The risk of venous thromboembolism in patients with heart failure

The era of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) virus has shown that non-core specialists can be involved in the treatment of epidemic diseases. However, the entire burden for the prevention and treatment of venous thromboembolism (VTE) falls on doctors – cardiovascular surgeons, phlebologists. It should be borne in mind that most of the thromboses – more than 2 million cases per year – are asymptomatic, and only a small part has pulmonary embolism, pulmonary hypertension, and death. The survival rate of patients with deep vein thrombosis (DVT) for 8 years is 65 %, with a combination of DVT with pulmonary embolism; the survival rate does not exceed 34 %, so a doctor of any specialty should know how to suspect VTE. The clinical picture of DVT is not always pronounced. Most often, with DVT, patients complain of swelling and pain in the affected lower limb, a decrease in the volume of active movements, and skin cyanosis. Diagnosis of DVT and thromboembolic complications at the non-specialized level should initially consist of assessing the risk of VTE using special scales, among which the Wales scale is of the greatest importance. The gold standard for diagnosing DVT is duplex ultrasound. Among the main indicators for hospitalization is not the fact of the established diagnosis of DVT, but the presence of comorbid pathology, chronic lung diseases, and old age. Additional risk factors include extended DVT, suspected pulmonary embolism, and pregnancy. The goal of anticoagulant therapy is to stop the process of pathological hypercoagulability, the progression of thrombus formation and create conditions for restoring vascular patency, while the pathological idea is that anticoagulants “dissolve the thrombus”. In this regard, anticoagulant therapy is the mainstay of treatment for DVT. To determine the duration of anticoagulant therapy, the etiology of thrombosis is of particular importance – the trigger that led to the formation of thrombotic masses.

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Diagnosis of hemostatic system disorders in patients with chronic heart failure using classical and integral methods

Lebedev,

Patsenko,

Pugachev

et al. 2024

Russian Military Medical Academy Reports

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BACKGROUND: The state of the hemostatic system in patients with chronic heart failure (CHF) remains an insufficiently studied problem. PURPOSE OF THE STUDY: to present the results of an original study of the coagulation system of patients with CHF using an integral technique — low-frequency piеzothromboelastography (LPTEG). MATERIAL AND METHODS: The study involved 90 patients with CHF due to hypertension and coronary artery disease aged 50–75 years. The subjects were divided into groups with CHF I–IIa (n = 30), CHF stages IIb–III (n = 60). All patients underwent a study of the hemostasis system using classical (coagulogram) and integral (NPTEG) methods before prescribing antiplatelet and anticoagulant therapy. The comparison group consisted of healthy patients of the same age group without CHF (n = 30). RESULTS: In patients with CHF, a general blood test revealed a statistically significant decrease in the number of platelets (group 1 — 215; group 2 — 185) compared to the control group — 241. When analyzing the coagulogram, a decrease in the levels of prothrombin (group 1 — 89; group 2 — 86; control group 105), antithrombin-III (group — 76.5; group 2 — 73; control group — 91) and increased INR (group 1 — 1.03; group 2 — 1.12; control group 1.01) in patients in groups with CHF compared to the control group (p 0.05). When using the NPTEG method in patients with CHF, a decrease in indicators characterizing the rate of clot polymerization (intensity of clot polymerization) and clot density (maximum amplitude) was determined when compared with the control group (p 0.05). CONCLUSION: In patients with CHF, changes in the hemostatic system are determined, characterized by a tendency to hypocoagulation, the frequency a severity of which increases with the progression of the stage of the disease.

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The risk of venous thromboembolism in patients with heart failure

Cited by 4 publications

References 14 publications

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Diagnosis of hemostatic system disorders in patients with chronic heart failure using classical and integral methods

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