Hemorrhagic complications on the background of heparin therapy during application. Complications of antithrombotic therapy for acute coronary syndrome

Dosage form:  solution for intravenous and subcutaneous administration 5000 IU/ml Compound:

1 ml contains:

active substance: sodium heparin 5000 ME

Excipients: benzyl alcohol - 9 mg; sodium chloride - 3.4 mg; 0.1 M hydrochloric acid solution or 0.1 M sodium hydroxide solution to pH 5.5 to 7.5; water for injection up to 1 ml.

Description: Transparent colorless or colorless liquid with a yellowish tint. Pharmacotherapeutic group:Direct acting anticoagulant ATX:  

B.01.A.B.01 Heparin

Pharmacodynamics:

Heparin sodium is a biological drug. is a heterogeneous mixture of polysaccharides with a molecular weight of 2000 to 30000 Da (mainly 15000-18000 Da), characterized by a heterogeneous chemical structure (variability in linear dimensions, different degrees of sulfation, different arrangement of pharmacologically active fragments in the polysaccharide chain).

Pharmacological action - anticoagulant.

The mechanism of action of heparin is based primarily on its binding to antithrombin III, which is a natural inhibitor of activated blood coagulation factors: IIa (thrombin), IXa, Xa, XIa and XIIa. Heparin binds to antithrombin III and causes conformational changes in its molecule. As a result, the binding of antithrombia III to blood coagulation factors IIa (thrombin), IXa, Xa, XIa and XIIa is accelerated and their enzymatic activity is blocked. The binding of heparin to antithrombin III is electrostatic in nature and largely depends on the length and composition of the molecule (a pentasaccharide sequence containing 3-O-sulfated is required to bind heparin to antithrombin III). The ability of heparin in combination with antithrombin III to inhibit coagulation factors IIa () and Xa is of the greatest importance. The ratio of sodium heparin activity against factor Xa to its activity against factor IIa is 0.9-1.1.

Heparin reduces blood viscosity, reduces vascular permeability stimulated by bradykinin, histamine and other endogenous factors, and thus prevents the development of stasis. Heparin is able to sorb on the surface of endothelial membranes and blood cells, increasing their negative charge, which prevents platelet adhesion and aggregation. Heparin slows down smooth muscle hyperplasia, activates lipoprotein lipase and thus has a hypolipidemic effect and prevents the development of atherosclerosis.

Heparin binds some components of the complement system, lowering its activity, prevents the cooperation of lymphocytes and the formation of immunoglobulins, binds histamine (i.e., has an anti-allergic effect). Heparin increases renal blood flow, increases cerebral vascular resistance, reduces cerebral hyaluronidase activity, reduces surfactant activity in the lungs, suppresses excessive aldosterone synthesis in the adrenal cortex, binds adrenaline, modulates the ovarian response to hormonal stimuli, and enhances parathyroid hormone activity. As a result of interaction with enzymes, heparin can increase the activity of brain tyrosine hydroxylase, pepsinogen, DNA polymerase and reduce the activity of myosin ATPase, pyruvate kinase, RNA polymerase, pepsin. The clinical significance of these effects of heparin remains uncertain and poorly understood.

In acute coronary syndrome without persistent ST segment elevation on the ECG (unstable angina, myocardial infarction without ST segment elevation), in combination with acetylsalicylic acid reduces the risk of myocardial infarction and reduces mortality. In myocardial infarction with ST elevation on the ECG, it is effective in primary percutaneous coronary revascularization in combination with inhibitors of glycoprotein IIb / IIIa receptors and in thrombolytic therapy with streptokinase (increase in the frequency of revascularization).

In high doses, it is effective in pulmonary embolism and venous thrombosis. In small doses, it is effective for the prevention of venous thromboembolism, incl. after surgical operations.

When administered intravenously, blood clotting slows down almost immediately. With subcutaneous administration, the effect of heparin occurs after 40-60 minutes. The duration of the anticoagulant effect of sodium heparin after intravenous and subcutaneous administration is 4-5 hours and 8 hours, respectively. Deficiency of antithrombin III in plasma or at the site of thrombosis may reduce the antithrombotic effect of sodium heparin.

