Материалы по флебологии

[Dr.Vad]

Risk assessment for recurrence and optimal agents for extended treatment of venous thromboembolism

ASH Education Book December 6, 2013: 471-477

[Ссылки доступны только зарегистрированным пользователям ]

[Iluhin]

Пришло оповещение о регистрации для Прадаксы показаний к лечению и профилактике ТГВ и/или ТЭЛА. С оповещением и с измененной инструкцией можно познакомиться здесь: [Ссылки доступны только зарегистрированным пользователям ]
На сайте Государственного реестра лекарственных средств пока новой инструкции не вижу, но, скорее всего, это вопрос небольшого времени.

[Dr.Vad]

Интересные недавние кейсы-публикации о применении местных бета-блокеров в лечении сосуд. язв:

Topical timolol for a refractory wound.
Tang JC, Dosal J, Kirsner RS.
Dermatol Surg. 2012 Jan;38(1):135-8.

Successful treatment of a chronic venous leg ulcer using a topical beta-blocker.
Lev-Tov H, Dahle S, Moss J, Isseroff RR.
J Am Acad Dermatol. 2013 Oct;69(4):e204-5.

Topical timolol for recalcitrant wounds.
Braun LR, Lamel SA, Richmond NA, Kirsner RS.
JAMA Dermatol. 2013 Dec;149(12):1400-2.

Topical timolol for a chronic ulcer--a case with its own control.
Manahan MN, Peters P, Scuderi S, Surjana D, Beardmore GL.
Med J Aust. 2014 Jan 20;200(1):49-50.
[Ссылки доступны только зарегистрированным пользователям ]

РКИ похоже в ближ. время не предвидится - из последней публикации: "Timolol has the potential to be an inexpensive, non-invasive and non-labour intensive means to assist wound healing for chronic ulcers. A Phase II trial, looking at the use of topical timolol in ulcers, was halted due to lack of funding..."

[Dr.Vad]

Прием статинов снижает риск повтора ТГВ на популяционном уровне:

Using the Danish National Patient Registry, we identified first-time and recurrent VTEs between 1 July 2004 and 31 December 2012 (n=27,862). VTE diagnoses were validated by medical record review of a subsample of patients. We ascertained nationwide prescription data and categorized statin use as current (further divided into new and long-term use), former, and no use. We identified statin use at baseline (mimicking an intention-to-treat analysis) and in time-varying manner during follow-up (mimicking per-protocol analysis) and computed hazard ratios (HRs) for recurrent VTE using Cox regression. In a supplementary nested case-control study, we identified statin use at time of VTE recurrence and computed odds ratios as unbiased estimates of the incidence rate ratios (IRRs) using conditional logistic regression. We adjusted for age, sex, year of diagnosis, provoking factors, comorbidities, and co-medications, including time-varying use of aspirin and anticoagulant drugs.

RESULTS: The adjusted HR comparing current use with no use was 0.72 (95% confidence interval [CI] 0.59-0.88) for recurrent VTE, with a stronger effect of high (0.40, 95% CI 0.21-0.78) vs. low potency statins (0.77, 95% CI 0.63-0.94). Consistently, the recurrence rate was reduced in both the time-varying analysis (HR=0.64, 95% CI 0.54-0.77) and nested case-control analysis (IRR=0.55, 95% CI 0.45-0.67). The effect was largest for recurrent deep venous thrombosis.

J Thromb Haemost. 2014 May 12.
Statin use and venous thromboembolism recurrence: a combined nationwide cohort and nested case-control study.

[Dr.Vad]

Blood. 2014 May 30.

D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study.

Palareti G1, et al.

The optimal duration of anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cut-offs and were followed up for up to two years. Out of 1010 patients, anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer, who subsequently experienced 25 recurrences (3.0% pt-y; 95% CI 2.0 - 4.4%). Of the remaining 482 patients, 373 resumed anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI 0.2-1.7; HR = 2.92; 95% CI 1.87 - 9.72; P = 0.0006). Major bleedings occurred in 14 patients (2.3% pt-y; 95% CI 1.3-3.9) who resumed anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom anticoagulation can be safely discontinued.

[Iluhin]

Канадские рекомендации по тромбопрофилактике при беременности от 2014 г.:
[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Применение бета-блокаторов у детей расширяется: опыт их применения при пиогенных грануломах описывается в недавней публикации

Pediatr Dermatol. 2014 Mar-Apr;31(2):203-7.
Treatment of pediatric pyogenic granulomas using β-adrenergic receptor antagonists.
Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L.
Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania; Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Propranolol and timolol are nonselective ß-adrenergic antagonists that induce peripheral vasoconstriction and affect angiogenic cytokines. Oral and topical ß-blocker therapy has become the de facto first-line treatment for complicated infantile hemangiomas because of its superior efficacy and tolerability. Pyogenic granulomas or lobular capillary hemangiomas are common acquired vascular tumors accounting for 0.5% of all skin nodules in children. Although they are benign vascular proliferations, treatment is often sought because of recurrent episodes of bleeding and for cosmetic considerations. Numerous treatment options are available, but recurrence rates are high. Noninvasive methods of treatment are being sought, particularly for young children. Herein we report a series of seven cases of cutaneous and mucosal pyogenic granulomas treated successfully using oral or topical ß-blockers.

[Iluhin]

Консенсусный документ по профилактике ВТЭО от 2013 г.


[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Family history of venous thromboembolism as a risk factor and genetic research tool.

полный текст доступен по ссылке [Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Апдейт ACCP гайда по ТГВ:
Chest. 2016 Feb;149(2):315-52.
Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report.
полный текст доступен по клику на странице
[Ссылки доступны только зарегистрированным пользователям ]

[Iluhin]

Российские рекомендации по профилактике и лечению венозных тромбоэмболических осложнений (ВТЭО) 2015
(во вложенном файле)

[Iluhin]

Рекомендации по диагностике и лечению варикоза Минздрава РФ, 2017: «[Ссылки доступны только зарегистрированным пользователям ]».
Разработаны рабочей группой от Ассоциации флебологов России.

[Dr.Vad]

Систематический обзор по тромбозу вен верхних конечностей:

Deep Vein Thrombosis of the Upper Extremity
A Systematic Review
Dtsch Arztebl Int. 2017 Apr; 114(14): 244–249

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

Cleve Clin J Med. 2017 Jul;84(7):545-554.
Optimizing diagnostic testing for venous thromboembolism.
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[Dr.Vad]

Некоторые тонкости назначения антикоагулянтов атлетам/спортсменам в недавней публикации:

J Thromb Haemost. 2017 Jun;15(6):1051-1054.
Athletes and blood clots: individualized, intermittent anticoagulation management.
Berkowitz JN, Moll S.
[Ссылки доступны только зарегистрированным пользователям ]