2009-4

.: Дата публікації 2009-12-22 :: Переглядів: 6 :: :.

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EFFICIENCY OF METHODS OF PROPHYLAXIS OF THROMBOSES OF VENOUS SYSTEM OF LOWER LIMBS AFTER OPERATION OF SAFENEKTOMY
V.B. Goschinskiy, I.K. Venger, V.Ya. Kadubets

The aims — to conduct the comparative analysis of frequency of formation of thrombosis in deep and superficial veins of lower limbs at administration of LMWH of the second generation — bemiparin in the complex of prevention techniques. To estimate efficiency of mechanical and pharmacological prophylaxis of venous thromboembolism (VTE).

Materials and methods. The analysis of efficiency of methods of thromboprophylaxis is in 168 patients to which the executed operation of safenectomy. Two clinical groups were selected. The first one — 84 patients in which for the postoperative prophylaxis of VTE mechanical and physical methods were administered: the strapping and pneumatic cyclic compression pumps of lower limbs. In the second group (84 patients) the prophylaxis of thromboses of the venous system of lower extremities included the strapping of lower limbs and administration of LMWH — bemiparin for duration 7—10 days of postoperative time. For the topical and functional diagnostics the duplex ultrasonography (DUS) of the venous system of lower limbs was conducted.

Results and discussion. VTE on the clinical and DUS data discovered in 11 (13,1 %) patients in the first group. From them the distal deep vein thrombosis (DVT) of lower limbs is set in 6 (7,1 %) patients, in 3 (3,6 %) patients — proximal DVT (to the operated extremity). 2 (2,4 %) cases of VTE are (distal DVT and superficial veins of pool of the system v. safena magna) on contralateral extremity. In the second group are marked of VTE at 4 (4,8 %) patients (significant difference (p < 0,05) vs. first group). In 2 (2,4 %) cases distal DVT is discovered in the operated extremity, on one case thrombosis of popliteal vein and distal part of v. safena magna on contralateral extremity.

Conclusions. The operation on the superficial venous system it moderate risk of VTE of lower limbs. Application only of mechanical prophylaxis is not enough effective. Combination of graduated compression stockings or intermittent pneumatic compression and administration LMWH of the second generation — bemiparin in prophylaxic doses allows more, than on 63 % to reduce the relative risk of venous thromboembolism of lower limbs. Application only of mechanical facilities of prophylaxis is it is not enough effective. Combination of mechanical methods of prophylaxis with pharmacological allows to reduce the relative risk of VTE after the operation of safenektomii more than on 63 % (from 13,1 % to 4,8 %). Bemiparin is effective and safe antithrombotic agent of pharmacological prophylaxis of VTE.