Современные возможности лабораторной диагностики по прогнозированию и раннему выявлению венозной тромбоэмболии у пациентов с ортопедической патологией после оперативного лечения (обзор литературы)

Аннотация

Одним из наиболее тяжёлых и трудно предсказуемых осложнений после ортопедических хирургических вмешательств является венозная тромбоэмболия. Точное прогнозирование возможности её возникновения и раннее своевременное выявление, остаются нерешённой проблемой. Это обусловливает запоздалое начало фармакологической коррекции гиперкоагуляции и, как следствие, снижение её эффективности. Основными причинами сложившейся ситуации являются отсутствие широкого применения в повседневной клинической практике высоковалидных лабораторных скрининговых биомаркеров, прогнозирующих возможность возникновения и позволяющих проводить раннее своевременное выявление венозной тромбоэмболии, а также недостаток сведений у медицинских специалистов по этому вопросу. В статье приведены сведения о спектре биомаркеров, применяемых или рассматриваемых как информативные для характеристики процессов коагуляции, а также воспаления, сопутствующего активации системы гемостаза. Дополнительные сложности создает отсутствие общепринятого эффективного алгоритма лабораторной диагностики венозной тромбоэмболии, основанного на комплексной системной и валидированной оценке рисков тромбозов, а также шкалы бальной оценки, необходимой для большей объективизации полученных результатов. Их научное обоснование и разработка являются приоритетными задачами будущих исследований, посвящённых решению проблемы прогнозирования возникновения и ранней диагностики венозной тромбоэмболии, у пациентов после выполнения ортопедического оперативного лечения. Обоснована необходимость проведения широкомасштабных многоцентровых клинических исследований, выполненных по единому дизайну, для внедрения в клиническую практику новых биомаркеров с целью более эффективного прогнозирования возникновения и ранней диагностики венозной тромбоэмболии у пациентов после выполнения ортопедического оперативного лечения.

Annotation

One of the most severe and difficult to predict complications following orthopedic surgery is venous thromboembolism. Accurate prediction of its occurrence and early, timely detection remain unresolved issues. This leads to delayed initiation of pharmacological correction of hypercoagulability and, consequently, reduced effectiveness. The main reasons for this situation are the lack of widespread use in routine clinical practice of highly valid laboratory screening biomarkers that predict the possibility of venous thromboembolism and enable early, timely detection, as well as a lack of information among medical professionals on this issue. This article presents information on the spectrum of biomarkers used or considered informative for characterizing coagulation processes, as well as the inflammation associated with activation of the hemostatic system. Additional complications are created by the lack of a generally accepted, effective algorithm for the laboratory diagnosis of venous thromboembolism based on a comprehensive, systemic, and validated assessment of thrombosis risks, as well as a scoring scale necessary for greater objectivity of the obtained results. Their scientific substantiation and development are priority tasks for future research focused on predicting the occurrence and early diagnosis of venous thromboembolism in patients undergoing orthopedic surgery. The need for large-scale, multicenter, uniformly designed clinical trials to introduce new biomarkers into clinical practice is justified, aiming to more effectively predict the occurrence and early diagnosis of venous thromboembolism in patients undergoing orthopedic surgery.

Key words: venous thromboembolism; thrombosis; diagnostics of thrombosis; biomarkers; review

Об авторах

Список литературы

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