[Non-vitamin K antagonist oral anticoagulants for heart diseases]. / Peroral'nye antikoagulianty - antagonisty vitamina K pri zabolevaniiakh serdtsa.

Non-vitamin K antagonist oral anticoagulants (NОАСs) are highly effective drugs that prevent venous thrombosis and stroke in atrial fibrillation. Their use has difficulties that are associated with the need for laboratory control and with the influence of many factors on the activity of these medications. The emerged direct oral anticoagulants have some advantages over NOACs. Nevertheless, there are a number of pathological conditions, in which NOACs remain first-line drugs. These include prosthetic mechanical heart valves, a glomerular filtration rate less than 60 mL/min/1.73 m2, and left atrial thrombus.

[INFLAMMATION AND HEMOCOAGULATION].

Problems of inflammation are extensively studied all over the world. Its mechanisms are known to involve hundreds of factors. The blood coagulation system is a major component of each living organism. This article was designed to analyze the relationship between inflammation and hemocoagulation and discuss definition of the term "low-grade inflammation" with reference to the blood coagulation system.

[ANTICOAGULANTS TODAY].

A review of modern concepts of clinical application of anti-thrombotic drugs, such as heparins, antivitamins K, oral anticoagulants, and thrombolytics is presented.

[New anticoagulants in clinical practice. Effectiveness and problems].

We analyze the effectiveness of new oral anticoagulants and antivitamins K for the treatment of patients with venous problems, atrial fibrillation, and acute coronary syndrome with reference to advantages of this therapy and methods of prevention of complications of these conditions.

Comparative assessment of the effectiveness of treatment of pulmonary thromboembolism in elderly patients.

We compared the efficiency of treatment of 99 patientswith pulmonary thromboembolism using thrombolytic agents, surgical intervention, and anticoagulation therapy with heparin and vitamins K. The surgical treatment proved more efficient than the two other options.

[ARTERIAL HYPERTENSION: A MODERN VIEW OF THE PROBLEM].

This article deals with debatable problems of etiology, pathogenesis, and classification of hypertensive disease including essential kypertension, hypertonic crisis and methods of treatment of these conditions.

[The metabolic syndrome].

This paper expounds the author's view of metabolic syndrome and its components based on the extensive personal experience

[Modern approaches to the treatment of primary arterial hypertension].

Modern approaches to the treatment of primary arterial hypertension are considered based on the results of multicenter randomized studies, their meta-analysis, and recommendations of scientific societies.

[Therapeutic strategy for patients with atrial fibrillation--ciliary arrhythmia].

Atrial fibrillation (AF) is the commonest heart arrhythmia with the estimated incidence of 1-2%. It affects over 6 mln persons in Europe, its prevalence is expected to be twice the current level within the next 50 years. AF is known to increase the risk of ischemic stroke by five times and be the cause of each fifth stroke. Ischemic stroke in AF patients as a rule has a fatal outcome and leads to more severe disability than stroke of different nature; also, it recurs more frequently. Modern approaches to the treatment of this pathology by antiarrhythmic medicines, defibrillation, and new antithrombotic agents as recommended by international societies of cardiologies.

[Intensity of intravascular microcoagulation in chronic obstructive pulmonary disease with atherotrombosis and thrombophilia].

The growing occurrence of thrombophilic conditions in recent years, the discovery of new forms of thrombophilia, the involvement of intravascular microcoagulation in the development of many diseases make their study of primary importance especially in patients with chronic obstructive pulmonary disease and atherothrombosis. Such investigations would facilitate a deeper understanding of the detailed mechanisms of thrombosis in these patients and thereby contribute to the optimization of their treatment and prevention.

[What are thrombophilias to-day?].

Modern concepts of thrombophilia, its role in pathogenesis of arterial and venous thrombosis are discussed. The author's view of further development of this issue is expounded.

[Thromboses and antithrombotic therapy today].

Current understanding of importance and danger of atherothrombosis and venous thromboembolism is illustrated. New preparations and methods for the management of these conditions are described.

[Stroke in the clinical practice of a therapist].

The stroke resulting in serious neurologic deficit is the third most frequent cause of death and loss of working ability. In 60-65% of the cases, it is provoked by atherothrombosis located in aortic arch, common and internal carotid arteries. Thromboembolism of cerebral vessels originating in heart cavities is responsible for 15-18% of the cases. Stroke prevention is an interdisciplinary problem encountered not only by neurologists but also by many other physicians. A major preventive tool for the stroke is healthy lifestyle while therapy with antithrombotic drugs (antiaggregants, oral anticoagulants) is the main component of secondary prevention. The choice of therapy depends on the cause and degree of stroke.

