vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2023.6.CLIN.16vmireaviz-881Research ArticleКлиническая медицинаClinical medicineСовременный подход к изучению проблемы патогенеза и профилактики венозных тромбоэмболических осложнений у пациентов с травмой (обзор литературы)A modern approach to the study of the problem of pathogenesis and prevention venous thromboembolic complications in patients with trauma (literature review)ЛегаД. Н.LegaD. N.

Лега Дмитрий Николаевич - Начальник хирургического отделения филиала № 4 426 военного госпиталя; старший преподаватель кафедры морфологии и патологии.

Ул. Чапаевская, д. 227, Самара, 443001; ул. Володарского, д. 79, Сызрань, 446026

Dmitriy N. Lega - Head of the Surgical Department of Branch No. 4,426 of the Military Hospital; senior lecturer at the Department of Morphology and Pathology.

227, Chapaevskaya str., Samara, 443001; 79, Volodarsky str., Syzran, 446026

doctorldn@mail.ruhttps://orcid.org/0000-0002-6446-1792СтоляровС. А.StolyarovS. A.

Столяров Сергей Анатольевич - Д-р мед. наук, профессор, заведующий кафедрой хирургических болезней.

Ул. Чапаевская, д. 227, Самара, 443001

Sergey A. Stolyarov - Dr. Sci. (Med.), Professor, Head of the Department of Surgical Diseases.

227, Chapaevskaya str., Samara, 443001

kafedra.hb.reaviz@yandex.ruhttps://orcid.org/0000-0002-1350-0704СупильниковА. А.SupilnikovA. A.

Супильников Алексей Александрович - Канд. мед. наук, доцент, первый проректор по научной работе, заведующий кафедрой морфологии и патологии.

Ул. Чапаевская, д. 227, Самара, 443001

Alexey A. Supilnikov - Cand. Sci. (Med.), Docent, First Vice-Rector for Scientific Work, Head of the Department of Morphology and Pathology.

227, Chapaevskaya str., Samara, 443001

a.a.supilnikov@reaviz.onlineМедицинский университет «Реавиз»; Филиал № 4 426 военного госпиталя,РоссияMedical University "Reaviz"; Branch No. 4 426 of the military hospitalRussian FederationМедицинский университет «Реавиз»РоссияMedical University "Reaviz"Russian Federation202314012024136131136Copyright © Лега Д.Н., Столяров С.А., Супильников А.А., 20242024Лега Д.Н., Столяров С.А., Супильников А.А.Lega D.N., Stolyarov S.A., Supilnikov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/881Актуальность

Актуальность. Пациенты с травмой подвержены повышенному риску венозных тромбоэмболических осложнений, которая включает тромбоз глубоких вен нижних конечностей и тромбоэмболию легочной артерии. В пределах хирургических и травматологических клиник тромбоэмболические осложнения – самая распространенная предотвратимая причина внутрибольничной смертности. Многочисленные исследования показали, что уровень заболеваемости тромбозом глубоких вен у пациентов с травмами без профилактики варьирует от 5 до 80 %.

Цель

Цель: проанализировать патогенез процесса развития венозных тромбозов и изучить существующие подходы к профилактике венозных тромбоэмболических осложнений у пациентов с травмой.

Материалы и методы

Материалы и методы. В ходе работы были проанализированы актуальные литературные источники отечественных и зарубежных авторов на заданную тему.

Результаты

Результаты. Механизм тромбообразования при травме включает замедление кровотока, повреждение стенки сосуда и нарушение свертываемости крови в виде гиперкоагуляции. Состояние гиперкоагуляции в сочетании с длительной неподвижностью увеличивает риск венозных тромбоэмболических осложнений. Низкомолекулярные гепарины является препаратом выбора для профилактики развития венозных тромбоэмболических осложнений при травме. Сегодня продолжаются исследования, связанные с коррекцией профилактических дозировок низкомолекулярных гепаринов и поиском единого стандарта в зависимости от многочисленных факторов.

Заключение

Заключение. Тяжесть и множественность повреждений коррелируют с выраженностью системного воспаления, гиперкоагуляции и частотой венозных тромбозов. Однако данная корреляция не достаточно изучена в научной литературе. Поиск специфических методов профилактики тромбозов глубоких вен, приводящих к тромбоэмболии легочной артерии, является актуальной проблемой хирургии повреждений как мирного, так и военного времени.

