DOI: 10.25881/20728255_2023_18_1_126

Authors

Lebedev N.N.1, Babitsky A.A. 2, Shikhmetov A.N.1, Davydenko V.V.3, Zadikyan A.M.1

1 MChU Branch Clinical and Diagnostic Center of PJSC «Gazprom», Moscow

2 Branch of the MChU Branch Clinical and Diagnostic Center PJSC «Gazprom» Polyclinic No. 3, St. Petersburg

3 The First St. Petersburg State Medical University named after Academician I.P. Pavlova, St. Petersburg

Abstract

Venous thromboembolic complications, which include pulmonary embolism, deep vein thrombosis, subcutaneous vein thrombophlebitis throughout the history of surgery is its constant companion. In some areas of the surgical profile, thrombosis in the lumen of the veins threatens almost every patient, which allowed doctors to form a false belief about the absolute inevitability of venous thrombosis in some cases in the postoperative period. Currently, the world surgical community is closely engaged in the prevention of postoperative venous thromboembolic complications. Experts from reputable professional communities have developed recommendations for the treatment and prevention of venous thromboembolic complications with mandatory revision of these documents every 4-5 years. Thanks to the work carried out, the majority of practicing surgeons have formed a clear understanding of the need to strictly follow the recommendations and standards aimed at preventing postoperative venous thromboembolic complications. However, despite all the work being done, against the background of the developed “general” clinical recommendations and standards, venous thromboembolic complications remain a frequent complication of surgical interventions, which indirectly confirms the idea of the need to develop personalized programs for the prevention of these formidable complications with individual consideration of certain patient parameters even during preoperative preparation and the strictest control in the near, and sometimes even in the long-term postoperative periods.

The review analyzes the literature devoted to the problem of venous thromboembolic complications in surgical patients in the postoperative period, modern methods of prevention of thrombosis in the lumen of venous vessels. The shortcomings of the available methods with the search for a solution to the problem by introducing new methods for diagnosing the coagulation potential of blood and the need to develop a personalized program for the prevention of venous thromboembolic complications in patients who are about to undergo surgical interventions are shown.

Keywords: hemostasis system, thrombodynamic test, risk of thromboembolic complications, personalized prevention program.

References

1. Lobastov KV, Dement’eva GI, Laberko LA. Current Insights on the Etiology and Pathogenesis of Venous Thrombosis: Virchow’s Triad Revision. Flebologiya. 2019; 13(3): 227-235. (In Russ.) doi: 10.17116/flebo201913031227.

2. Frederick AJr, Frederick A. Risk factors for venous thromboembolism. Circulation. 2003; 107(23S1): 19-16. doi: 10.1161/01.CIR.0000078469.07362.E6.

3. Gologorskij VA, Kirienko AI, Andriyashkin VV. Profilaktika venoznyh tromboembolicheskih oslozhnenij u gospital’nyh bol’nyh. Russkij medicinskij zhurnal. 2001; 3: 110-113. (In Russ.)

4. Kuznecov MR, Marchenko IP, Fedorov EE. Profilaktika tromboembolicheskih oslozhnenij v hirurgii. Ambulatornaya hirurgiya: stacionarozameshchayushchie tekhnologii. 2018; 1-2: 20-25. (In Russ.)

5. Kashaev MSH, Nartajlakov MA, Hamitov AA. Venoznye trombozy v hirurgii. Monografiya. Ufa: Media Print, 2014. (In Russ.)

6. Bokeriya LA, Zatevahin II, Kirienko AI, et al. Rossijskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhnenij (VTEO). Flebologiya. 2015; 4: 1-52. (In Russ.)

7. Iliukhin EA, Zolotukhin IA. Current Tendencies in the Prevention of Recurrent Venous Thromboembolism. Flebologiya. 2017; 11(2): 83-90. (In Russ.) doi: 10.17116/flebo201711283-90.

8. Savel’ev V.S., CHazov E.I., Gusev E.I. i dr. Rossijskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhnenij. Flebologiya. 2010;4(2):3–37. (In Russ.)

