Klinicist最新文献

{"title":"Роль высокопольной магнитнорезонансной томографии головного мозга в диагностике ранней стадии болезни Паркинсона: клинический случай","authors":"Н.А. Шнайдер, М. Р. Сапронова, Марина Михайловна Петрова, И. П. Артюхов","doi":"10.17650/1818-8338-2016-10-4-76-80","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-76-80","url":null,"abstract":"Objective : to demonstrate the role of high field magnetic resonance imaging (MRI) in the diagnosis of early-stage Parkinson’s disease on a clinical case. Materials and methods . Patient S., 1962 (53 years), referred to the Neurological Center of Epileptology, Neurogenetic and Brain Research of University Clinic of the Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetskiy with of the early stages of Parkinson’s disease. The patient received the recommendation of a neurologist was not performed in connection with the doubts about the correctness of his diagnosis of the disease (diagnosed clinically). To confirm the diagnosis, the patient is recommended to carry out high field MRI of the brain according to the Protocol of neurodegenerative diseases, including images, weighted by magnetic susceptibility (SWI)  and magnetic resonance spectroscopy at the level of subcortical ganglia of the cerebral hemispheres and substantia nigra of the brain stem. Results. On brain MRI in SWI  mode revealed structural changes of the substantia nigra (absence of Nigrosome-1 on both sides) – early signs of MRI-negative cases of Parkinson’s disease. Conclusion. In this clinical example illustrates the role of high field MRI in the diagnosis of early-stage Parkinson’s disease. Should remain wary of doctors of primary health care (district internists, family practitioners, neurologists) regarding the debut of Parkinson’s disease even in patients younger than 50 years.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"76-80"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47266551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ДОФАМИНОВЫЙ ДИЗРЕГУЛЯЦИОННЫЙ СИНДРОМ ПРИ БОЛЕЗНИ ПАРКИНСОНА И ПОДХОДЫ К ЕГО МЕДИКАМЕНТОЗНОЙ КОРРЕКЦИИ","authors":"С. М. Омарова, Наталья Владимировна Федорова","doi":"10.17650/1818-8338-2016-10-4-81-85","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-81-85","url":null,"abstract":"The objective is to describe a clinical case of dopamine dysregulation syndrome (DDS) with compulsive intake of large doses of levodopa in a patient with Parkinson’s disease (PD). Materials and methods. Male patient R., born in 1956, has had PD since 2004 when he noticed changes in his handwriting, difficulties to perform small movements with the right hand. Therapy with levodopa/benserazide was started at 300 mg/day.  With time symptoms of the disease escalated: gait impairment and motor fluctuations started. Action duration after administration of levodopa/benserazide sin gle dose shortened to 2 hours, peak dose dyskinesia developed, as well as instability with frequent falls. In 2012, clinical picture of the disease included symptoms of DDS. The patient independently increased the drug dose, decreased time between doses, didn’t follow the doctor’s recommendations. Relatives noticed a state of euphoria in the patient after taking a dose of levodopa/benserazide. At the time of visiting the Department of Neurology of the Russian Medical Academy of Continuous Professional Education in the beginning of 2016, the daily equivalent levodopa dose was 2000 mg, and 800 mg of it were taken at night. Results. The patient was transferred to a three-component modern levodopa drug Stalevo (levodopa + carbidopa + entacapone) 150 mg + levodopa/benserazide 50 mg 6 times a day (daily dose 1200 mg). Decreased levodopa daily dose achieved by transferring the patient to a three-component drug with better bioavailability lead to significant reduction of motor and non-motor symptoms, significant increase in effect duration after a single dose of levodopa. In a year of follow-up, DDS symptoms gradually regressed, time between drug administration increased, the patient stopped taking the drug at night, fluctuations and drug-induced dyskinesias significantly decreased. Conclusion. In this clinical case, manifestations of DDS caused by long-term compulsive levodopa intake at doses significantly exceeding daily dose (necessary for control of motor symptoms) are described. One of the approaches to reduction of high doses of levodopa and control of motor fluctuations is prescription of Stalevo which stabilizes levodopa level in plasma and provides a more continuous stimulation of dopamine receptors in the striatum.