[Atherothrombosis: state-of-the-art review and approaches to the problem].

Acute ischemia resulting from arterial lesions poses a real threat to mankind. The concept of atherothrombosis aims to unite doctors of different specialities to combat this pathology; it suggests active exchange of experience in the management of aherothrombosis between representatives of different medical disciplines. The concept is expected to promote treatment of the patients. The common pathogenetic mechanism of ischemic disorders of the heart, brain, and lower extremities provides a basis for the recommendation of active antithrombotic therapy for their prevention. The current approach to the management of atherothrombosis is prone to further improvement despite certain reports of successful inpatient treatment of acute myocardial infarction. Prevention of blood clot formation, i.e. prophylaxis of atherosclerosis, remains a challenging problem. Statins may prove of great help in this respect. Studies of the effect of infectious factors on the integrity of the fibrous envelope of an atherosclerotic plaque are currently underway.

[Fibrinogens and their role in atherogenesis in diabetes mellitus].

In the recent years, measurement of blood level of fibrinogen has been treated very seriously and this parameter has been considered an individual cardiovascular risk factor. A correlation between serum fibrinogen and the frequency of acute myocardial or cerebral ischemia has been found in a large number of studies. A distinct association between a high fibrinogen level and vascular complications in diabetic patients has been revealed as well. Two types of fibrinogen--high molecular weight fibrinogen (HMWF) weighing 340 kD, and low molecular weight fibrinogen (LMWF), weighing 280 kD and lacking a certain part of A alpha-polypeptide chain, are known today. B. Lipinski created a technique to measure the content of LMWF in blood serum, which made it possible to study the role played by this protein in the clinical presentation of atherothrombosis in diabetic patients. This work presents the results of research into the role of LMWF in the clinical picture of atherothrombosis in patients with type 2 diabetes mellitus. According to the localization of the manifestation of arterial ischemia and the presence of diabetes, three groups ofpatients were formed. The study revealed significantly higher LMWF level in all the three groups compared to controls. The LMWF/total blood fibrinogen ratio was also elevated.

[Carbohydrate exchange in patients with acute coronary syndrome].

Blood sugar measurement may be important for determining therapeutic tactics in patients in urgent pathological conditions. The role of hyperglycemia in the development of acute myocardial ischemia is under constant study, because the risk of death from myocardial infarction (MI) in patients with diabetes mellitus (DM) is twice higher than in those who do not suffer from DM. Having studied literature data, presented in the article, the authors report preliminary results of their work. Carbohydrate exchange disturbances are found almost in a half (49.1%) of patients with acute coronary syndrome (ACS). In patients with substantial and severe ACS manifestations that were considered to be those of acute myocardial infarction (MI) with ST interval elevation, as well as in patients with a repeated MI, carbohydrate exchange disorder was revealed in 65% and 77% of cases. In 30% of patients with a repeated MI, and in 14% of patients with MI with ST interval elevation, hyperglycemia was transient and disappeared on its own. Evaluation of this group of patients revealed type 2 DM in 44% of cases, which once more confirmed the information that DM patients were more liable to atherothrombosis. In half of the patients DM was newly revealed. This can be explained by the fact that a stressful situation urged revealing of the disease, which otherwise could be concealed. Data that suggest a higher hyperglycemia level in patients who finally could not be saved are of certain importance.

[The activity of Willebrand factor--glycoproteins IIb/IIIa complex in patients with coronary and low extremity arterial atherothrombosis and type 2 diabetes mellitus].

A lot of attention has been paid lately to the study of risk factors of cardiovascular diseases in patients with diabetes mellitus type 2 (DM2). Numerous investigations have revealed a connection between the intensity of thrombus formation and carbohydrate exchange disturbances. In the present paper, the dependence of the levels of Willebrand factor--glycoproteins IIb/IIIa complex on the clinical forms of coronary artery disease (I-II functional class stenocardia; old myocardial infarction) and lower limb ischemic disease (intermittent claudication) in patients with DM2 were studied. The comparison group consisted of DM2 patients without clinical manifestations of coronary artery disease or lower limb ischemic disease; the control group consisted of practically healthy individuals. The study found that the level of Willebrand factor--glycoproteids IIb/IIIa complex was significantly higher in all DM2 patients vs. healthy controls.