Pharmacokinetics:

After subcutaneous administration, the time to reach maximum plasma concentration is 4-5 hours. Communication with plasma proteins is up to 95%, the volume of distribution is very small - 0.06 l / kg (does not leave the vascular bed due to strong binding to plasma proteins). It does not cross the placenta and into breast milk. Intensively captured by endothelial cells and cells of the mononuclear-macrophage system (cells of the reticulo-endothelial system), concentrated in the liver and spleen. It is metabolized in the liver with the participation of N-desulfamidase and platelet heparinase, which is included in the metabolism of heparin at later stages. Participation in the metabolism of platelet factor IV (antiheparin factor), as well as the binding of heparin to the macrophage system, explain the rapid biological inactivation and short duration of action. Desulfated molecules under the influence of kidney endoglycosidase are converted into low molecular weight fragments. The half-life is 1-6 hours (average - 1.5 hours); increases with obesity, liver and / or kidney failure; decreases with pulmonary embolism, infections, malignant tumors.

It is excreted by the kidneys, mainly in the form of inactive metabolites, and only with the introduction of high doses is it possible to excrete (up to 50%) unchanged. Not excreted by hemodialysis.

Indications:

Prevention and treatment of venous thrombosis (including thrombosis of the superficial and deep veins of the lower extremities; renal vein thrombosis) and pulmonary embolism.

Prevention and treatment of thromboembolic complications associated with atrial fibrillation.

Prevention and treatment of peripheral arterial embolism (including those associated with mitral heart disease).

Treatment of acute and chronic consumption coagulopathy (including stage I DIC).

Acute coronary syndrome without persistent ST segment elevation on the ECG (unstable angina, myocardial infarction without ST segment elevation on the ECG).

ST-segment elevation myocardial infarction: with thrombolytic therapy, with primary percutaneous coronary revascularization (balloon angioplasty with or without stenting) and with a high risk of arterial or venous thrombosis and thromboembolism.

Prevention and therapy of microthrombosis and microcirculation disorders, incl. with hemolytic-uremic syndrome; glomerulonephritis (including lupus nephritis) and with forced diuresis.

Prevention of blood coagulation during blood transfusion, in extracorporeal circulation systems (extracorporeal circulation during heart surgery, hemosorption, cytopheresis) and hemodialysis.

Treatment of peripheral venous catheters.

Contraindications:

Hypersensitivity to sodium heparin or animal products.

Heparin - induced thrombocytopenia (with or without thrombosis) in history or at present.

Bleeding (unless the benefit of sodium heparin outweighs the potential risk).

At a therapeutic dose, it should not be prescribed if it is not possible to provide regular laboratory monitoring of blood coagulation.

Pregnancy and the period of breastfeeding.

Newborns, especially premature or low birth weight infants.

Carefully:

It should be used with caution in conditions associated with an increased risk of bleeding, such as:

Diseases of the cardiovascular system: acute and subacute infective endocarditis, severe uncontrolled arterial hypertension, aortic dissection, cerebral aneurysm.

Diseases of the digestive system: erosive and ulcerative lesions of the gastrointestinal tract (including stress-induced), varicose veins of the esophagus with cirrhosis of the liver and other diseases, prolonged use of gastric and small intestine drains, ulcerative colitis, hemorrhoids.

Diseases of the blood-forming organs of the blood and lymphatic system: leukemia, hemophilia, thrombocytopenia, hemorrhagic diathesis.

Diseases of the central nervous system: hemorrhagic stroke, traumatic brain injury.

Malignant neoplasms.

Congenital antithrombin III deficiency and antithrombin III replacement therapy (lower doses of heparin should be used to reduce the risk of bleeding).

Other physiological and pathological conditions: period of menstruation, threatened miscarriage, early postpartum period, severe liver disease with impaired protein-synthetic function, chronic renal failure, recent surgery on the eyes, brain or spinal cord, a recent spinal (lumbar) puncture, or epidural anesthesia, proliferative diabetic retinopathy, vasculitis, old age (especially in women).

The use of heparin sodium is possible in cases where the expected benefit of therapy outweighs the potential risk.

