References

rmt

Общая реаниматология

General Reanimatology

1813-97792411-7110

FSBI "SRIGR" RAMS

10.15360/1813-9779-2007-6-192-198

rmt-910

Research Article

ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ

REVIEWS & SHORT COMMUNICATIONS

Приобретенные коагулопатии: современные подходы к дифференциальной диагностике и интенсивной терапии с позиций доказательной медицины

Acquired Coagulopathies: Current Approaches to Differential Diagnosis and Intensive Care in the Context of Evidence-Based Medicine

Синьков

С. В.

Sinkov

S. V.

Заболотских

И. Б.

Zabolotskikh

I. B.

Шапошников

С. А.

Shaposhnikov

S. A.

Department of Anesthesiology, Reanimatology, and Transfusiology, Kuban State Medical University Department of Reanimatology and Intensive Care, All!Russian Center for Functional Surgical Gastroenterology, Ministry of Health and Social Development of the Russian Federation, Krasnodar

Кубанский государственный медицинский университет, Краснодар Кафедра анестезиологии-реаниматологии и трансфузиологии ФПК и ППС ФГУ Российский центр функциональной хирургической гастроэнтерологии МЗСР РФ, Отдел реаниматологии и интенсивной терапии, КраснодарDepartment of Anesthesiology, Reanimatology, and Transfusiology, Kuban State Medical University Department of Reanimatology and Intensive Care, All!Russian Center for Functional Surgical Gastroenterology, Ministry of Health and Social Development of the Russian Federation, Krasnodar

2007

20122007

Том III № 5-6 2007 г.

192198

2007

Синьков С.В., Заболотских И.Б., Шапошников С.А.

Sinkov S.V., Zabolotskikh I.B., Shaposhnikov S.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.reanimatology.com/rmt/article/view/910

Приобретенные коагулопатии — один из наиболее часто встречаемых синдромов критических состояний. По данным литературы, клинические признаки коагулопатии (кровотечения) наблюдаются у 16% пациентов отделений реанимации и интенсивной терапии (ОРИТ), лабораторные признаки коагулопатии — у 66% пациентов ОРИТ. Говоря о приобретенных коагулопатиях, необходимо помнить не только о ДВС-синдроме, как наиболее часто встречаемой коагулопатии, но и о многих других нарушениях гемостаза, имеющих свои лабораторные диагностические критерии и, соответственно, особенности интенсивной терапии. При этом, краеугольным камнем остается дифференциальная диагностика выявляемых приобретенных коагулопатий. В литературном обзоре с позиций доказательной медицины представлены основные принципы дифференциальной диагностики и интенсивной терапии следующих приобретенных коагулопатий: различных видов тромбоцитопений, тромбоцитопатий, ДВС-синдрома, гемодилюционной, печеночной и уремической коагулопатии, передозировки прямых (гепарина) и непрямых антикоагулянтов (варфарина).

Acquired coagulopathies are one of the commonest syndromes of critical conditions. According to the data available in the literature, the clinical signs of coagulopathy (bleedings) are observed in 16% of intensive care unit (ICU) patients, its laboratory signs are seen in 66% of ICU patients. While on the subject of acquired coagulopathies, consideration must be given not only to the disseminated intravascular coagulation (DIC) syndrome as the most frequently encountered coaglopathy, but also to many other hemostatic disorders having their laboratory diagnostic criteria and accordingly the specific features of intensive care, the differential diagnosis of identified acquired coagulopathies remaining the corner-stone. In the context of evidence-based evidence, the literature review presents the basic principles of the differential diagnosis and intensive therapy of the following acquired coagulopathies: different types of thrombocytopenias, thrombocytopathies, DIC syndrome, hemodilu-tion, hepatic, and uremic coagulopathies, overdosage of direct (heparin) and indirect (warfarin) anticoagulants.

приобретенные коагулопатиитромбоцитопениитромбоцитопатиипередозировка антикоагулянтовДВС-синдром

acquired coagulopathiesthrombocytopeniathrombocytopathiesoverdosage of anticoagulantsdisseminated intravascular coagulation syndrome

References1

Health A. Science policy committee of the Amerikan college of chest physians; 2000.

Chakraverty R., Davidson S., Peggs K. et al. The incidence and cause of coagulopathies in an intensive care population. Br. J. Haematol. 1996; 93: 460—463.

Синьков С. В., Аверьянова Л. Е. Частота и динамика развития ДВС-синдрома в абдоминальной хирургии. Вестн. интенс. терапии 2005; 5: 52—59.

Kitchens C. S. Consultative hemostasis and thrombosis. W.B.: Saunders Company; 2004.

Баркаган З. С., Момот А. П. Диагностика и контролируемая терапия нарушений гемостаза. М.: Ньюдиамед; 2001.

Момот А. П. Патология гемостаза: принципы и алгоритмы клинико-лабораторной диагностики. СПб.: Формат; 2006.

