Cancer is one of the most significant risk factors for venous thromboembolic complications (VTEC). The article discusses the features of the treatment of cancer patients with VTEC. The issues of alternative anticoagulant therapy are considered. The article presents the results of HOKUSAI VTE Cancer study, the first completed study to compare the efficacy and safety of a direct oral anticoagulant endoxaban with a low molecular weight heparin dalterapin for the treatment of VTEC in cancer patients.

The review article discusses the options to extend anticoagulant therapy after completing the main anticoagulant therapy course in patients, who survived pulmonary embolism. It presents the results of randomized RE-MEDY and RE-SONATE studies of dabigatran, EINSTEIN-Extension study of rivaroxaban and AMPLIFY-Extension study of apixaban, which evaluated the feasibility, efficacy and safety of extended anticoagulant therapy with direct acting oral anticoagulants compared with placebo or warfarin. The article also provides the results of ASPIRE and WARFASA studies, which evaluated the possibility of using low-dose aspirin vs. Placebo for the extended treatment. The authors reviewed in details the results of einstein choice study, in which they compared the extended therapy with two doses of rivaroxaban (10 or 20 mg once a day) versus low (100 mg/day) doses of aspirin and against each other. The data obtained indicate that both doses of rivaroxaban significantly exceed aspirin in efficacy and reduce the risk of recurrent venous thrombosis by 74 and 66 %, respectively, without significantly increasing the risk of bleeding.

Aim. The aim of study was to examine the relationship between serum and mammary gland homocysteine levels with the carrier of separate SNP (single nucleotide polymorphism) genes of the folate metabolism system in patients with proliferative diseases and breast cancer. Methods and results. The study included 182 patients with proliferative diseases of the mammary gland in transbaikalia. The control group included 144 women who did not have oncological diseases. The serum homocysteine level and the supernatant of the mammary tissue homogenate were evaluated by high performance liquid chromatography. Genotyping for the detection of polymorphism MTHFRС677T, MTHFRА1298C, MTRA2756G, MTRRA66G was carried out by polymerase chain reaction with the detection of the amplification product in real time. In the course of molecular genetic testing in patients with proliferative diseases of the mammary gland, there was found: 1) the absence of an explicit association of the carriage of genetic polymorphism MTHFRС677T, MTHFRА1298C, MTRA2756G and MTRRA66G with serum homocysteine concentration, however, comparative hyperhomocysteinemia and, to a lesser extent, in women with the benign breast diseases; 2) the highest homocysteine content in the blood in patients with breast cancer whose genotype was characterized by combinations of polymorphic alleles MTR2756G x MTRR66G; 3) that the MTR2756A allele and genotype MTHFR1298AC, especially their combination of MTHFR1298AC x MTR2756A, increase the risk of developing benign breast formations; 4) the effect of the risk alleles MTR2756G and MTRR66GON the concentration of homocystein in the tumor tissue of the mammary gland. Conclusion. These patterns indicate a certain contribution of the polymorphisms studied, especially their additive effect, both in the development of proliferative diseases of the mammary gland and in the possible potentiation of prothrombotic effects in these patients against the background of tumor progression and homocysteine metabolism disorders.

The review analyzes data on the safety of apixaban for the prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation and venous thromboembolic complications obtained in randomized controlled studies.

The presented material summarizes the main clinical and theoretical data on the peculiarities of atrial fibrillation (AP) flow in combination with diabetes mellitus (DM). This combination, although associated with a lower age than in patients without diabetes, is associated with a higher risk of stroke and systemic embolism and other adverse complications. The material presents the data of the rocket-AF randomized trial subanalysis on the peculiarities of the use of oral anticoagulant - a direct inhibitor of Xa-factor Rivaroxaban in patients with non-valve AF in combination with DM. Comparative efficacy and safety of Rivaroxaban in patients with diabetes were comparable to those in patients without diabetes. Rivaroxaban in patients with diabetes was associated with lower vascular death rates than warfarin. The results of the randomized trial are largely confirmed in several observational studies that reflect actual clinical practice. Thus, it can be affirmed that Rivaroxaban is not only the most commonly used direct oral anticoagulant in russian practice, but can also be widely used in patients with non-valve AF and diabetes to prevent strokes and systemic embolisms.

Double antiplatelet therapy, which includes aspirin and platelet P2Y12 receptor inhibitors (hereinafter P2Y12 inhibitor) is the main component of treatment and secondary prevention after ACS. In recent years, the issue of determining whether it is expedient for P2Y12 inhibitors to be early prescribed to patients with ACS – prior to coronary angiography, when coronary anatomy is unknown – has been widely debated. The review provides comprehensive up-to-date information on this topic based on data from randomized trials, registers, and official clinical guidelines.

Interview with Dr. of Sci. (Med.), Professor, Sergey Y. Martsevich

The paper presents the clinical discussion of a patient with atrial fibrillation, who underwent a planned percutaneous coronary intervention. It also provides the recommendations for modern principles in diagnosis, the choice of optimal antithrombotic therapy in this pathology.

