gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2024-1032-2784gastro-j-1383Research ArticleСОГЛАШЕНИЕ СПЕЦИАЛИСТОВEXPERTS’ AGREEMENTКоррекция тромбоцитопении у пациентов с циррозом печени перед плановыми хирургическими вмешательствами / инвазивными процедурами (соглашение специалистов)Correction of Thrombocytopenia before Elective Surgery / Invasive Procedures in Patients with Liver Cirrhosis (Experts’ Agreement)https://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Маевская Марина Викторовна — доктор медицинских наук, профессор, консультант лечебно-диагностического отделения Университетской клинической больницы № 2

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Marina V. Maevskaya — Dr. Sci. (Med.), Professor, Consultant at the Diagnostic and Treatment Department of the University Clinical Hospital No. 2

119048, Moscow, Trubetskaya str., 8/2

mvmaevskaya@me.comhttps://orcid.org/0000-0002-1210-2528НадинскаяМ. Ю.NadinskaiaM. Yu.

Надинская Мария Юрьевна — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Maria Yu. Nadinskaia — Cand. Sci. (Med.), Associate Professor at the Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

nadinskaya_m_yu@staff.sechenov.ruhttps://orcid.org/0000-0002-4223-3473БессоноваЕ. Н.BessonovaE. N.

Бессонова Елена Николаевна — доктор медицинских наук, доцент кафедры поликлинической терапии; главный внештатный гастроэнтеролог Министерства здравоохранения Свердловской области; руководитель Свердловского областного гепатологического центра

620102, г. Екатеринбург, ул. Волгоградская, 185

 

Elena N. Bessonova — Dr. Sci. (Med.), Associate Professor at the Department of Polyclinic Therapy; Chief Freelance Gastroenterologist of the Ministry of Health of the Sverdlovsk Region, Head

620102, Yekaterinburg, Volgogradskaya str., 185

benbessonova@yandex.ruhttps://orcid.org/0000-0001-5920-5703ГейвандоваН. И.GeyvandovaN. I.

Гейвандова Наталья Иогановна — доктор медицинских наук, профессор кафедры госпитальной терапии; консультант гастроэнтерологического отделения

355017, г. Ставрополь, ул. Мира, 310

Natalia I. Geyvandova — Dr. Sci. (Med.), Professor of the Department of Hospital Therapy; Consultant, Gastroenterology Department

355017, Stavropol, Mira str., 310

ngeyvandova@yandex.ruhttps://orcid.org/0000-0001-5939-1032ЖарковаМ. С.ZharkovaM. S.

Жаркова Мария Сергеевна — кандидат медицинских наук, заведующая отделением гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Maria S. Zharkova — Cand. Sci. (Med.), Head of the Hepatology Department, V. Kh. Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

zharkova_m_s@staff.sechenov.ruhttps://orcid.org/0000-0002-8268-3129КиценкоЕ. А.KitsenkoE. A.

Киценко Евгений Александрович — доктор медицинских наук, профессор, ведущий научный сотрудник

119991, г. Москва, Абрикосовский пер., 2

Evgeniy A. Kitsenko — Dr. Sci. (Med.), Professor, Leading Researcher

119991, Moscow, Abrikosovsky lane, 2

kitsenko-surgeon@mail.ruhttps://orcid.org/0000-0002-5538-9418КорочанскаяН. В.KorochanskayaN. V.

 

Корочанская Наталья Всеволодовна — доктор медицинских наук, профессор кафедры хирургии № 3; руководитель гастроэнтерологического центра

350063, г. Краснодар, ул. Седина, 4

Natalia V. Korochanskaya — Dr. Sci. (Med.), Professor of the Department of Surgery No. 3; Head of the Gastroenterological Center

350063, Krasnodar, Sedina str., 4

nvk-gastro@mail.ruhttps://orcid.org/0000-0003-1762-4760КуркинаИ. А.KurkinaI. A.

Куркина Ирина Александровна — врач-трансфузиолог высшей категории, заведующая отделением клинической трансфузиологии

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Irina A. Kurkina — Transfusiologist of the Highest Category, Head of the Department of Clinical Transfusiology

119048, Moscow, Trubetskaya str., 8/2

kyrkinaia@rambler.ruhttps://orcid.org/0000-0002-2119-3775МеликянА. Л.MelikyanA. L.