Taylor F. B., Ton C. H., Hoots W. K. et al. Scientific and standardization committee communications: towards a definition. Clinical and laboratory criteria, and a scoring system for disseminated intravasciilar coagulation. Scientific subcommittee on disseminated intravascular coagulation (DIG) of the international society on thrombosis and haemostasis; 2001.

Matsuda T. Clinical aspects of DIC- disseminated intravascular coagulation. Pol. J. Pharmacol. 1996; 48 (1): 73—75.

Заболотских И. Б., Синьков С. В., Мануйлов А. М. Протокол диагностики и лечения синдрома диссеминированного внутрисосудистого свертывания. Вестн. интенс. терапии 2004; 5: 201—204.

Crowther M. A., Ginsberg J. S., Hirsh J. Practical aspects of anticoagulant therapy. In: George J. N. et al (еds). Hemostasis and thrombosis: basic principles and clinical practice. Philadelphia: Lippincott Williams & Wilkens. 2001: 1497—1516.

Ragni M. V. Liver Disease, Organ transplantation, and hemostasis. In: Kitchens C. S. (ed). Consultative hemostasis and thrombosis. W.B.: Saunders Company; 2004. 481—492.

Deloughery T. G. Hemorrhagic and thrombotic disorders in the intensive care setting. In: Kitchens C. S. (ed). Consultative hemostasis and thrombosis. W. B.: Saunders Company; 2004. 493—514.

Angiolillo A., Abu-Ghosh A. M., Cairo M. S. General aspects of thrombocytopenia, platelet transfusions, and thrombopoietic growth factors. In: Kitchens C. S. (ed). Consultative hemostasis and thrombosis. W.B.: Saunders Company; 2004. 103—116.

Goebel R. A. Thrombocytopenia. Emerg. Med. Clin. North. Am. 1993; 11: 445—464.

Lilleyman J. S. Management of childhood idiopathic thrombocytopenic purpura. Br. J. Haematol. 1999; 105: 871—875.

Rebulla P., Finazzi G., Marangoni F. et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N. Engl. J. Med. 1997; 337: 1870—1875.

Bellucci S., Charpak Y., Chastang C., Tobelem G. Low doses v conventional doses of corticoids in immune thrombocytopenic purpura (ITP): Results of a randomized clinical trial in 160 children, 223 adults. Blood 1988; 71: 1165—1169.

George J. N., Woolf S. H., Raskob G. E. et al. Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American society of hematology. Blood 1996; 88: 3—40.

Law C., Marcaccio M., Tarn P. et al. High-dose intravenous immune globulin and the response to splenectomy in patients with idiopathic thrombocytopenic purpura. N. Engl. J. Med. 1997; 336: 1494—1498.

Pizzuto J., Ambriz R. Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: multicentric trial of the cooperative Latin American group on hemostasis and thrombosis. Blood 1984; 64: 1179—1183.

Burrows R. F., Kelton J. G. Pregnancy in patients with idiopathic thrombocytopenic purpura: Assessing the risks for the infant at delivery. Obstet. Gynecol. Surv. 1993; 48 (12): 781—788.

Guyatt G., Schunemann H., Cook D. et al. Grades of recommendation for antithrombotic agents. Chest 2001; 119: 3—7.

Hirsh J., Warkentin T. E., Shaughnessy S. G. et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics. dosing, monitoring, efficacy, and safety. Chest 2001; 119: 64—94.

Marcus A .J. In: Kaplan B. S., Trompeter R. S., Moake J. L. (eds). Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura. N.Y.: Marcel Dekker; 1992. 19—27.

Moake J. L. Thrombotic thrombocytopenic purpura. In: Kitchens C.S. (ed.) Consultative hemostasis and thrombosis. W.B.: Saunders Company; 2004. 343—354.

Zeigler Z. R., Shadduck R. K., Gryn J. F. et al. Cryoprecipitate poor plasma does not improve early response in primary adult thrombotic thrombocytopenic purpura (TTP). J. Clin. Apheresis 2001; 16: 19—22.

Sarode R., McFarland J. G., Flomenberg N. et al. Therapeutic plasma exchange does not appear to be effective in the management of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome following bone marrow transplantation. Bone Marrow Transplant. 1995; 16: 271—275.

Minakami H., Sato I. HELLP syndrome. JAMA 1999; 281: 703—704.

Miller R. D. Transfusion therapy. In: Miller R.D. (ed.) Miller's Anesthesia; 2005. 1799—1830.

Guidelines for the use of platelet transfusions. Brit. J. Haematology 2003; 122:10—23.

Рандомизированные клинические испытания коллоидных плазмозамещающих растворов на основе модифицированной желатины и гидроксиэтилкрахмала. Отечественный и зарубежный опыт их применения. Сб. ст. СПб.; 2002.

Воробьев А. И. Руководство по гематологии. М.:Ньюдиамед; 2005.

Bolan C. D. Transfusion medicine and pharmacologic aspects of hemostasis. In: Kitchens C.S. (ed). Consultative hemostasis and thrombosis. W.B.: Saunders Company; 2004. 395—416.