The article dwells upon the various strategies for prevention of thromboembolic events in patients with atrial fibrillation. The main focus is put on the endovascular strategies for prevention of tromboembolism. In recent years, the endovascular strategies for the prevention of thromboembolic events in patients with atrial fibrillation, who have contraindications to oral anticoagulant therapy, are increasingly gaining popularity and find evidence of its safety for the prevention of thromboembolism. The patients with AF with a high risk of bleeding is the most interesting category for studying. The large studies confirm the effectiveness of non-drug prevention of thromboembolic events as compared to the anticoagulant therapy in these patients.

The review deals with the main trials devoted to the study of genetic markers of individual variability in drug response to antithrombotic agents. The first part describes the studies of the genes encoding the platelet receptor subunits studied in the association of the possible insufficient effect of acetylsalicylic acid, and transporter proteins and allelic variants with reduced CYP450 functional activity, which are associated with insufficient effect on clopidogrel therapy. The second part considers polymorphisms that determine the individual dose and the risk of bleeding due to excessive hypocoagulation in patients taking warfarin. It also presents current data on the study of genetically determined individual reactions to the new inhibitors: P2Y12 inhibitors (prasugrel and ticagrelor) and direct oral anticoagulants.

Aortobifemoral bypass is still the gold standard treatment in surgery of the aortofemoral segment. The 1980s – 1990s classic publications showed that primary patency ranges from 76–95% in 5 years, and 75–85% in 10-years [1, 2]. Thrombosis of both branches of the bifurcation prosthesis occurs in 1–4% of patients. These patients may undergo thrombectomy with reconstruction of the distal anastomoses, re-aortofemoral prosthetics and, finally, extraanatomic bypass surgery.

Objective: to analyze the results of endovascular stent-graftingin dissections and atherosclerotic aneurysms of descending part of thoracic aorta.

Material and method: in this analysis includes 28 patients with dissections and atherosclerotic aneurysms of descending part of thoracic aorta. Acute aortic dissection type 3 was occurred in 10 patients and two of them were complicated with rupture into the left pleural cavity. 10 patients with chronic aortic dissection type bunderwent operations and one of them was complicated with rupture into the left pleural cavity. Among 8 operated patients due to chronic aneurysms of descending part of thoracic aorta, 4 patients were manifested with symptoms of hemothorax. In 3 patients with aortic dissection type 1 in long-term period, endovascular stent-grafting was performed concerning with the dilatation of descending thoracic aorta and patent false lumen. During in-hospital and long-term periods immediate clinical results, serious clinical complications and long-term survival were compared.

Results: technical success of endovascular stent-grafting was achieved in 100 % of cases. In-hospital mortality was 4 (14,2 %) and 30-day mortality was 3 (10,7 %). Events of paraplegia, TIA (Transient Ischemic Attack), prosthetic infection were not found in our research. Two clinical occurrences of vascular approach site complication were found; one case of endoleak type 1 and stent-graft dislocation which required repeated endovascular stent-grafting and one case of endoleak type 2 which was performed subclaviancarotid bypass and ligation of left subclavian artery. Prolong intubation was needed in 5 patients (18,5 %).conclusion: Endovascular stent-grafting in dissections and atherosclerotic aneurysms of descending part of thoracic aorta contributes good immediate clinical results associating with less quantity of serious complications.

This article provides indications for and description of surgical technique of carotid endarterectomy with the formation of a new bifurcation. It also presents the results of observations in the immediate postoperative period based on the findings of this surgery among patients of Vishnevsky National Medical Research Center of Surgery.

Idaruzizumab (Praxbind©) is a specific reversal agent for dabigatran, which is a humanized Fab fragment of a monoclonal antibody. Immediately after administration, the drug binds to dabigatran and its metabolites, inhibiting 99% of the anti-coagulant activity of dabigatran from the very first minutes. In most cases, after the administration of two doses of idaruzizumab, 2.5 mg each, the anticoagulant effect of dabigatran is inhibited for 24 hours. The drug is safe, has no prothrombotic action on its own. The evidencebase administration of idarucizumab is supported by the open prospective cohort REVERSE-AD study. The study showed that idaruzizumab effectively inhibits the anticoagulant effect of dabigatran in patients with life-threatening bleeding, as well as in patients who required emergency invasive intervention. This study is characterized by the absence of a placebo group, which makes it possible to make only indirect evaluation of the clinical efficacy of this drug. The absence of the placebo group was due to ethical concerns that did not allow the investigators to leave patients with life-threatening conditions without a specific reversal agent for dabigatran. So far, several small series of clinical cases have been published, describing the use of idarucizumab in actual practice. In addition to official indications for the use of the drug, its use as a step to thrombolysis in patients receiving dabigatran has been described. The leading experts of cardiological communities believe that existing experience in using idaruzizumab is sufficient to recommend its use in patients with life-threatening bleeding on the top of already administered dabigatran therapy along with general measures aimed at eliminating the source of bleeding and maintaining hemodynamics.