a secondary character. They evolve as acute and subacute syndrome with generalized, hypercompensated or moderate fibrinolysis in the form of hemodilution coagulopathy with predominant reduction of the number of platelets and their dysfunctions, or are mixed in character. A complex of rapid methods for the diagnosis of coagulopathic hemorrhages is recommended.