Cancer is one of the most significant risk factors for venous thromboembolic events (VTEE). The article discusses the contemporary landscape of drug thromboprophylaxis in various groups of patients with cancer.

The article describes the features of lower limb vessel lesions in patients with diabetes, modern methods for diagnosing critical lower limb ischemia (CLLI), indications for endovascular interventions, and reviews the clinical outcomes of percutaneous transluminal balloon angioplasty in patients with diabetes. The authors emphasized high efficacy of endovascular operations in CLI in patients with diabetes. The issues of the prevention of CLLI and the treatment of the lower limb vascular diseases in diabetes are discussed.

The aim of this study was to assess the risk of use of rivaroxaban, which was associated with gastro-duodenal bleeding in patients with deep venous thrombosis. Methods: an analysis of anticoagulant treatment in 683 patients with deep venous phlebothrombosis. All the patients underwent fiberoptic gastroduodenoscopic procedure prior to the anticoagulant treatment. When erosive-ulcerative lesions were detected, the patients received antisecretory therapy with proton pump inhibitors along with anticoagulant therapy. Results: EGD did not show any only stomach pathology only in 10.7 percent of patients at the time of admission. A symptom-free pathology that became a diagnostic finding was identified in 53.1 percent of patients. Fiberoptic gastroduodenoscopy showed completed bleeding or bleeding that was stopped using endoscopic balloon tamponade with achievement of stable hemostasis in 12.9 patients. 59.1 percent of patients received anti-coagulant therapy with rivaroxaban (Xarelto®). In the presented series of patients with acute deep vein thrombosis, the use of rivopoxaban appeared a safe therapeutic option not only in patients with erosive-ulcerative lesions in the gastroduodenal system, but also in those with endoscopic signs of stopped bleeding (on the top of already administered antisecretory therapy with proton pump inhibitors).

Over the past 20 years, the burden of atrial fibrillation (AF) has increased. AF is associated with increased risk of death, ischemic stroke and disability, hospitalization rates, and reduced quality of life. Treatment for this pathology is based on the correction of risk factors, underlying disease and anticoagulant therapy. The review considers strategies to minimize the risk of complications during oral anticoagulant therapy.

The widespread use of new oral anticoagulants in clinical practice requires improving the safety of medication use, i.e. the use of specific reversal agents, if necessary. Idarucizumab, a humanied monoclonal antibody fragment, is the first reversal agent authorized in our country that binds to dabigatran. Its efficacy and safety have been validated in several clinical trials, and its use gains experience in real clinical practice.

The use of modern oral anticoagulants is associated with a significant reduction in the risk of stroke and systemic embolism in patients with atrial fibrillation, and thus with an increase in the life expectancy of patients. That is why multicomponent therapy and perioperative tactics are actual during prolonged anticoagulation, the aspects of which seem to be one of the most difficult from the practical point of view. This clinical observation is an illustration of the management of a patient with atrial fibrillation at high thromboembolic risk who is receiving Rivaroxaban therapy and who has indications for catheter ablation and multicomponent antithrombotic therapy.

The article deals with the possibility of suppressing the effect of drugs inhibiting the activity of the Xa-Factor of the clotting blood system. Wide indications for oral anticoagulants are atrial fibrillation, venous thrombosis, thromboembolism, etc. - more and more patients are involved in this treatment, and the use of nonvitamin-K-associated (NOAC) anticoagulants is increasing. Although these drugs have a relatively good safety profile, their use may also lead to “large”, including life-threatening, bleeding. Current approaches to the treatment of such bleeding include, in addition to a wide range of non-specific hemostatic measures, the use of drugs that can selectively suppress the effects of NOAC. A specific antagonist, the andexanet-alfa, has been developed relatively recently for anticoagulants that suppress the activity of the coagulation Xa-factor (such as Apixaban and Rivaroxaban). This drug represents a molecule of catalytically inactive modified human recombinant Xa-factor, obtained from human Xa-factor by genetically engineered modification. Being inactive with respect to coagulation, the drug molecule has the ability to bind the molecules of Xa-factor inhibitors with a high degree of strength, neutralizing their action.
In the recently completed ANNEXA-4 clinical trial, 352 patients (average age 77 years) were injected with Rivaroxaban (36%), Apixaban (55%), Edoxaban (3%) or Enoxaparin (6%), with life-threatening bleeding (intracranial - 64%, gastrointestinal - 26%). The study showed that the anti-Ha activity of NOAC decreased by more than 90% in the first minutes after the introduction of andexanet and remained reduced 12 hours after its infusion. In 82% of patients in the ANNEXA-4 study, the hemostatic effect of the andexanet was assessed as excellent or good, and it did not differ significantly depending on the sex, age of the patients, the dose of the andexanet and the place of bleeding. No significant procoagulant or immunogenic effect of the andexanet was found. Thus, in the case of life-threatening bleeding with Xa-factor inhibitory anticoagulants, the use of their specific andexanet-alfa antagonist is recommended by clinical guidelines and should be an integral part of the hemostatic therapy and may potentially extend the safety spectrum of these anticoagulants.