9. Lobastov KV, Barinov VE, Schastlivcev IV, et al. SHkala Caprini kak instrument dlya individual’noj stratifikacii riska razvitiya posleoperacionnyh venoznyh tromboembolij v gruppe vysokogo riska. Hirurgiya. ZHurnal im. N.I. Pirogova. 2014; 12: 16-23. (In Russ.)

10. Gavrilov EK, Polyakov AS, Tyrenko VV, et al. Algoritmy profilaktiki, diagnostiki i lecheniya venoznyh tromboembolicheskih oslozhnenij pri infekcii, vyzvannoj COVID-19. Klinicheskaya patofiziologiya. 2020; 26(3): 29-41. (In Russ.)

11. Savel’ev VS, Kirienko AI, Andriiashkin VV, et al. How real is the prevention of postoperative venous thromboembolic complications. Pirogov Russian Journal of Surgery. 2012; 10: 4-8. (In Russ.)

12. Lobastov KV, Barinov VE, Laberko LA. Toward the individual approach to the evaluation of risks and prevention of postoperative venous thromboembolism. Flebologiya. 2015; 8(1): 41-51. (In Russ.) doi: 10.17116/flebo20159141-50.

13. Bogachev VYU, Lobastov KV, Fokin AA, et al. O tekushchej situacii v otnoshenii riskov i profilaktiki razvitiya venoznyh tromboembolicheskih oslozhnenij posle hirurgicheskogo lecheniya varikoznoj bolezni. Ambulatornaya hirurgiya. 2022; 19(1): 157-160. (In Russ.) doi: 10.21518/1995-1477-2022-19-1-157-160.

14. Barinov VE, Lobastov KV, Boyarincev VV, et al. Venoznyj tromboz — prediktor letal’nogo iskhoda u operirovannyh pacientov? Medline.ru. 2013; 14(51): 619-632. (In Russ.)

15. Somonova OV, Sel’chuk VYU, CHistyakov SS, et al. Profilaktika tromboembolicheskih oslozhnenij geparinami. Russkij medicinskij zhurnal. 2013;1:22. (In Russ.)

16. Treasure T, Carter K, Gautam N, et al. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital Produced by the National Clinical Guideline Centre — Acute and Chronic Conditions (formerly the National Collaborating Centre for Acute Care). 2015; 2: 519.

17. Robertson L, Kesteven P, McCaslin JE. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of deep vein thrombosis (Review). Cochrane Database of Systematic Reviews. 2015; 30(6): CD010956. doi: 10.1002/14651858.CD010956.pub2.

18. Klinicheskie rekomendacii. Flebit i tromboflebit poverhnostnyh sosudov. Utverzhdeny Minzdravom RF 21.09.2021g. 58 р. (In Russ.)

19. Popchenko AL, Perepelica SI, Stasevich VN. Profilaktika tromboembolicheskih oslozhnenij v abdominal’noj hirurgii. Uchebno-metodicheskoe posobie. Minsk, 2009. (In Russ.)

20. Mironov AV, Leont’ev SG, Mamadumarov VA, et al. Vtorichnaya profilaktika VTEO: sovremennyj vzglyad. Russkij medicinskij zhurnal. 2014; 17: 1254. (In Russ.)

21. Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975; 17: 259-270.

22. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353(9162): 1386-9.

23. Gillet JL. Management of superficial vein thrombosis of the lowerlimbs: update and current recommendations. Phlebolymphology. 2015; 22(2); 82-88.

24. Avram J, Cadariu F, Pasztori M, et al. The results of the surgical treatment of superficial venous thrombosis. Cercetari Experimentale & Medico-Chirurgicale. J. Experim. Med. Res. 2010; 17(3): 79-84.

25. Monreal M, Mahe I, Bura-Riviere A, et al. Pulmonary embolism: Epidemiology and registries. Presse Med. 2015; 44: 377-383. doi: 10.1016/j. lpm.2015.10.006.

