kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2015-1-81-85kpccz-121Research ArticleСЛУЧАЙ ИЗ КЛИНИЧЕСКОЙ ПРАКТИКИCASE FROM CLINICAL PRACTICE 5-9ПЕРВЫЙ ОПЫТ ПРИМЕНЕНИЯ ПРЯМОГО ИНГИБИТОРА ТРОМБИНА БИВАЛИРУДИНА ВО ВРЕМЯ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ В АЛТАЙСКОМ КРАЕВОМ КАРДИОЛОГИЧЕСКОМ ДИСПАНСЕРЕTHE FIRST EXPERIENCE OF APPLICATION OF INHIBITOR BIVALIRUDIN DIRECT TROMBIN DURING CORONARY BYPASS SURGERY UNDER CONDITIONS OF EXTRACORPOREAL CIRCULATION IN ALTAY REGIONAL CARDIOLOGIC DISPANSARYПокутневА. П.PokutnevA. P.

Для корреспонденции: Покутнев Андрей Павлович Адрес: 656055, г. Барнаул ул. Малахова 46 Тел. 8 (961) 232 23 66 E-mail: apokutnev72@mail.ru

For correspondence: Pokutnev Andrew Address: 46, Malahova st.,Barnaul, 656055, Russian Federation Tel. 8 (961) 232 23 66 E-mail: apokutnev72@mail.ru

 

apokutnev72@mail.ruЕфремушкинА. Г.EfremushkinA. G.apokutnev72@mail.ruКосоуховА. П.KosoukhovA. P.apokutnev72@mail.ruДудаА. И.DudaA. I.apokutnev72@mail.ruЕфремушкинаА. А.EfremushkinaA. A.apokutnev72@mail.ruБендриковО. А.BendrikovO. A.apokutnev72@mail.ruАлтайский краевой кардиологический диспансер, БарнаулРоссияAltay Regional Cardiologic Dispansary, BarnaulRussian Federation201503072015018185Copyright © Покутнев А.П., Ефремушкин А.Г., Косоухов А.П., Дуда А.И., Ефремушкина А.А., Бендриков О.А., 20152015Покутнев А.П., Ефремушкин А.Г., Косоухов А.П., Дуда А.И., Ефремушкина А.А., Бендриков О.А.Pokutnev A.P., Efremushkin A.G., Kosoukhov A.P., Duda A.I., Efremushkina A.A., Bendrikov O.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/121

В статье изложена ключевая информация о механизме действия прямого ингибитора тромбина – бивалирудина, показано его отличие от нефракционированного гепарина. Тезисно представлены основные клинические исследования с использованием бивалирудина в сердечно-сосудистой хирургии и собственный первый опыт применения во время коронарного шунтирования в условиях искусственного кровообращения. 

In article key information on the mechanism of effect of direct inhibitor trombina-Bivalirudina, its difference from unfractionated heparin is stated. The main clinical trials with Bivalirudin’s use in cardiovascular surgery and own first experience of application are presented in thesis during coronary shunting with cardiopulmonary-bypass. 