The article demonstrates a clinical case of forced renewal of anticoagulant therapy after the endovascular closure of the left atrial appendage. Patient with atrial fibrillation and high risk of thromboembolic complications and bleeding on the background of warfarin administration and inappropriate INR values had an acute hemorrhagic cerebral blood flow disorder developed. Endovascular closure of the left atrial appendage was performed. However, the thrombosis of the area of the delivery system fastening revealed after 12 months was an indication for the resumption of anticoagulant therapy.
The article presents modern data on the use of occluders for closing the left atrial appendage, the frequency of complications and antiplatelet therapy schemes depending on the presence of thrombosis risk factors and bleeding.

Antiphospholipid syndrome (APS) is an immune-mediated violation of coagulation, the diagnosis of which requires mandatory laboratory confirmation. Since the clinical manifestations of APS are extremely diverse, various specialists are involved in the diagnostic process – neurology, cardiologists, surgeons, hematologists, endocrinologists, laboratory medicine specialists, etc. So far, it remains an open question what specialist exactly should make the final diagnosis and supervise patient with APS. The experience of a separate diagnostic center shows the distribution of prescriptions and their compliance with the international recommendations. This study also provides data on the frequency of prescribing laboratory tests to confirm APS, which is 1.2% of all coagulation tests. Among the patients with suspected APS on the basis of clinical signs, only 12.2% of the diagnosis was confirmed. Presents the dangers of obtaining false-positive results that should be taken into account when prescribing laboratory tests.

Heparin-induced thrombocytopenia (HIT) is a serious and potentially life-threatening side effect of heparinotherapy. It is an antibody-mediated process that causes platelet activation, increases the procoagulant characteristics of the blood and, as a result, endangering limbs and life-threatening thrombosis. Venous thrombosis is more common than arterial thrombosis, especially deep vein thrombosis of the lower limbs and pulmonary artery thrombosis. Mortality from complications of heparinotherapy occurs with a frequency of 20–30 % of cases. Diagnosis of HIT is difficult. Such basic symptoms as thrombocytopenia and thrombosis are extremely non-specific and may be present in cancer patients and patients with cardiosurgical pathologies without the impact of heparin. Women are twice as likely to have HIT as men. This review describes pathogenesis, clinical features, modern diagnostic methods, risk factors for the emergence of this formidable complication of heparinotherapy, gives an overview of the most frequent use of drugs for the treatment of HIT, and gives modern clinical recommendations for different groups of patients.

This article presents a clinical observation of a patient with a giant atherosclerotic abdominal aortic aneurysm and comorbid uncorrected coronary artery disease. Taking into account the threat of aneurysm rupture, we have chosena surgical intervention using methods that reduce the risk of cardiovascular events in the perioperative period: the distal-first technique allowed us to reduce the aortic clamping time, and the use of temporary axillofemoral bypass grafting reduced peripheral resistance and stress on myocardium.

This article describes the clinical observation of a patient with an atherosclerotic abdominal aortic aneurysm and pelvic dystopia of the left kidney. Due to the anomalous origin of renal arteries, we have chosen a method of treatment consisted of resection and an aortic prosthetics and reimplantation of vessels extending from the aortic aneurysm. 5 years after surgery, the patient had an aneurysm of the left iliac artery, which required repeated intervention. Our approach allowed us to preserve all the renal arteries and renal function.

This article describes a hybrid surgical technique for high-risk patients with thoraco-abdominal aortic dissections and aneurysms. The technical aspects of the first stage of surgical treatment - visceral and brachiocephalic debranching are described in detail. 17 surgical interventions for chronic dissection and aneurysm in the thoracic and thoracoabdominal aortas were performed at the Vishnevsky National Medical Research Center of Surgery of Ministry of Health of the Russian Federation in the period from 2014 to 2019. In two cases, we observed postoperative pancreatitis after surgical treatment of the abdominal aorta branches, which we managed using conservative therapy. After open surgery, all patients were discharged in a satisfactory condition. The selected technique made it possible to prepare patients for the following stage of treatment - endografting of the aorta - without developing serious complications.

Introduction. According to the literature, 27 to 65 % of patients with abdominal aortic aneurysm also suffer from coronary heart disease. Mortality from coronary heart disease after surgical treatment for abdominal aortic aneurysm according to some data exceeds 20 %.
Objective: improvement of results of treatment of patients with combined lesions of coronary arteries and aneurysm of the abdominal aorta
Subjects and method. A retrospective analysis of case histories of 100 patients hospitalized in our clinic diagnosed with «abdominal aortic aneurysm» for examination. Of all patients, 37 % were diagnosed with significant coronary artery lesions. The average ejection fraction was 58.2 ± 5.4 %, 13 % of the study diagnosed significant violations of local myocardial contractility. 16 % of patients had previous myocardial infarction, 7 % – a permanent form of atrial fibrillation. 4 % of patients complained of chest pain during exercise. Hypertension was present in 100 % of patients, the average maximum systolic blood pressure was 176 ± 24.5 mmHg.
Results. Hospital mortality was 2 % (all patients were non-operated on coronary arteries and had no significant coronary pathology). There were no significant complications (cardiac, neurological, respiratory) in the early postoperative period. The average length of hospital stay was 9.8 ± 1.99 bed days.
Conclusions. Determination of cardiac status before surgery for abdominal aortic aneurysm is the most important moment of stratification of the risk of perioperative complications. Coronary angiography in patients with abdominal aortic aneurysm is a mandatory point of diagnosis, allowing to identify cardiac risk factors.