AimsPatients suffering from gastric cancer have a high risk of postoperative thrombotic complications and often use anticoagulants. Direct oral anticoagulants absorb in the proximal region of the digestive tract. Consequently, a reduction in anticoagulating activity is possible. In the present research given is an evaluation of the anti-Xa activity upon administration of Rivaroxaban at a fixed dose of 20 mg once daily in oncological patients after gastrectomy or cases of extensive resection of the stomach. Materials and methodsThe study cohort covered 20 patients after surgical treatment of gastric cancer having normal renal/hepatic function. The patients received Rivaroxaban at a fixed dose of 20 mg once daily to prevent venous thromboembolic complications. ResultsWhen evaluating absorption and bioavailability of 20 mg of Rivaroxaban sufficient anti-Xa blood plasma activity (1.37±0.16 UI/ml) was recorded. However, in 5 patients the absorption of a therapeutic agent was not-critical, their average anti-Xa activity being 0.32 ± 0.14 UI/ml. ConclusionsAbsorption of peroral anticoagulants in most patients who have experienced extensive stomach resections, is satisfactory.However, the level of anticoagulant activity showed significant changeability, as in a quarter of patients malabsorption of rivaroxaban was observed. Thus, when prescribing anticoagulant tablets to this category of patients it is necessary to control the absorption of medical drugs.
The aim of this work was to assess the significance of investigating clinical and laboratory parameters for diagnosing acute monocytic leukemia in children on the basis of a clinical case. The article demonstrates specific features of differentiating AML M5a from other forms of acute myeloid leukemia. According to the results of hematological, morphological and cytofluorimetric studies of blood and bone marrow samples, the diagnosis of acute myeloid leukemia was established. The morphological and phenotypic characteristics of blast cells hampered the diagnosis of an AML form. However, a comprehensive analysis of the expressed CD antigens allowed acute monocytic leukemia to be identified, which diagnosis was subsequently confirmed by a cytochemical study. Thus, the clinical diagnosis was established over a short period of time. This was of importance given the rising severity of the patient’s condition requiring immediate treatment, the initial hyperleukocytosis and the development of life-threatening complications associated with leukostasis in the lungs and the central nervous system. In the presented case, the clinical manifestations of the underlying disease and the results of flow cytofluorimetry were determining factors in initiating timely specific therapy.
e23513 Background: The purpose of the study was to reveal the levels of biochemical parameters for assessing the intensity of bone metabolism in patients with primary and metastatic bone tumors. Methods: The study included 29 patients aged 55.9±12.17 years with primary (group 1, n = 12) and metastatic (group 2, n = 17) bone tumors. Group 2 included patients with breast cancer (2a, n = 10) and renal cancer (2b, n = 7) with a history of pathological fractures. Serum levels of the bone turnover marker osteocalcin, TSH, the resorption marker β-Cross Laps (C-terminal telopeptide) (Cobas e411, Japan) and calcium (Vitros 5600, USA) were measured before and after (day 14) organ-preserving treatment. The data were compared with that in non-cancer patients of similar age (n = 15) and evaluated in the Statistika 10.0 program. Results: Osteocalcin levels in group 1 prior to surgery was 1.74 times (p < 0.05) higher than in controls (13.56±1.35 ng/mL) and decreased by 35% (p < 0.05) compared to the initial values. In group 2, changes in osteocalcin levels were multidirectional: group 2a – 24% (p < 0.05) higher than in controls both before and after surgery; group 2b – similar to control values before surgery and decreased by 19% (p < 0.05) after it. Levels of β-Cross Laps in all patients before surgery were within the control range (0.49±0.02 ng/mL). After surgery, the levels in groups 1 and 2a did not change, while group 2b showed an increase in β-Cross Laps by 1.5 times (p < 0.05) and a decrease in calcium by 20% (p < 0.05) from the initial levels (2.33±0.09 mmol/L), which, along with a decrease in osteocalcin, could be the result of specific kidney damage. TSH in groups 1 and 2b was similar to controls, but initial TSH levels in group 2a were increased by 86% (p < 0.05) and did not change after surgery, as well as osteocalcin levels, which in the absence of changes in β-Cross Laps suggested a more favorable prognosis after organ-preserving treatment. Conclusions: Bone tissue remodeling processes are determined by the nature of the initial tumor. Measuring osteocalcin and β-Cross Laps in patients with specific bone lesions may be useful in assessing the risk of fractures.
e24106 Background: Immune suppression and coagulopathy development in cancer patients receiving chemotherapy determines a high incidence of complications, including venous thrombosis, and mortality from COVID-19 infection. There are still no explicit data on managing cancer patients when anticancer treatment is resumed after coronavirus disease. According to clinical guidelines for the prevention of venous thromboembolic complications in cancer patients receiving chemotherapy, patients with breast cancer are classified as having a low risk of these complications and do not require prophylactic anticoagulation. The purpose of this study was to assess the parameters of the blood coagulation system and the frequency of venous thrombosis in breast cancer patients with chemotherapy resumption after coronavirus disease. Methods: The study included 30 patients receiving anticancer medical therapy for breast cancer after COVID-19. Anticancer treatment was resumed no earlier than 4 weeks after clinical recovery, absence of SARS-CoV-2 RNAs in nasopharyngeal swabs, infiltrative lung damage according to a chest CT scan, exclusion of venous thrombosis by a lower extremity venous ultrasound. Control group included 20 breast cancer patients without a history of COVID-19. Stage I tumors were registered in 26.6% in the main group vs 15% controls; II - 40% vs 60%; III - 20% vs 15%. Some patients were diagnosed with distant metastases (stage IV- 13.3% vs 10%). Results: Initially, before chemotherapy resumption in the main group, half of the patients had elevated levels of fibrinogen and D-dimer compared with the control group (66.7% vs. 35%, p > 0.05). After a cycle of chemotherapy, a significant difference in the coagulation system parameters was noted (73.3% vs 30%). A lower extremity venous ultrasound after the end of the therapy cycle in the main group showed venous thrombosis in 3 patients (catheter-related n = 2, distal vein thrombosis of the lower extremities n = 1), while no venous thrombotic complications were detected in the control group (10% vs. 0%). Conclusions: Breast cancer patients after coronavirus disease 2019 have hemostasis abnormalities and higher risk of venous thrombosis, and the resumption of anticancer treatment increases the incidence of thrombotic complications. COVID-19 should be considered an additional risk factor of venous thrombosis in cancer patients and requires reconsideration of indications for prophylactic anticoagulation when resuming anticancer treatment for patients with breast cancer.
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