бивалирудиннефракционированный гепаринтромбингепарин-индуцированная тромбоцитопениягипокоагуляцияискусственное кровообращениеbivalirudinunfractionated heparinthrombingeparin-indutsirovanny thrombocytopeniahypocoagulationcardiopulmonary-bypassReferencesПирогов А. Л. Гепарин-индуцированная тромбоцитопения при сердечно-сосудистых вмешательствах. Механизмы развития, диагностики и методы коррекции. Комплексные проблемы сердечно-сосудистых заболеваний. 2014; 4: 96–98. Pirоgov A. L. Heparin inducent thrombocytohenia in cardiovascular surgery. Pathogenesis, diagnostics and correction methods. Complex Issues of Cardiovascular Diseases. 2014; 4: 96–98.Пирогов А. Л. Гепарин-индуцированная тромбоцитопения при сердечно-сосудистых вмешательствах. Механизмы развития, диагностики и методы коррекции. Комплексные проблемы сердечно-сосудистых заболеваний. 2014; 4: 96–98. Pirоgov A. L. Heparin inducent thrombocytohenia in cardiovascular surgery. Pathogenesis, diagnostics and correction methods. Complex Issues of Cardiovascular Diseases. 2014; 4: 96–98.Чарная М. А., Дементьева И. И., Морозов Ю. А., Гла¬ дышева В. Г., Исаева А. М. «Искусственная» гипокоагуляция у больных с гепарин-индуцированными тромбоцитопениями (обзор литературы). Часть 1. Кардиология и сердечнососудистая хирургия. 2013; 2: 87–89. Часть 2. Кардиология и сердечно-сосудистая хирургия. 2013; 3: 90–91. Charnaia M. A., Dementeva I. I., Morozov Iu. A., Gladysheva V. G., Isaeva A. M. Artificial hypocoagulation in with Heparin-induced thrombocytohenias (literature review). Part I. Cardiology & cardiovascular surgery. 2013; 2: 87–89. Part II. Cardiology & cardiovascular sergery. 2013; 3: 90–91.Чарная М. А., Дементьева И. И., Морозов Ю. А., Гла¬ дышева В. Г., Исаева А. М. «Искусственная» гипокоагуляция у больных с гепарин-индуцированными тромбоцитопениями (обзор литературы). Часть 1. Кардиология и сердечнососудистая хирургия. 2013; 2: 87–89. Часть 2. Кардиология и сердечно-сосудистая хирургия. 2013; 3: 90–91. Charnaia M. A., Dementeva I. I., Morozov Iu. A., Gladysheva V. G., Isaeva A. M. Artificial hypocoagulation in with Heparin-induced thrombocytohenias (literature review). Part I. Cardiology & cardiovascular surgery. 2013; 2: 87–89. Part II. Cardiology & cardiovascular sergery. 2013; 3: 90–91.Greinacher A., Warkentin T. E. Heparin-induced thrombocytopenia. N. Y: Marcel Dekker. 2004; 627.Greinacher A., Warkentin T. E. Heparin-induced thrombocytopenia. N. Y: Marcel Dekker. 2004; 627.Mar A. W., Dixon B., Ibrahim K., Parkin J. D. Skin necrosis following subcutaneous heparin injection. Australas. J. Dermatol. 1995; 36 (4): 201–203.Mar A. W., Dixon B., Ibrahim K., Parkin J. D. Skin necrosis following subcutaneous heparin injection. Australas. J. Dermatol. 1995; 36 (4): 201–203.Warkentin T. E., Roberts T. S., Hirsch J., Kelton J. G. Heparininduced skin lesions and other unusual sequelae of the heparininduced-thrombocytopenia syndrome: a nested cohort study. Chest. 2005; 127 (5): 1857–1861.Warkentin T. E., Roberts T. S., Hirsch J., Kelton J. G. Heparininduced skin lesions and other unusual sequelae of the heparininduced-thrombocytopenia syndrome: a nested cohort study. Chest. 2005; 127 (5): 1857–1861.Ling E., Warkentin T. E. Intraoperative heparin flushes and subsequent acute heparin-induced thrombocytopenia. Anesthesiology. 1998; 89 (6): 1567–1569.Ling E., Warkentin T. E. Intraoperative heparin flushes and subsequent acute heparin-induced thrombocytopenia. Anesthesiology. 1998; 89 (6): 1567–1569.Warkentin T. E., Kelton J. G. A 14-year study of heparininduced thrombocytopenia. Am. J. Med. 1996; 101 (5): 502–507.Warkentin T. E., Kelton J. G. A 14-year study of heparininduced thrombocytopenia. Am. J. Med. 1996; 101 (5): 502–507.Xiao Z., Theroux P. Platelet activation with unfractionated heparin at therapeutic concentrations and comparisons with low molecular weight heparin and with direct thrombin inhibitor. Circulation. 1998; 97: 251–256.Xiao Z., Theroux P. Platelet activation with unfractionated heparin at therapeutic concentrations and comparisons with low molecular weight heparin and with direct thrombin inhibitor. Circulation. 1998; 97: 251–256.WarkentinT.E.CookR. J. et al. Anti-PF 4/heparin antiboby formation postorhopedic surhery thromboprophylaxis: the role of nondrug risk factor and evidence for a stoichiometrybased model of immunization. J. Thromb. Haemost. 2010; 8 (3): 505–511.WarkentinT.E.CookR. J. et al. Anti-PF 4/heparin antiboby formation postorhopedic surhery thromboprophylaxis: the role of nondrug risk factor and evidence for a stoichiometrybased model of immunization. J. Thromb. Haemost. 