Hemorrhagic complications of antithrombotic therapy in real clinical practice


DOI: https://dx.doi.org/10.18565/therapy.2022.4.15-22

Vorobyeva N.A., Vorobyeva A.I., Shchapkov A.A.

Northern State Medical University of the Ministry of Healthcare of Russia, Arkhangelsk
Abstract. Currently, for the prevention and treatment of thrombosis, drugs from the group of glucose K antagonists (VKAs) and direct oral anticoagulants are widely used. Prolonged significant antithrombotic therapy (ATT) increases the risk of hemorrhagic complications.
Purpose of the study was analysis of possible causes of the development of intracranial hemorrhagic complications against the background of prolonged oral anticoagulant therapy in real clinical practice.
Material and methods. A prospective clinical study included an analysis of intracranial hemorrhagic complications during prolonged oral antithrombotic therapy on an outpatient basis. We studied the presence of probable factors that could lead to the development of hemorrhagic complications, the outcomes of complications and their frequency, data on the drug, indications for the appointment of ATT, concomitant diseases and their pharmacotherapy, the level of international normalized ratio (INR) for patients receiving VKA, features of pharmacogenetic profile of the patient, as well as the level of blood pressure (BP) when the patient is admitted to the hospital.
Results. At admission, 93,5% of patients had arterial hypertension without reaching the target BP value, (in 60,9% of cases, grade 3 hypertension) was recorded at admission, requiring pharmacotherapy with antihypertensive drugs. Concomitant therapy was represented by drugs that interact with the level of cytochrome 450 with the antithrombotic agents used. Laboratory monitoring of drug hypocoagulation during warfarin therapy showed that at the time of hospitalization the INR level was above 3.0 units in 91,67% of cases. In the group of patients with ICH, polymorphism of the MDR1(C/T), MDR1(G/T) genes may have influenced the development of bleeding.
Conclusion. Insufficient adherence of the patient to pharmacotherapy, underestimation of kidney function leads to adverse consequences in the form of bleeding, increased mortality and, consequently, increased health care costs.
Keywords: antithrombotic clinic, direct oral anticoagulants, antithrombotic therapy, bleeding, intracerebral hemorrhage, warfarin
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About the Autors

Nadezhda A. Vorobyeva, Dr. med. habil., professor, head of the Department of clinical pharmacology and pharmacotherapy, Northern State Medical University of the Ministry of Healthcare of Russia. Address: 163001, Arkhangelsk, 51 Troitskiy Avenue. E-mail: nadejdav29@yandex.ru; nadejdav0@gmail.com. ORCID: https://orcid.org/0000-0001-6613-2485. SPIN-code: 4545-2558. Author ID: 637455. Researcher ID: E-4115-2018. Scopus Author ID: 57200828966
Alena I. Vorobyeva, researcher at Central Research Laboratory of Northern State Medical University of the Ministry of Healthcare of Russia. Address: 163001, Arkhangelsk, 51 Troitskiy Avenue. E-mail: greeenhamster@rambler.ru. ORCID: https://orcid.org/0000-0003-4817-6884. Scopus Author ID: 57200384556
Alexei A. Shchapkov, assistant at the Department of clinical pharmacology and pharmacotherapy, Northern State Medical University of the Ministry of Healthcare of Russia. Address: 163001, Arkhangelsk, 51 Troitskiy Avenue.
E-mail: kerolotpaladin@yandex.ru


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