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"81-85"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45622531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"НЕЙРОСИФИЛИС В ТЕРАПЕВТИЧЕСКОЙ ПРАКТИКЕ (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)","authors":"Надежда Александровна Шостак, Д. П. Котова, А. А. Клименко, Наталья Григорьевна Правдюк, Анна Владимировна Новикова, Ю. О. Каша","doi":"10.17650/1818-8338-2016-10-4-65-70","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-65-70","url":null,"abstract":"Objective : to describe a clinical case of neurosyphilis diagnosed in a therapeutic inpatient facility. Materials and methods . Female patient T., 61, was hospitalized in the therapeutic department of a general hospital with referral diagnosis of “Stage II hypertensive heart disease, risk 4. Hypertensive crisis of 03.12.2015” with complaints of general fatigue, episodes of transient memory loss with full recovery, unstable blood pressure level. The patient was examined: She underwent treponemal and nontreponemal serological tests for antibodies against Treponema рallidum, hepatitis, human immunodeficiency virus; electrocardiogram; angiography of carotid and vertebral arteries; magnetic resonance imaging (MRI)  of the brain with contrast; serological and microscopic examinations of the cerebrospinal fluid (CSF). Results . The patient»s medical history described episodes of transient global amnesia with full memory recovery, more frequent in the last year; arterial hypertension; chronic urinary tract infection; and chronic cholecystitis with frequent courses of antibacterial therapy (ceftriaxone). Since 1986, a positive serological reaction for syphilis was observed (Wassermann reaction (WR) +++) due to a history of primary syphilis. Considering reliable history of syphilis, positive serum confirmation tests for syphilis (nontreponemal: rapid plasma reagin test 3+; treponemal: passive hemagglutination reaction 4+, antibodies against T. pallidum (total) – present), history of neuropsychological symptoms (transient amnesia) and acute neurological symptoms before hospitalization (transient ischemic attack), brain MRI data (2 lesions of cerebral circulation disorders of ischemic type in the cortical branches of left and right mesencephalic arteries), a diagnosis of neurosyphilis was proposed, and lumbar puncture was performed for confirmation. Inflammatory characteristics of the CSF (cytosis 19/3, neutrophilia up to 12 cells, insignificant lymphocytosis up to 7 cells) and positive confirmation serological reactions (nontreponemal test: serum microprecipitation reaction negative, treponemal test: immunoassay: total antibodies – positivity coefficient (PC) 4.3; immunoglobulin  G – PC 2.8) were indications for standard therapy for the “neurosyphilis” diagnosis with subsequent serological control of the CSF and serum. Conclusion . The clinical case demonstrates complexity of neurosyphilis diagnosis due to a lack of pronounced clinical manifestations of the disease and advisability of a multidisciplinary approach to treatment of these patients.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47374840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"КОНЦЕНТРИЧЕСКИЙ СКЛЕРОЗ БАЛО: КЛИНИЧЕСКИЙ СЛУЧАЙ РЕМИССИИ","authors":"Л В Лорина, Александр Олегович Буршинов","doi":"10.17650/1818-8338-2016-10-4-71-75","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-71-75","url":null,"abstract":"Objective. Case report of a rare form of multiple sclerosis, Balo’s concentric sclerosis (BCS). Materials and methods. 66 year old female patient L., admitted with complaints of gait disorder with tendency to fall towards the left side, left upper limb weakness and decreased memory. Neurological examination revealed left sided hemiparesis, and left sided positive Romberg’s test. Contrast brain magnetic resonance imaging (MRI) was performed. Treatment was prescribed as well as dynamic follow up during the course of 1.5 years. Results. Based on complaints, clinical picture and MRI result, patient was diagnosed with an atypical form of multiple sclerosis, Balo’s concentric sclerosis. The main diagnostic method used confirm the diagnosis was contrast brain MRI: Non homogenous circular-form space occupying lesion with dimensions 3.7 × 3.4 × 3.5 cm was visualized in the supraventricular area of right parietal lobe with increased and decreased signals on T2 and T1 weighted images respectively. Following intravenous administration of contrast substance, an increased T1-WI signal is observed