Relevance

Relevance. Patients with trauma are at increased risk of venous thromboembolic complications (VTE), which includes deep vein thrombosis of the lower extremities (DVT) and pulmonary embolism (PE). Within surgical and trauma clinics, thromboembolic complications are the most common preventable cause of in-hospital mortality. Numerous studies have shown that the incidence rate of deep vein thrombosis (DVT) in trauma patients without prevention varies from 5 to 80%.

Aim

Aim. To analyze the pathogenesis of the development of venous thrombosis and explore existing approaches to prevent VTE in trauma patients.

Materials and methods

Materials and methods. In the course of the work, topical literary sources of domestic and foreign authors on a given topic were analyzed.

Results

Results. The mechanism of thrombus formation in trauma involves slowing blood flow, damage to the vessel wall and impaired blood clotting in the form of hypercoagulation. The state of hypercoagulation combined with prolonged immobility increases the risk of VTE. LMWH is the treatment of choice for the prevention of VTE in trauma. Today, there are ongoing studies related to the correction of preventive doses of LMWH and the search for a single standard, depending on numerous factors.

Conclusion

Conclusion. Severity and multiplicity of lesions correlate with severity of systemic inflammation, hypercoagulation, and incidence of venous thrombosis. However, this correlation has not been sufficiently studied in the scientific literature. The search for specific methods for the prevention of deep vein thrombosis leading to PE is an urgent problem of surgery of injuries both peaceful and wartime.