26. Kostiuchenko MV. Modern methods for the prevention of thromboembolic complications in the postoperative period. Consilium Medicum. 2019; 21(8): 102-107. (In Russ.) doi: 10.26442/20751753.2019.8.190570.

27. Andriyashkin AV, Kuliev SA, Nikishkov AS, et al. The Prevention of Venous Thromboembolism in the Patients with Incisional Hernias: the Results of an Observational Cross-Sectional Study. Flebologiya. 2017; 11(1): 17-20. (In Russ.) doi: 10.17116/flebo201711117-20.

28. Zubrickij VF, Koltovich AP, SHabalin AYU, et al. Profilaktika venoznyh tromboembolicheskih oslozhnenij pri ognestrel’nyh raneniyah zhivota i taza. Politravma. 2016. (In Russ.)

29. Kakkar VV, Corrigan TP, Fossard DP, et al. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial. Lancet. 1975; 2: 45-51.

30. Collins R, Scrimgeour A, Yusuf S, et al. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic and urologic surgery. N Engl J Med. 1988; 318: 1162-1173. doi: 10.1056/NEJM198805053181805.

31. Ian Siao. Intsidentnost venoznykh trombozov v evropeiskoi populiatsii: rol khirurgicheskikh vmeshatelstv. Meditsina neotlozhnykh sostoianii. 2017; 4(83): 24-29. (In Russ.) doi:10.11603/2414-4533.2017.2.7691.

32. Zatevahin I.I. Rol’ ul’trazvukovogo angioskanirovaniya v rannej diagnostike bessimptomnyh ostryh venoznyh trombozov sistemy nizhnej poloj veny u operirovannyh bol’nyh. Materialy III konferencii Associacii flebologov Rossii. Rostov-na-Donu. 2001. Р.191. (In Russ.)

33. Barinov VE, Lobastov KV, Schastlivtsev IV, et al. Predictors of venous thromboembolism in the high risk surgical patients. Flebologiya. 2014; 8(1): 21-32. (In Russ.)

34. Kirienko AI, Ciciashvili MSH, Agafonov VF. Posleoperacionnye trombozy glubokih ven nizhnih konechnostej. Diagnosticheskoe znachenie ul’trazvukovogo skanirovaniya. Russkij medicinskij zhurnal. 2002; 8:385. (In Russ.)

35. Virchow R. Thrombose und Embolie: Gefassenzundung und Septische Infektion, in Gesammelte Abhandlungen zur wissen schaftlichen Medicin. 1856. Meidinger, Sohn und Co: Frankfurt.

36. Laberko LA, Rodoman GV, Barinov VE, et al. Epidemiology of venous thromboembolias among the high-risk surgical patients and the role of sural sinus in initiation of thrombus formation. Pirogov Russian Journal of Surgery. 2013; 6:38-43. (In Russ.)

37. Coleridge Smith PD, Hasty JH, Scurr JH. Deep vein thrombosis: effect of graduated compression stockings on distension of the deep veins of the calf. Br J Surg. 1991; 78(6): 724-726. doi: 10.1002/bjs.1800780628 PMID: 2070243.

38. Vagin IV, Karipidi GK, Baryshev AG, et al. Ispol’zovanie testa trombodinamiki v kompleksnom perioperacionnom monitoringe svertyvayushchej sistemy krovi u hirurgicheskih bol’nyh. Kubanskij nauchnyj medicinskij vestnik. 2018; 25(6): 44-49. (In Russ.) doi: 10.25207 / 1608-6228-2018-25-6-44-49.

39. Balandina AN, Panteleev MA, Ataullahanov FI. Sistema svertyvaniya krovi i ee regulyaciya. Priroda. 2011; 3: 32-38. (In Russ.)

40. Vorob’ev AI, Ataullahanov FI, Emel’yanenko V, et al. Analiz prostranstvennoj dinamiki svertyvaniya. Sovremennye naukoemkie tekhnologii. 2010; 4: 32-37. (In Russ.)