along the periphery of the described lesion in the right parietal lobe. MRI conclusion: brain demyelination disease with large foci in the right post-frontal lobe region, typical of Balo’s concentric sclerosis. Following the acute clinical state, cytostatic and immunomodulation therapy was prescribed. MRI dynamic observation revealed decrease in dimensions of the significantly enhanced concentric areas. Follow up demonstrated marked remission. Conclusion. This clinical case is of interest due to the rarity of this disease. The basis of diagnosis in our study was MRI investigation which allows for in vivo diagnosis of this pathology. These observations confirm the fact that timely use of modern methods of treatment can achieve not only stabilization of the patients’ state, but also positive clinical and MRI dynamics.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"71-75"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41624337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Фармакоэкономическая эффективность нафтидрофурила у больных с ишемическим инсультом","authors":"А. Н. Боголепова, Д. Ю. Белоусов, А. Е. Чеберда","doi":"10.17650/1818-8338-2016-10-4-86-92","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-86-92","url":null,"abstract":"The study objective is to conduct a pharmacoeconomic analysis of naftidrofuryl effectiveness in patients with ischemic stroke. Materials and methods. The work is based on the results of clinical studies of effectiveness, tolerability, and safety of naftidrofuryl in patients who suffered an ischemic stroke. The study design included data on 1000 patients of 45 and older with first-time acute cerebrovascular disease of ischemic type. Results. Direct medical costs for the chosen patient cohort per the Standard of stroke treatment current at the time of the study were 730 575 189 rubles, in case of naftidrofuryl inclusion they were 476 467 620 rubles. Cost minimization is 254 107 569 rubles. Indirect nonmedical costs associated with temporary incapacity for work for treatment per the Standard of stroke treatment were 124 156 950 rubles, and 64 559 180 rubles for naftidrofuryl use which demonstrates the drug’s economic benefit. Budget impact analysis has shown that the possible savings constitute 7.59 %. Conclusion. Inclusion of naftidrofuryl into treatment of patients with ischemic stroke is justified as it decreases duration of rehabilitation. This leads to a positive economic effect expressed as decreased direct and non-direct medical costs.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"86-92"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Образование в правом предсердии при болезни Бехчета, симулирующее опухоль","authors":"А. А. Горбаченков, Н. В. Кривошеева, И. В. Эренбург, И. А. Бабина, Е. А. Пилипосян, М. В. Ходырева","doi":"10.17650/1818-8338-2016-10-4-55-59","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-55-59","url":null,"abstract":"The objective is to describe a rare clinical case of Behcet’s disease with right atrium thrombosis and suspicion of a heart tumor. Materials and methods. Woman,  34 years old, in December of 2015 sought medical help at a local outpatient facility, and then from a gynecologist at the Central Clinical Hospital of Civil Aviation due to painful ulcers in the genital area and fever. Her state was considered a nonherpetic infection, antiviral therapy was administered. Ulcers in the oral cavity and genital area were first diagnosed in August of 2015. In April of 2016, aphthous stomatitis developed. The patient also complained of oral ulcers, fatigue, body temperature increase up to subfebrile values, slight shortness of breath during physical activity, discomfort in the upper part of the stomach. Ultrasound of the abdominal organs and heart had shown a mass resembling a thrombus in the hepatic vein and inferior vena cava which reached the right atrium. The size of the non-mobile mass in the atrium was 38 × 25 mm. The patient was hospitalized in a cardiological department. The following examinations were performed: standard laboratory tests, electrocardiogram, repeat ultrasound of the abdominal organs and heart, X-ray of the chest, oncocytomarker tests, magnetic resonance imaging (MRI),  spiral computed tomography (SCT) with contrast of the pelvic and abdominal organs. Subsequently, due to uncertain diagnosis the patient was consulted at the A.N. Bakoulev Scientific Center for Cardiovascular Surgery, N.N. Blokhin Russian Cancer Research Center, V.A. Nasonova Research Institute of Rheumatology. Results. Ultrasound of the