Pregnancy and lactation:

Controlled clinical studies of the use of sodium heparin in pregnant women have not been conducted. According to published data, the use of heparin during pregnancy does not adversely affect the fetus. In studies in humans and animals, it has been found that it does not cross the placenta. not excreted into breast milk.

The use of heparin sodium during pregnancy or during breastfeeding is possible only in cases where the expected benefit of therapy for the mother outweighs the potential risk to the fetus or child. Sodium heparin preparations containing benzyl alcohol should not be used.

Dosage and administration:

Heparin sodium is administered intravenously (as a continuous infusion or repeated bolus injections) or subcutaneously. should not be administered intramuscularly due to the risk of developing intramuscular hematomas.

Subcutaneous injections are preferably performed in the region of the anterior abdominal wall. As an exception, other injection sites (outer thigh, shoulder) can be used with sufficiently developed subcutaneous adipose tissue. It is not recommended to re-introduce at the site of previous injections.

continuous intravenous infusion	Initial dose	5000-10000 MEi/v jet
	Continuous infusion	20000-40000 IU/day (injection rate about 1000 IU/hour)
Bolus intravenous introduction	Starting dose:	10000 ME
	maintenance doses	5000-10000 MEevery 4-6 hours
Subcutaneous introduction	Starting dose:	333 IU / kg (with body weight less than 75 kg - 20000me,with a body weight of 75-90 kg 25000 IU, with a body weight of 90-105 kg - 30000me,with a body weight of more than 105 kg - 35000ME)
	maintenance doses	250 IU/kg (15000-25000ME)every 12 hours.

Laboratory monitoring of the efficacy and safety of sodium heparin therapy

The dose of heparin sodium must be adjusted based on laboratory parameters of blood clotting. When using heparin sodium, it is necessary to control the activated partial thromboplastin time (APTT) or blood clotting time (CWT). The administered dose of heparin sodium is considered adequate if the APTT is 1.5-2.0 times higher than the normal values ​​or if the patient's VSC is 2.5-3.0 times higher than the control values.

With continuous intravenous infusion sodium heparin, it is recommended to determine the initial APTT, then determine the APTT every 4 hours, followed by an increase or decrease in the rate of sodium heparin infusion until the target level of the APTT is reached (1.5-2 times higher than normal), then determine the APTT every 6 hours.

Bolus intravenous injection sodium heparin, it is recommended to determine the initial APTT, then determine the APTT before each bolus injection, followed by an increase or decrease in the administered dose of heparin sodium.

When injected subcutaneously sodium heparin, it is recommended to control the APTT 4-6 hours after injection, followed by an increase or decrease in the administered dose of sodium heparin.

When using heparin sodium in low doses for the prevention of thromboembolic complications, it is not necessary to control APTT.

The use of heparin sodium in special clinical situations

Primary percutaneous coronary angioplasty for acute non-ST elevation coronary syndrome and ST elevation myocardial infarction: administered intravenously as a bolus at a dose of 70-100 U / kg (if it is not planned to use inhibitors of glycoprotein IIb / IIIa receptors) or at a dose of 50-60 U / kg (when used together with inhibitors of glycoprotein IIb / IIIa receptors).

Thrombolytic therapy for ST elevation myocardial infarction: is administered intravenously as a bolus at a dose of 60 U / kg (maximum dose 4000 IU), followed by an intravenous infusion at a dose of 12 U / kg (no more than 1000 U / hour) for 24-48 hours. The target level of APTT is 50-70 seconds or 1.5-2.0 times higher than the norm; APTT control after 3.6, 12 and 24 hours after the start of therapy.

Prevention of thromboembolic complications after surgical interventions using low doses of sodium heparin: s / c, deep into the fold of the skin of the abdomen. Initial dose of 5000 ME 2 hours before the start of the operation. In the postoperative period: 5000 IU every 8-12 hours for 7 days or until the patient is completely mobilized (whichever comes first). When using heparin sodium in low doses for the prevention of thromboembolic complications, it is not necessary to control APTT.