41. Serebrijskij II. «Global’nye» i «lokal’nye» testy sistemy gemostaza v diagnostike giperkoagulyacionnogo sindroma. Spravochnik zaveduyushchego kliniko-diagnosticheskoj laboratoriej. 2012; 12: 27-34. (In Russ.)

42. Spravochnik po laboratornoj diagnostike. Gemostaz. Rostov-na-Donu. 2014. (In Russ.)

43. YArec YUI. Tromboelastografiya: osnovnye pokazateli, interpretaciya rezul’tatov. Prakticheskoe posobie dlya vrachej. Gomel’: RNPC RMiECH, 2018. 26 р. (In Russ.)

44. Sinauridze E, Vuimo T, Tarandovskiy I, et al. Thrombodynamics, a new global coagulation test: Measurement of heparin efficiency. Talanta. 2018; 180: 282-291. doi: 10.1016/j.talanta.2017.12.055.

45. Calderara D, Aliotta А, Zermatten М, et al. Hyper-coagulability in obese patients accurately identified by combinations of global coagulation assay parameters. Thrombosis research. 2020; 187: 91-102. doi: 10.1016/j.thromres.2020.01.012.

46. Balandina AN, Kol’cova EM, SHibeko AM, et al. Trombodinamika: novyj podhod k diagnostike narushenij sistemy gemostaza. Voprosy gematologii/onkologii i immunopatologii v pediatrii. 2018; 17(4): 114-126. (In Russ.) doi: 10.24287/1726-1708-2018-17-4-114-126.

47. SHulutko AM, Ataullahanov FI, Balandina AN, et al. Primenenie testa trombodinamiki dlya ocenki sostoyaniya sistemy gemostaza. Uchebno- metodicheskie rekomendacii. Moskva. Pervyj Moskovskij gosudarstvennyj medicinskij universitet im. I.M. Sechenova. 2015. 72 р. (In Russ.)

48. Nacional’nyj standart Rossijskoj Federacii. Klinicheskie rekomendacii (protokoly lecheniya) profilaktika tromboembolicheskih sindromov. GOST R 56377-2015. Utverzhden i vveden v dejstvie Prikazom Federal’nogo agentstva po tekhnicheskomu regulirovaniyu i metrologii ot 31 marta 2015 g. №201-st. Data vvedeniya 1 marta 2016 goda. (In Russ.)

49. Lobastov KV, Sautina EV, Kovalchuk AV, et al. Concurrent Validation of the Russian Version of Patient-Completed Caprini Risk Assessment Tool in Surgical Patients. Flebologiya. 2022; 16(1): 6-15. (In Russ.) doi:10.17116/flebo2022160116.

50. Cronin М, Dengler N, Eugene S, et al. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clinical and Applied Thrombosis/Hemostasis. 2019; 25: 1-10. doi: 10.1177/1076029619838052.

51. Lobastov K, Dementieva G, Soshitova N, et al. Use of the Caprini Score Integrated With a Thrombodynamics Test Reduces the Incidence of Unpredicted, Postoperative Deep Venous Thrombosis. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2019; 7(2): 289-290. doi: 10.1016/j.jvsv.2019.01.010.

52. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2): 227-277. doi: 10.1378/chest.11-2297.

53. Pannucci CJ, Swistun L, MacDonald JK, et al. Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score to Identify the Benefits and Harms of Chemoprophylaxis in Surgical Patients: A Meta-analysis. Ann Surg. 2017; 265(6): 1094-1103. doi: 10.1097/SLA.0000000000002126.

For citation

Lebedev N.N., Babitsky A.A. , Shikhmetov A.N., Davydenko V.V., Zadikyan A.M. Modern approaches and unresolved issues of prevention of venous thromboembolic complications during surgical interventions. Bulletin of Pirogov National Medical & Surgical Center. 2023;18(1):126-133. (In Russ.) https://doi.org/10.25881/20728255_2023_18_1_126