Меликян Анаит Левоновна — доктор медицинских наук, заведующая отделением стандартизации методов лечения гематологических заболеваний

125167, г. Москва, Новый Зыковский пр., 4

Anait L. Melikyan — Dr. Sci. (Med.), Head of the Department of Standardization of Treatment Methods for Hematological Diseases

125167, Moscow, Novy Zykovsky dr., 4

anoblood@mail.ruhttps://orcid.org/0000-0002-4451-7891МорозовВ. Г.MorozovV. G.

Морозов Вячеслав Геннадиевич — доктор медицинских наук, профессор, директор

443063, г. Самара, ул. Сердобская, 36А

Viacheslav G. Morozov — Dr. Sci. (Med.), Professor, Director

 

viacheslavmorozov@yandex.ruhttps://orcid.org/0000-0002-3752-3193ХоронькоЮ. В.KhoronkoYu. V.

Хоронько Юрий Владиленович — доктор медицинских наук, профессор, заведующий кафедрой оперативной хирургии и топографической анатомии

344022, г. Ростов-на-Дону, Нахичеванский пер., 29

Yury V. Khoronko — Dr. Sci. (Med.), Professor, Head of the Department of Operative Surgery and Topographic Anatomy

344022, Rostov-on-Don, Nakhichevansky lane, 29

khoronko507@gmail.comhttps://orcid.org/0000-0002-3126-141XДееваТ. А.DeevaT. A.

Деева Татьяна Андреевна — кандидат медицинских наук, доцент кафедры биологической химии

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Tatiana A. Deeva — Cand. Sci. (Med.), Associate Professor at the Department of Biological Chemistry

119048, Moscow, Trubetskaya str., 8/2

deeva_t_a@staff.sechenov.ruhttps://orcid.org/0000-0002-3462-0123ГуляеваК. А.GulyaevaK. A.

Гуляева Ксения Александровна — аспирант кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Kseniya A. Gulyaeva — Postgraduate, Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119048, Moscow, Trubetskaya str., 8/2

xen59@mail.ruhttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович — доктор медицинских наук, академик РАН, профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии; главный внештатный специалист гастроэнтеролог МЗ РФ, президент Российского общества по изучению печени (РОПИП)

119048, г. Москва, ул. Трубецкая, 8, стр. 2

Vladimir T. Ivashkin — Dr. Sci. (Med.), Academician of the Russian Academy of Sciences, Professor, Head of the Department of Propaedeutics of Internal Diseases; Chief Gastroenterologist of the Ministry of Health of the Russian Federation; President of the Russian Scientific Liver Society.

119048, Moscow, Trubetskaya str., 8/2

fivashkin_v_t@staff.sechenov.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБОУ ВО «Уральский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ГАУЗ Свердловской области «Свердловская областная клиническая больница № 1»РоссияUral State Medical University; Sverdlovsk Regional Clinical Hospital No. 1Russian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ГБУЗ Ставропольского края «Ставропольская краевая клиническая больница»РоссияStavropol State Medical University; Stavropol Regional Clinical HospitalRussian FederationФГБНУ «Российский научный центр хирургии им. академика Б.В. Петровского»РоссияRussian Scientific Center of Surgery named after Academician B.V. PetrovskyRussian FederationФГБОУ ВО «Кубанский государственный медицинский университет» Министерства здравоохранения Российской Федерации; ГБУЗ «Краевая клиническая больница № 2»РоссияKuban State Medical University; Regional Clinical Hospital No. 2Russian FederationФГБУ «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Center for HematologyRussian FederationМедицинская компания «Гепатолог»РоссияMedical Company “Hepatologist”Russian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияRostov State Medical UniversityRussian Federation202421082024343115134Copyright © Маевская М.В., Надинская М.Ю., Бессонова Е.Н., Гейвандова Н.И., Жаркова М.С., Киценко Е.А., Корочанская Н.В., Куркина И.А., Меликян А.Л., Морозов В.Г., Хоронько Ю.В., Деева Т.А., Гуляева К.А., Ивашкин В.Т., 20242024Маевская М.В., Надинская М.Ю., Бессонова Е.Н., Гейвандова Н.И., Жаркова М.С., Киценко Е.А., Корочанская Н.В., Куркина И.А., Меликян А.Л., Морозов В.Г., Хоронько Ю.В., Деева Т.А., Гуляева К.А., Ивашкин В.Т.Maevskaya M.V., Nadinskaia M.Y., Bessonova E.N., Geyvandova N.I., Zharkova M.S., Kitsenko E.A., Korochanskaya N.V., Kurkina I.A., Melikyan A.L., Morozov V.G., Khoronko Y.V., Deeva T.A., Gulyaeva K.A., Ivashkin V.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1383Введение