Schafer A. Bleeding and thrombosis in myeloproliferative disorders. Blood 1984; 64: 1—12.

Becker R. C., Berkowitz S. D. Hemostatic aspects of cardiovascular medicine In: Kitchens C. S. (ed). Consultative hemostasis and thrombosis. W. B.: Saunders Company; 2004. 279—310.

Carr J. A., Silverman N. The heparin-protamine interaction. A review. J. Cardiovasc. Surg. (Torino) 1999; 40: 659—666.

Crowther M. A., Ginsberg J. S., Hirsh J. Practical aspects of anticoagulant therapy. In: Colman R. W. et al. (eds). Hemostasis and thrombosis: basic principles and clinical practice. Philadelphia: Lippincott Williams & Wilkens; 2001. 1497—1516.

Butler A. C., Tait R. C. Management of oral anticoagulant-induced intracranial haemorrhage. Blood Rev. 1998; 12: 35—44.

Crowther M. A., Julian J., McCarty D. et al. Treatment of warfarin-associated coagulopathy with oral vitamin K: a randomised con trolled trial. Lancet 2000; 356: 1551—1553.

Hylek E. M., Chang Y. C., Skates S. J. et al. Prospective study of the outcomes of ambulatory patients with excessive warfarin anticoagulation. Arch. Intern. Med. 2000; 160: 1612—1617.

Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant. Brit. J. Haematology 2004; 126:11—28.

Barrons R. W., Jahr J. S. A Review of post-cardiopulmonary bypass bleeding, aminocaproic acid, tranexamic acid, and aprotinin. Am. J. Ther. 1996; 3 (12): 821—838.

Kyriss T., Wurst H., Friedel G. et al. Reduced blood loss by aprotinin in thoracic surgical operations associated with high risk of bleeding. A placebo-controlled, randomized phase IV study. Semin Thromb. Hemost. 1997; 23: 365—370.

Samama C. M., Langeron O., Rosencher N. et al. Aprotinin versus placebo in major orthopedic surgery: a randomized, double-blinded, doseranging study. Anesth. Analg. 2002; 95 (2): 287—293.

Frenette L., Cox J., McArdle P. et al. Conjugated estrogen reduces transfusion and coagulation factor requirements in orthotopic liver transplantation. Anesth. Analg. 1998; 86: 1183—1186.

Kang Y. G., Lewis J. H., Novalgund A. et al. Epsilon aminocaproic acid for treatment of fibrinolysis during liver transplantation. Anesthesiology 1987; 66: 766—773.

Boylan J. F., Klinck J. R., Sandier A. N. et al. Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation. Anesthesiology 1996; 85:1043—1048.

Porte R. J., Molenaar B., Groenland T. H. N., et al. Aprotonin and transfusion requirements in orthotopic liver transplantation: a multicenter randomised double-blind study. Lancet 2000; 355: 1303—1309.

Bronner M. H., Pate M. B., Cunningham J. T., Marsh W. H. Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial. Ann. Intern. Med. 1986; 105: 371—374.

Mannucci P. M. Desmopressin (DDAVP) in the treatment of bleeding disorders: The first 20 years. Blood 1997; 90: 2515—2521.

Moia M., Mannucci P. M., Vizzotto L. et al. Improvement in the haemostatic defect of uraemia after treatment with recombinant human erythropoietin. Lancet 1987; 2 (8570): 1227—1229.

Triulzi D. J., Blumberg N. Variability in response to cryoprecipitate treatment for hemostatic defects in uremia. Yale J. Biol. Med. 1990; 63: 1—7.

Dice R. D. Intraoperative disseninated intravascular coagulopathy. Crit. Care Nursing Clin. N. Amer. 2000; 12 (2): 175—179.

Hebert P. C., Wells G., Marshall J. et al. Transfusion requirements in critical care: A pilot study. JAMA 1999; 273: 1439—1444.

Baglin T., Barrowcliffe T. W., Cohen A., Greaves M. Guidelines on the use and monitoring of heparin. Brit. Society Haematol. 2006; 133: 19—34.

Hardaway R. M., Williams C. H., Vasquez Y. Disseminated intravascular coagulation in sepsis. Semin Thromb. Hemost. 2001; 27(6): 577—583.

de Jonge E., Eevi M., Stoutenbeek C. P., van Deventer S. J. Current drug treatment strategies for disseminated intravascular coagulation. Drugs 1998; 55 (6): 767—77.

Kitchens C. S. Disseminated Intravascular Coagulation. In: Kitchens C.S. (ed). Consultative hemostasis and thrombosis. W.B.: Saunders Company; 2004. 165—178.

Levi M. M., Vink R., de Jonge. Management of bleeding disorders by progemostatic therapy. Int. J. Hematol. 2002; 76 (Suppl 2): 139—144.

Hirasawa H., Baue A. E. Blood purificacion therapy to prevent or treat MOF. In: Baue A. E., Faist E., Fry D. E. (eds). Multiple organ failure. N.Y.: Springer-Verlag; 2000. 501—504.

The authors declare that there are no conflicts of interest present.