венозные тромбоэмболические осложнениятромбоз глубоких вентромбоэмболия легочной артериигиперкоагуляциятравмаранениеНМГНФГпрофилактикаvenous thromboembolic complicationsdeep vein thrombosispulmonary embolismhypercoagulationtraumawoundLMWHLDHpreventionИсследование проводилось без спонсорской поддержки.This research received no external fundingReferencesModarres SR, Shokrollahi MH, Yaserian M, Rahimi M, Amani N, Manouchehri AA. Epidemiological Characteristics of Fatal Traumatic Accidents in Babol, Iran: A Hospital-Based Survey. Bull Emerg Trauma. 2014;2(4):146-150.Modarres SR, Shokrollahi MH, Yaserian M, Rahimi M, Amani N, Manouchehri AA. Epidemiological Characteristics of Fatal Traumatic Accidents in Babol, Iran: A Hospital-Based Survey. Bull Emerg Trauma. 2014;2(4):146-150.Cochrane Library Cochrane Database of Systematic Reviews Thromboprophylaxis for trauma patients (Review) Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CHBarrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe C.H. Thromboprophylaxis for trauma patients. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD008303.Cochrane Library Cochrane Database of Systematic Reviews Thromboprophylaxis for trauma patients (Review) Barrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe CHBarrera LM, Perel P, Ker K, Cirocchi R, Farinella E, Morales Uribe C.H. Thromboprophylaxis for trauma patients. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD008303.Selby R., Geerts W., Ofosu F.A., Craven S., Dewar L., Phillips A., Szalai J.P. Hypercoagulability after trauma: Hemostatic changes and relationship to venous thromboembolism. Thrombosis Research. 2009;124:281–287.Selby R., Geerts W., Ofosu F.A., Craven S., Dewar L., Phillips A., Szalai J.P. Hypercoagulability after trauma: Hemostatic changes and relationship to venous thromboembolism. Thrombosis Research. 2009;124:281–287.Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338–400.Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338–400.Paffrath T, Wafaisade A, Lefering R, Simanski C, Bouillon B, Spanholtz T, Wutzler S, Maegele M, Trauma Registry of DGU Venous thromboembolism after severe trauma: incidence, risk factors and outcome. Injury. (2010)41(1):97–101.Paffrath T, Wafaisade A, Lefering R, Simanski C, Bouillon B, Spanholtz T, Wutzler S, Maegele M, Trauma Registry of DGU Venous thromboembolism after severe trauma: incidence, risk factors and outcome. Injury. (2010)41(1):97–101.Lichte P, Kobbe P, Almahmoud K, Pfeifer R, Andruszkow H, Hildebrand F, Lefering R, Pape H-K. Post-traumatic thrombo-embolic complications in polytrauma patients. J. International Orthopaedics (SICOT). 2015;02:24–31.Lichte P, Kobbe P, Almahmoud K, Pfeifer R, Andruszkow H, Hildebrand F, Lefering R, Pape H-K. Post-traumatic thrombo-embolic complications in polytrauma patients. J. International Orthopaedics (SICOT). 2015;02:24–31.Meizoso JP, Karcutskie CA 4th, Ray JJ, Ruiz X, Ginzburg E, Namias N et al. A simplified stratification system for venous thromboembolism risk in severely injured trauma patients. J Surg Res. 2017;207:138-144.Meizoso JP, Karcutskie CA 4th, Ray JJ, Ruiz X, Ginzburg E, Namias N et al. A simplified stratification system for venous thromboembolism risk in severely injured trauma patients. J Surg Res. 2017;207:138-144.Петров А.Н., Борисов М.Б., Денисенко В.В., Ганин Е.В., Семенов Е.А., Коскин В.С. и др. Профилактика острых тромбоэмболических осложнений у пострадавших с многоэтапным хирургическим лечением сочетанной скелетной травмы. Скорая медицинская помощь. 2016;2:42–48.Petrov AN, Borisov MB, Denisenko VV, Ganin EV, Semenov EA, Koskin VS et al. Prevention of acute thromboembolic events in patients with multistage surgical treatment was combined skeletal trauma. Emergency Medical Care. 2016;2:42–48. (In Russ).Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО). Флебология. 2015;9(4-2):2-52.Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Phlebology. 2015;9(4-2):2-52. (In Russ).Yorkgitis BK, Berndtson AE, Cross A, Kennedy R, Kochuba MP, Tignanelli C et al. American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma. J Trauma Acute Care Surg. 2022 Mar 1;92(3):597–604.Yorkgitis BK, Berndtson AE, Cross A, Kennedy R, Kochuba MP, Tignanelli C et al. American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma Clinical Protocol for inpatient venous thromboembolism prophylaxis after trauma. J Trauma Acute Care Surg. 2022 Mar 1;92(3):597–604.Scolaro J.A., Taylor R.M., Wigner N.A. Venous thromboembolism in orthopaedic trauma. J. Am. Acad. Orthop. Surg. 2015;23:1–6.Scolaro J.A., Taylor R.M., Wigner N.A. Venous thromboembolism in orthopaedic trauma. J. Am. Acad. Orthop. Surg. 2015;23:1–6.Van Adrichem R., Debeij J., Nelissen R., Schipper I., Rosendaal F., Cannegieter S. Below-knee cast immobilization and the risk of venous thrombosis: Results from a large population-based case-control study. J. Thromb. Haemost. 2014;12:1461–1469.Van Adrichem R., Debeij J., Nelissen R., Schipper I., Rosendaal F., Cannegieter S. Below-knee cast immobilization and the risk of venous thrombosis: Results from a large population-based case-control study. J. Thromb. Haemost. 2014;12:1461–1469.Yumoto T., Naito H., Yamakawa Y., Iida A., Tsukahara K., Nakao A. Venous thromboembolism in major trauma patients: A single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening. Acute Med. Surg. 2017;4:394–400.Yumoto T., Naito H., Yamakawa Y., Iida A., Tsukahara K., Nakao A. Venous thromboembolism in major trauma patients: A single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening. Acute Med. Surg. 2017;4:394–400.Brakenridge S.C., Henley S.S., Kashner T.M., Golden R.M., Paik D.