gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2019-29-2-23-26gastro-j-351Research ArticleОБЗОРЫREVIEWSТромботические осложнения при воспалительных заболеваниях кишечникаThrombotic Complications in Inflammatory Bowel Diseasehttps://orcid.org/0000-0003-4203-2361БоротаА. В.BorotaA. V.

доктор медицинских наук, профессор, заведующий кафедрой общей хирургии № 1

Dr. Sci. (Med.), Prof., Departmental Head, General Surgery Department

https://orcid.org/0000-0001-8750-7792БоротаА. А.BorotaA. A.

кандидат медицинских наук, доцент кафедры общей хирургии № 1

Cand. Sci. (Med.), Assoc. Prof., General Surgery Department

Borota@ukr.netОнищенкоЕ. В.OnishchenkoE. V.

кандидат медицинских наук, ассистент кафедры трансплантологии и клинической лабораторной диагностики

Cand. Sci. (Med.), Research Assistant, Department of Transplantology and Clinical Laboratory Diagnostics

ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»УкраинаM. Gorky Donetsk National Medical UniversityUkraine2019150520192922326Copyright © Борота А.В., Борота А.А., Онищенко Е.В., 20192019Борота А.В., Борота А.А., Онищенко Е.В.Borota A.V., Borota A.A., Onishchenko E.V.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/351

Общий риск тромботических осложнений у пациентов с воспалительными заболеваниями кишечника (ВЗК) в 3 раза превышает риск в здоровой популяции, во время развития рецидивов болезни относительный риск возрастает в 15 раз.

Цель

Цель. Изучение и обобщение существующих литературных данных по профилактике и лечению тромботических осложнений при ВЗК.

Основные положения

Основные положения. Наличие хронического воспаления и повышение кровоточивости стенки кишки при данных заболеваниях инициирует активацию свертывающей системы, ухудшает систему фибринолиза, а также снижает активность естественных механизмов антикоагуляции. Концентрация фибриногена, одного из белков острой фазы воспаления, возрастает значительно. В результате развивается дисбаланс свертывающей системы крови со склонностью к гиперкоагуляции, что значительно повышает риск развития тромботических осложнений и синдрома диссеминированного внутрисосудистого свертывания. В свою очередь, активация каскада свертывания может поддерживать активацию воспалительной реакции, что приводит к формированию порочного круга между хроническим воспалением и тромбозом. Патогенез тромбоза при воспалительных заболеваниях толстой кишки является мультифакторным и изучен не до конца.Заключение. Ведение пациентов с ВЗК в сочетании с тромбоэмболическими осложнениями требует индивидуального мультидисциплинарного подхода. С учетом факторов патогенеза возможны следующие варианты направлений в профилактике и лечении тромботических осложнений при ВЗК: усиление базисной терапии основного заболевания; назначение профилактических доз антикоагулянтов под динамическим непрерывным лабораторным контролем в остром периоде; применение методов консервативной терапии тромботических осложнений (эластическая компрессия нижних конечностей) в периоде обострения основного заболевания.

 

 

The risk of thrombotic complications is known to be 3 times higher in patients with inflammatory bowel disease (IBD) than in healthy individuals, with the relative risk being 15 times higher during the periods of relapses.

Aim

Aim. To study and generalize literature data available on the prevention and treatment of IBD thrombotic complications.

Key findings

Key findings. In the сonditions under study, the presence of chronic inflammation and increased bleeding of the intestinal wall is shown to activate the coagulation system, impair the fibrinolysis system and reduce the activity of natural anticoagulation mechanisms. The concentration of fibrinogen — a protein of the acute inflammation phase — increases significantly. This results in an imbalance of the blood coagulation system with a tendency to hypercoagulation, which significantly increases the risk of thrombotic complications and the disseminated intravascular coagulation syndrome. In turn, the activation of the coagulation cascade may trigger the inflammatory response, which eventually leads to the formation of a vicious circle between chronic inflammation and thrombosis. The pathogenesis of thrombosis in inflammatory colon diseases is a multifactor process, which remains to be understood.Conclusion.The management of patients with IBD in combination with thromboembolic complications requires an individual multidisciplinary approach. Taking into account the pathogenetic factors, the following options are possible in the prevention and treatment of thrombotic complications in IBD: strengthening the basic therapy of the primary disease; administration of prophylactic doses of anticoagulants under dynamic continuous laboratory control in the acute period using the methods of conservative therapy of thrombotic complications (elastic compression of the lower extremities) in the period of exacerbation of the primary disease.

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