heart and abdominal organs had shown a large mass in the inferior vena cava extending to the right atrium, which lead to a suspicion of a myxoma or thrombosis. After MRI of the heart and abdominal organs, an infectious thrombus in the heart and inferior vena cava was suggested. SCT with contrast of the pelvic and abdominal organs, oncocytomarker tests didn’t show any pathology. The combination of aphtous ulcers of the mouth and genitalia and inferior vena cava thrombosis allowed to suspect the Behcet’s disease. This diagnosis was confirmed at the V.A. Nasonova Research Institute of Rheumatology. Prescribed immunosuppressive therapy (meripred, azathioprine, colchicine), which is still ongoing, led to a decrease in inflammatory activity (С-reactive protein), reduction of the thrombus in the right atrium and inferior vena cava. Currently, the patient continues to receive the prescribed immunosuppressive therapy. No complaints, feeling healthy, working. The patient remains under the care of physicians. Conclusion. This clinical case demonstrates diagnostic complications of detection of masses in the heart which can represent a tumor or a thrombus. In the described case, diagnosis of the Behcet’s disease was facilitated by typical aphtous ulcers of the mucosa of the mouth and genitalia and development of vasculitis with subsequent thrombosis o","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"55-59"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45437980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Современные методы амбулаторного мониторирования электрокардиограммы. Технические аспекты","authors":"Е. В. Первова","doi":"10.17650/1818-8338-2016-10-4-16-28","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-16-28","url":null,"abstract":"The review considers the main characteristics and diagnostic capabilities of current noninvasive and invasive methods of ambulatory electrocardiogram monitoring used in diagnosis of cardiac rhythm and conduction disturbances. Strength and weaknesses of different methods of long-term electrocardiogram monitoring are discussed.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"16-28"},"PeriodicalIF":0.0,"publicationDate":"2017-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49300907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ИНФАРКТ МИОКАРДА У МОЛОДЫХ: ПРИЧИНЫ И ПРОГНОЗ ЗАБОЛЕВАНИЯ","authors":"Екатерина Владимировна Константинова, Н. М. Балаян, Надежда Александровна Шостак","doi":"10.17650/1818-8338-2016-10-4-10-15","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-10-15","url":null,"abstract":"Myocardial infarction (MI) is unusual among young people, but with an upward trend in changing to unhealthy lifestyle, there is growing proportion of patients with MI are aged > 45 years. Premature MI individuals were predominantly males, characterized by smoking, obesity, and dyslipidemia (an essential key contributing to atherosclerosis). Many studies have reported that unemployment has also a negative effect on health. MI in young adults is generally caused by thrombus arising secondary to the rupture of the atherosclerotic plaque in coronary artery. As opposed to lesions associated with plaque rupture, those thatunderlie superficial erosion do not have thin fibrous caps, harbor fewer inflammatory cells, lack large lipid pools. Superficial erosion occurs morecommonly in women and the elderly. Normal coronary arteries in young adults with MI is related to coronary vasospasm, embolus arising from endocardium or heart vessels, platelet aggregation, and other reasons. Heart failure (HF) is a common complication of MI. With timely access to medical care and good adherence to treatment older patients are at greater risk of developing heart failure.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"10-15"},"PeriodicalIF":0.0,"publicationDate":"2017-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46039036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ТРОМБОТИЧЕСКИЕ И ТРОМБОЭМБОЛИЧЕСКИЕ ОСЛОЖНЕНИЯ ПРИ СИСТЕМНЫХ ВАСКУЛИТАХ","authors":"Евгений Арсеньев, С. В. Тополянская","doi":"10.17650/1818-8338-2017-11-2-24-32","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-24-32","url":null,"abstract":"Nowadays, there is no doubt about the relationship between immune inflammation and the development of thrombosis due to the similarity of many pathogenetic machanisms underlying both pathological processes. Systemic vasculitis, along with other immuno- mediated inflammatory diseases, represent one of the most clear examples of such interaction. Thrombotic