2010; 8 (3): 505–511.Montalescot G., Collet J. P., Lison L. et al. Effects of various anticoagulant treatments on von Willebrand factor release in unstable angina. J. Am. Coll. Cardiol. 2000; 36: 110–1115.Montalescot G., Collet J. P., Lison L. et al. Effects of various anticoagulant treatments on von Willebrand factor release in unstable angina. J. Am. Coll. Cardiol. 2000; 36: 110–1115.Sciulli T. M., Mauro V. F. Pharmacology and clinical use of bivalirudin. Ann. Pharmacother. 2002 Jun; 36 (6): 1028– 1041. Review.Sciulli T. M., Mauro V. F. Pharmacology and clinical use of bivalirudin. Ann. Pharmacother. 2002 Jun; 36 (6): 1028– 1041. Review.Maraganore J. M., Bourdon P., Jablonski J., Ramachandran K. L., Fenton J. W. 2nd. Design and characterization of hirulogs: a novel class of bivalent peptide inhibitors ofthrombin. Biochemistry. 1990 Jul; 31; 29 (30): 7095–7101.Maraganore J. M., Bourdon P., Jablonski J., Ramachandran K. L., Fenton J. W. 2nd. Design and characterization of hirulogs: a novel class of bivalent peptide inhibitors ofthrombin. Biochemistry. 1990 Jul; 31; 29 (30): 7095–7101.Ганюков В. И., Протопопов А. В. Медикаментозное сопровождение чрезкожных коронарных вмешательств. Новосибирск. 2014; 19–20, 47–48, 59–61. Ganiukov V. I., Protopopov A. V. Medicamentoznoe soprovogdenie chrezkognyx koronarnyx vmeshatelstv. Novosibirsk. 2014; 19–20, 47–48, 59–61.Ганюков В. И., Протопопов А. В. Медикаментозное сопровождение чрезкожных коронарных вмешательств. Новосибирск. 2014; 19–20, 47–48, 59–61. Ganiukov V. I., Protopopov A. V. Medicamentoznoe soprovogdenie chrezkognyx koronarnyx vmeshatelstv. Novosibirsk. 2014; 19–20, 47–48, 59–61.Dyke C. M., Smedira N. G., Koster A., Aronson S., Harry L., McCarthy II et al. A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery withcardiopulmonary bypass: The EVOLUTION-ON study. The Journal of Thoracic and Cardiovascular Surgery. 131 (3): 534–539.Dyke C. M., Smedira N. G., Koster A., Aronson S., Harry L., McCarthy II et al. A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery withcardiopulmonary bypass: The EVOLUTION-ON study. The Journal of Thoracic and Cardiovascular Surgery. 131 (3): 534–539.Кoster A., Dyke C. M., Aldea G. et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the СHOOSE-ON trial. Ann. Thorac. Surg. 2007; 83 (2): 572–577.Кoster A., Dyke C. M., Aldea G. et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the СHOOSE-ON trial. Ann. Thorac. Surg. 2007; 83 (2): 572–577.Smedira N. G., Dyke C. M., Koster A., Jurmann M., Bhatia D. S. et al. Anticoagulation with bivalirudin for offpump coronary arterybypass grafting: The results of the EVOLUTION-OFF study. The Journal of Thoracic and Cardiovascular Surgery. March 2006; 688–692.Smedira N. G., Dyke C. M., Koster A., Jurmann M., Bhatia D. S. et al. Anticoagulation with bivalirudin for offpump coronary arterybypass grafting: The results of the EVOLUTION-OFF study. The Journal of Thoracic and Cardiovascular Surgery. March 2006; 688–692.Dyke C. M., Кoster A., Aldea G. et al. Off-pump coronary artery bypass with Bivalirudin for pacients with heparin-induced thrombocytopenia antiplatelet factor four/ heparin antibodies. Ann. Thorac. Surg. 2007; 84 (3): 836–839.Dyke C. M., Кoster A., Aldea G. et al. Off-pump coronary artery bypass with Bivalirudin for pacients with heparin-induced thrombocytopenia antiplatelet factor four/ heparin antibodies. Ann. Thorac. Surg. 2007; 84 (3): 836–839.Riess F. C., Poetzsch B., Madlener K. et al. Recombinant hirudin as an alternative for cardiopulmonary bypass anticoagulation: a randomized, prospective, and heparin-controlled pilot study. Thorac. Cardiovasc. Surg. 2007; 55 (4): 233–238.Riess F. C., Poetzsch B., Madlener K. et al. Recombinant hirudin as an alternative for cardiopulmonary bypass anticoagulation: a randomized, prospective, and heparin-controlled pilot study. Thorac. Cardiovasc. Surg. 2007; 55 (4): 233–238.Кoster A., Hansen R., Kuppe H. et al. Recombinant hirudin as an alternative for anticoagulation during cardiopulmonary bypass in patients with previous with heparin-induced thrombocytopenia typeII6 1 year experience in 57 patients. J. Cardiothorac. Vasc. Anesth. 2000; 14 (3): 243–248.Кoster A., Hansen R., Kuppe H. et al. Recombinant hirudin as an alternative for anticoagulation during cardiopulmonary bypass in patients with previous with heparin-induced thrombocytopenia typeII6 1 year experience in 57 patients. J. Cardiothorac. Vasc. Anesth. 2000; 14 (3): 243–248.

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