Application in cardiovascular surgery during operations using, systems, extracorporeal circulation: the initial dose of heparin sodium is not less than 150 IU / kg of body weight. Then it is administered by continuous intravenous infusion at a rate of 15-25 drops / min, 30,000 IU per 1 liter of infusion solution. The total dose of heparin sodium is usually 300 IU/kg of body weight (if the expected duration of the operation is less than 60 minutes) or 400 IU/kg of body weight (if the expected duration of the operation is 60 minutes or more).

Use in hemodialysis: Initial dose of heparin sodium: 25-30 IU/kg (or 10,000 IU) IV bolus followed by continuous infusion of sodium heparin 20,000 IU/100 mg sodium chloride solution at a rate of 1500-2000 IU/hour (unless otherwise indicated in the instructions for use of systems for hemodialysis).

The use of sodium heparin in pediatrics: Adequate controlled studies of the use of sodium heparin in children have not been conducted. The recommendations presented are based on clinical experience.

Initial dose: 75-100 U/kg IV bolus over 10 minutes

Maintenance dose: children aged 1-3 months - 25-30 U / kg / hour (800 U / kg / day), children aged 4-12 months - 25-30 U / kg / hour (700 U / kg / day). day), children over 1 year old - 18-20 IU / kg / hour (500 IU / kg / day) intravenously.

The dose of heparin sodium should be selected taking into account the indicators of blood coagulation (target level of APTT 60-85 seconds).

Side effects:

Classification of the World Health Organization (WHO) of adverse drug reactions according to the frequency of development: very often (> 1/10 appointments); often (>1/100 and<1/10 назначений); нечасто (>1/1000 and<1/100 назначений); редко (>1/10000 and<1/1000 назначений); очень редко (<1/10000), включая отдельные сообщения.

Hemorrhagic complications: They develop very frequently. The most typical are bleeding from the gastrointestinal tract, urinary tract, from the injection sites of sodium heparin, from postoperative wounds, as well as hemorrhages in areas subjected to pressure. Hemorrhages in other internal organs may also develop, incl. in the adrenal glands (with the development of acute adrenal insufficiency), retroperitoneal space, ovaries. More frequent occurrence of bleeding is observed in patients older than 60 years (especially in women).

Allergic reactions: infrequently - skin flushing, rash, itching and burning sensation in the soles, pain in the extremities, hyperthermia, urticaria, rhinitis, conjunctivitis, shortness of breath, bronchospasm, angioedema; very rarely - anaphylactic shock.

Reactions at the injection site: often - irritation, soreness, tissue hyperemia, slight hematoma and ulceration at the injection site, infrequently - histamine-like reactions (including skin necrosis at the injection site), very rarely - soft tissue calcification at the injection site (mainly in patients with severe chronic renal failure).

Heparin-induced thrombocytopenia (HIT): severe immune reaction due to the formation of antibodies and leading to irreversible platelet aggregation. It can develop both during heparin therapy (rarely) and within a few weeks after its termination (very rarely). Clinical manifestations: venous and arterial thrombosis (including deep vein thrombosis, pulmonary embolism, cerebral vein thrombosis, stroke, myocardial infarction, thrombosis of the mesenteric and renal arteries, arterial thrombosis of the extremities with the development of gangrene).

Laboratory diagnostics: It is necessary to determine the number of platelets before the appointment of heparin sodium, on the first day of treatment, and then every 2-3 days during the entire period of treatment (especially from 6 to 14 days of therapy). With a decrease in the number of platelets below 100 * 10 9 /l and / or with the development of recurrent thrombosis, it should be immediately canceled. If necessary, alternative antithrombotic therapy should be prescribed.

Therapy and prevention: If HIT occurs, it should be canceled immediately. The patient should be warned that in the future he should not be prescribed unfractionated heparin (including for hemodialysis) and low molecular weight heparins. If the patient needs antithrombotic therapy, then other drugs should be used.

Other adverse events:

From the side of the central nervous system and sensory organs: infrequently - dizziness, headache.

From the side of the cardiovascular system: infrequently - a decrease in blood pressure.