complications remain one of the most serious and life-threatening conditions that occur in patients with autoimmune diseases, in particular systemic vasculitis. This serves as powerful stimulus for studing the problem of hypercoagulation, which often accompanies the course of systemic vasculitis. Of interest are thrombosis that occure both in the injury of large vessel and in the involvement of medium and small vessels in the pathological process. According to the literature, thrombotic and thromboembolic complications are most common in ANCA-associated vasculitis and Behcet’s disease. This review discusses current studies regarding features of clinical picture and mechanisms of thrombosis development in systemic vasculitis. Because of these studies it became clear that for some vasculitis a high frequency of both arterial and venous thrombosis is characteristic. At the same time, other vasculitis are accompanied by high risk of only venous thrombosis. Finally, thrombosis and thromboembolism are quite rare complications for some vasculitis. Among the presented mechanisms of thrombosis involvement, disruptions of the hemostasis are widely considered. For examples, the presents the results of researches, which is actively discussed the role of neutrophil extracellular traps and antiendothelial cell antibodies in the development on thrombotic complictions. Special attention is paid to the possible role of some disorders of hemostasis, such as polymorphism V coagulation factor G1691FA and prothrombin G20210A. To search for literature sources, the following queries were used: “vasculitis”, “thrombosis”, “neutrophil extracellular traps”, “ANCA-associated vasculitis”, “venous thrombosis”, “arterial thrombosis”, “Behcet’s disease”, “Takayasu arteritis”, “granulomatosis with polyangiitis”, “eosinophilic granulomatosis with polyangiitis”, “Mmicroscopic polyangiitis”, “Henoch–Schonlein purpura”, “Kawasaki disease”, “polyarteritis nodosa”, “giant cell arteritis”, “Buerger’s disease”. In addition, use similar requests in English. The search was carried out in PubMed.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"24-32"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67770688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"РОЛЬ АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ПРОТЕЗИРОВАННЫМИ КЛАПАНАМИ СЕРДЦА","authors":"Надежда Александровна Шостак, А. А. Клименко, Д. Ю. Андрияшкина, А. А. Кондрашов, Анна Владимировна Новикова","doi":"10.17650/1818-8338-2016-10-2-10-17","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-2-10-17","url":null,"abstract":"Cardiac surgery is the only radical method of treatment of valvular defects (congenital or acquired): valve preservation procedures or prosthetics operations. 250 000 – 280 000 valve prostheses are implanted every year worldwide, while the number of prosthetic valves operation increases by an average of 5–7 % per year (biological prostheses – 8–11 %, mechanical prostheses – 3–5 %). Selection of biological or mechanical types of prosthesis, its location, the presence of associated risk factors for embolic events, such as atrial fibrillation, previous embolism, left ventricular dysfunction, hypercoagulable states determine patient management tactics. Particularly high risk of prosthetic thrombosis and thromboembolic complications can be seen in case of mechanical prosthesis implantation. Numerous prospective and retrospective clinical studies have proven high effectiveness of anticoagulants for reduction the risk of cardioembolic complications. The degree of anticoagulation (optimal international normalized ratio (INR)) is determined by risk factors for prosthetic thrombosis and thromboembolic complications in a patient, as well as thrombogenicity of the prosthesis by itself; INR may range from 2.5 to 4.0. International recommendations take into account the presence/absence of additional risk factors for thromboembolism, and based on warfarin administration with the achievement of target INR values combined with low-dose aspirin. Administration of novel direct oral anticoagulation remedies in patients with prosthetic heart valves has not been studied sufficiently up to date and is contraindicated. Thus, warfarin currently is a drug of choice for the prevention of thromboembolic complications in patients with prosthetic heart valves.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"4 1","pages":"10-17"},"PeriodicalIF":0.0,"publicationDate":"2016-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67769438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}