Введение. В результате портальной гипертензии (секвестрация тромбоцитов в увеличенной селезенке) и печеночной недостаточности (снижение синтеза тромбопоэтина в печени) при циррозе печени развивается тромбоцитопения, которая ассоциирована с риском перипроцедурных/периоперационных геморрагических осложнений. На сегодняшний день остаются вопросы по стратификации риска геморрагических осложнений, роли прогностического значения тромбоцитопении, а также необходимости и методам медикаментозной коррекции тромбоцитопении.

Материалы и методы

Материалы и методы. Российское общество по изучению печени объединило экспертов в области терапевтической и хирургической гепатологии, гематологии, трансфузиологии для вынесения аргументированных рекомендаций и положений по проблеме «Коррекция тромбоцитопении у пациентов с циррозом печени перед плановыми хирургическими вмешательствами / инвазивными процедурами».

Результаты

Результаты. Формулировка актуальных клинических вопросов осуществлялась по принципу PICO (patient or population; intervention; comparison; outcome). Эксперты работали по упрощенному дельфийскому методу, сформулировали пять вопросов и дали на них аргументированные ответы, оформленные как «рекомендации и положения для клинической практики» с комментариями на основе принципов доказательной медицины. В основу формулировки вопросов, рекомендаций и положений лег критический анализ медицинской литературы, найденной по ключевым словам в англоязычных и русскоязычных базах данных. Объединить сформулированные вопросы можно в четыре категории: стратификация риска геморрагических осложнений, прогностическое значение тромбоцитопении, необходимость и методы медикаментозной коррекции тромбоцитопении, снижение риска геморрагических осложнений.

Выводы

Выводы. Результаты работы экспертов имеют прямое отношение к качественному ведению пациентов с циррозом печени и тромбоцитопенией перед плановыми инвазивными процедурами / хирургическими вмешательствами; сформулированные экспертами рекомендации и положения могут использоваться в клинической практике.

Introduction

Introduction. As a result of portal hypertension (sequestration of platelets in an enlarged spleen) and liver failure (decreased production of thrombopoietin in the liver) in liver cirrhosis, thrombocytopenia develops, which is associated with the risk of periprocedural/perioperative bleeding complications. There are still unresolved questions regarding risk stratification of bleeding complications, the prognostic role of thrombocytopenia, as well as the need for treatment of thrombocytopenia and its methods.

Materials and methods

Materials and methods. The Russian Scientific Liver Society selected a panel of experts in the field of therapeutic and surgical hepatology, hematology, transfusion medicine to make reasoned statements and recommendations on the issue of treatment of thrombocytopenia before elective surgery / invasive procedures in patients with liver cirrhosis.

Results

Results. Relevant clinical issues were determined based on the PICO principle (patient or population, intervention, comparison, outcome). The Delphi panel made five questions and gave reasoned answers, framed as ‘clinical practice recommendations and statements’ with evidence-based comments. The questions and statements were based on the results of search and critical analysis of medical literature using keywords in English- and Russian-language databases. The formulated questions could be combined into four categories: bleeding risk stratification, the prognostic value of thrombocytopenia, the necessity and methods of thrombocytopenia drug correction, and bleeding risk reduction.

Conclusions

Conclusions. The results of experts' work are directly related to high-quality management of patients with liver cirrhosis and thrombocytopenia, who have scheduled invasive procedures/surgery. Thus, this recommendations and statements can be used in clinical practice.

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