From the digestive system: infrequently - loss of appetite, nausea, vomiting, diarrhea, often - an increase in the content of "liver" transaminases (ACT and ALT) in the blood plasma.

From the side of the hematopoietic organs: often - moderate thrombocytopenia (platelet count 150-100 * 10 9 / l) not associated with the production of antibodies and not accompanied by thrombosis (may occur in 6-30% of patients receiving heparin); rarely - reversible eosinophilia.

From the musculoskeletal system: rarely - osteoporosis (with prolonged use of sodium heparin), spontaneous bone fractures.

From the endocrine system: rarely - hypoaldosteronism (due to inhibition of aldosterone synthesis).

From the side of water-electrolyte metabolism: rarely - reversible potassium retention, metabolic acidosis.

Others: infrequently - transient alopecia, very rarely - priapism.

Laboratory indicators: often - a reversible increase in the content of "liver" transaminases (ACT and ALT); infrequently - an increase in the content of free fatty acids after discontinuation of heparin, an increase in the content of thyroxine in the blood plasma, a false decrease in cholesterol, a false increase in glucose, and incorrect results of the bromsulfalein test.

If any side effects indicated in the instructions for use are aggravated, or if other undesirable effects occur that are not indicated in the instructions, you should immediately inform your doctor.

Overdose:

Symptoms: bleeding of varying severity.

Treatment: in case of minor bleeding caused by an overdose of heparin sodium, it is enough to stop using the drug.

In case of large bleeding, excess sodium heparin is neutralized with protamine sulfate. 1 mg of protamine sulfate neutralizes 100 IU of sodium heparin. A 1% solution of protamine sulfate is administered intravenously very slowly. Do not inject more than 50 mg (5 ml) of protamine sulfate every 10 minutes. Given the rapid metabolism of heparin, the required dose of protamine decreases over time. To calculate the required dose of protamine sodium, it can be assumed that the half-life of heparin is 30 minutes. When using protamine sodium, severe anaphylactic reactions with a fatal outcome were noted, and therefore the drug should be administered only in a department equipped to provide emergency medical care for anaphylactic shock. Heparin is not excreted during hemodialysis.

Interaction:

Pharmaceutical interaction: A solution of sodium heparin is diluted only with saline. Sodium heparin solution is incompatible with the following substances: , amikacin sulfate, sodium, sodium, danorubicin, doxorubicin hydrochloride, gentamicin sulfate, haloperidol lactate, sodium hydrocortisone succinate, glucose, fat emulsions, kanamycin sulfate, sodium methicillin, netilmicin sulfate, opioids, oxytetracycline hydrochloride, polymyxin B sulfate, promazine hydrochloride, promethazine hydrochloride, streptomycin sulfate, sulfafurasol diethanolamine, tetracycline hydrochloride, tobramycin sulfate, cephalothin sodium, cephaloridine, vancomycin hydrochloride, vinblastine sulfate, labetalol hydrochloride, nicardipine hydrochloride.

Pharmacokinetic interaction: Sodium heparin displaces , and benzodiazepine derivatives from their binding sites with blood plasma proteins, which can lead to an increase in the pharmacological action of these drugs. dipyridamole

The anticoagulant effect of sodium heparin decreases with simultaneous use with ACTH, antihistamines, ascorbic acid, ergot alkaloids, nicotine, nitroglycerin, cardiac glycosides, thyroxine, tetracycline and quinine.

Heparin sodium can reduce the pharmacological action of ACTH, glucocorticoids and insulin.

Special instructions:

Switching to warfarin therapy: To ensure a sustained anticoagulant effect, full-dose sodium heparin therapy should be continued until a stable target INR level is reached. After this, the introduction of heparin sodium must be stopped.

Switching to dabigatran therapy: Continuous intravenous heparin sodium should be discontinued immediately after the first dose of dabigatran. For split intravenous administration, the patient should take the first dose of dabigatran orally 1-2 hours before the scheduled administration of the next dose of sodium heparin.

Before elective surgical interventions, in order to reduce blood loss during surgery and in the postoperative period, it is usually recommended to stop oral anticoagulants () and antiplatelet drugs ( , ) 7 days before surgery. As an antithrombotic therapy, it is possible to prescribe sodium heparin in therapeutic doses. The introduction of heparin sodium is stopped 6 hours before the operation and resumes 6 hours after the end of the operation.