-H., Phelan H.A. et al. Comparing clinical predictors of deep venous thrombosis vs. pulmonary embolus after severe injury: A new paradigm for post-traumatic venous thromboembolism? J. Trauma Acute Care Surg. 2013;74:1231–1237.Brakenridge S.C., Henley S.S., Kashner T.M., Golden R.M., Paik D.-H., Phelan H.A. et al. Comparing clinical predictors of deep venous thrombosis vs. pulmonary embolus after severe injury: A new paradigm for post-traumatic venous thromboembolism? J. Trauma Acute Care Surg. 2013;74:1231–1237.Van Adrichem R., Debeij J., Nelissen R., Schipper I., Rosendaal F., Cannegieter S. Below-knee cast immobilization and the risk of venous thrombosis: Results from a large population-based case-control study. J. Thromb. Haemost. 2014;12:1461–1469.Van Adrichem R., Debeij J., Nelissen R., Schipper I., Rosendaal F., Cannegieter S. Below-knee cast immobilization and the risk of venous thrombosis: Results from a large population-based case-control study. J. Thromb. Haemost. 2014;12:1461–1469.Peltan ID, Vande Vusse LK, Maier RV, Watkins TR. An international normalized ratio-based definition of acute traumatic coagulopathy is associated with mortality, venous thromboembolism, and multiple organ failure after. Injury Crit Care Med. 2015;43(7):1429–1438.Peltan ID, Vande Vusse LK, Maier RV, Watkins TR. An international normalized ratio-based definition of acute traumatic coagulopathy is associated with mortality, venous thromboembolism, and multiple organ failure after. Injury Crit Care Med. 2015;43(7):1429–1438.Van Haren RM, Valle EJ, Thorson CM, Jouria JM, Busko AM, Guarch GA et al. Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism. J Trauma Acute Care Surg. 2014;76(2):443–449.Van Haren RM, Valle EJ, Thorson CM, Jouria JM, Busko AM, Guarch GA et al. Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism. J Trauma Acute Care Surg. 2014;76(2):443–449.Brill JB, Badiee J, Zander AL, Wallace JD, Lewis PR, Sise MJ et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulablethromboelastography. J Trauma Acute Care Surg. 2017;83(3):413–419.Brill JB, Badiee J, Zander AL, Wallace JD, Lewis PR, Sise MJ et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulablethromboelastography. J Trauma Acute Care Surg. 2017;83(3):413–419.Park MS, Perkins SE, Spears GM, Ashrani AA, Leibson CL, Boos CM et al.Risk factors for venous thromboembolism after acute trauma: A population-based case-cohort study. Thromb Res. 2016;144:40–45.Park MS, Perkins SE, Spears GM, Ashrani AA, Leibson CL, Boos CM et al.Risk factors for venous thromboembolism after acute trauma: A population-based case-cohort study. Thromb Res. 2016;144:40–45.Tan L, Qi B, Yu T, Wang C. Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta-analysis. Int Wound J. 2016;13(6):1359–1371.Tan L, Qi B, Yu T, Wang C. Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta-analysis. Int Wound J. 2016;13(6):1359–1371.Rogers F.B., Cipolle M.D., Velmahos G., Rozycki G., Luchette F.A. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. Journal of Trauma. 2002;53(1):142–164.Rogers F.B., Cipolle M.D., Velmahos G., Rozycki G., Luchette F.A. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. Journal of Trauma. 2002;53(1):142–164.Arnold J.D., Dart B.W., Barker D.E. et al. Unfractionated heparin three times a day versus enoxaparin in the preventionof deep vein thrombosis in trauma patients. J American Surgeon. 2010;76(6):563–570.Arnold J.D., Dart B.W., Barker D.E. et al. Unfractionated heparin three times a day versus enoxaparin in the preventionof deep vein thrombosis in trauma patients. J American Surgeon. 2010;76(6):563–570.Malinoski D., Jafari F., Ewing T. et al. Standard prophylactic enoxaparin dosing leads to inadequate anti-Xa levels and increased deep venous thrombosis rates in critically Ill trauma and surgical patients. Journal of Trauma. 2010;68(4):874–879.Malinoski D., Jafari F., Ewing T. et al. Standard prophylactic enoxaparin dosing leads to inadequate anti-Xa levels and increased deep venous thrombosis rates in critically Ill trauma and surgical patients. Journal of Trauma. 2010;68(4):874–879.Cothren C.C., Smith W.R., Moore E.E., Morgan S.J. Utility of once-daily dose of low-molecular-weight heparin to prevent venous thromboembolism in multisystem trauma patients. World Journal of Surgery. 2007; 31(1):98–104.Cothren C.C., Smith W.R., Moore E.E., Morgan S.J. Utility of once-daily dose of low-molecular-weight heparin to prevent venous thromboembolism in multisystem trauma patients. World Journal of Surgery. 2007; 31(1):98–104.Sems S.A., Levy B.A., Dajani K., Herrera D.A., Templeman D.C. Incidence of deep venous thrombosis after temporary joint spanning external fixation for complex lower extremity injuries. The Journal of trauma. 2009;66(4):1164–1166.Sems S.A., Levy B.A., Dajani K., Herrera D.A., Templeman D.C. Incidence of deep venous thrombosis after temporary joint spanning external fixation for complex lower extremity injuries. The Journal of trauma. 2009;66(4):1164–1166.Brohi K., Cohen M.J., Ganter M.T. et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. Journal of Trauma. 2008;64(5):1211–1217.Brohi K., Cohen M.J., Ganter M.T. et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. Journal of Trauma. 2008;64(5):1211–1217.Tai S.M., Buddhdev P., Baskaradas A., Sivarasan N., Tai N.R. Venous thromboembolism in the trauma patient. Orthop. Trauma. 2013;27:379–392.Tai S.M., Buddhdev P., Baskaradas A., Sivarasan N., Tai N.R. Venous thromboembolism in the trauma patient. Orthop. Trauma. 2013;27:379–392.

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