Intramuscular administration of heparin sodium should be avoided (due to the possible occurrence of hematomas).

The use of drugs containing benzyl alcohol as a preservative in neonates (especially premature and underweight infants) can lead to serious adverse events (central nervous system depression, metabolic acidosis, gasping breathing) and death. Therefore, in newborns and children under 1 year of age, sodium heparin preparations that do not contain preservatives should be used.

Resistance to heparin sodium is often observed in fever, thrombosis, thrombophlebitis, infectious diseases, myocardial infarction, malignant neoplasms, as well as after surgical interventions and in antithrombin III deficiency. In such situations, more thorough laboratory monitoring (APTT control), including the determination of antithrombin III, is required.

In persons over 60 years of age (especially women), the risk of bleeding is increased, and therefore the dose of sodium heparin in this category of patients should be reduced.

During therapy with sodium heparin, it is necessary to constantly monitor clinical symptoms indicating possible bleeding (bleeding of the mucous membranes, hematuria, etc.).

When using heparin sodium in patients with arterial hypertension, blood pressure should be regularly monitored and adequate antihypertensive therapy should be carried out.

Influence on the ability to drive transport. cf. and fur.:in most cases, it does not significantly affect the concentration of attention and the speed of psychomotor reactions. In the event of adverse reactions from the central nervous system (dizziness, headache), patients are advised to refrain from driving vehicles and other mechanisms, as well as to be careful when engaging in activities that require an increased concentration of attention and speed of psychomotor reactions. Release form / dosage:Solution for intravenous and subcutaneous administration 5000 IU/ml. Package:

5 ml bottles of neutral colorless glass, sealed with a rubber stopper and crimped with an aluminum cap with a protective plastic cap. Each vial is labeled or inscribed with fast setting paint.

5 bottles are placed in a PVC tray. 1 or 2 pallets, together with instructions for use, are placed in a cardboard box.

Storage conditions:Store in a place protected from light at a temperature not exceeding 25 ° C. Do not freeze! Keep out of the reach of children. Best before date: 3 years. Do not use after the expiration date. Conditions for dispensing from pharmacies: On prescription Registration number: LP-002434 Close Instructions

Typical injection sites: outer surface of the upper arm. The outer surface of the thigh. Subscapular region. Anterior abdominal wall.

Possible complications:

Infiltrate is the most common complication of subcutaneous and intramuscular injections. It is characterized by the formation of a seal at the injection site, which is easily determined by palpation.

An allergic reaction is an increased sensitivity of the body to the introduction of a particular drug. Manifested by a rash, swelling, itching, fever.

Abscess - purulent inflammation of soft tissues with the formation of a cavity filled with pus.

Anaphylactic shock - (allergic reaction) develops within a few seconds or minutes from the moment the drug is administered.

Hematoma.

Drug embolism (Greek Embolia - throwing) is a blockage of a vessel with a medicinal solution, for example, with the introduction of oil solutions.

Features of the use of heparin.

Heparin is a direct-acting anticoagulant: it inhibits the formation of thrombin, prevents blood clotting.

Doses are set individually: 5,000 units are administered intravenously or intramuscularly after 4-6 hours, it can be deeply s / c, in the epigastric region - to stimulate the production of endogenous heparin.

Complications. When using heparin, hemorrhagic complications may occur:

* hematuria (blood in

* hemorrhages in the joints,

gastrointestinal bleeding,

* hematomas at the injection site s / c and / m.

Allergic reactions are possible:

* urticaria,

* lacrimation.

In case of an overdose of heparin, as its antagonist, 5 ml of a 1% solution of protamine sulfate, 1-2 ml of dicynone intravenously or intramuscularly are administered intravenously.

syringe 1-2 ml single use; needle 20 mm, section 0.4 mm.

Heparin, if used incorrectly and insufficiently controlled, can cause both hemorrhagic and thrombotic complications.

Bleeding caused by heparin can be divided into local, occurring at the injection sites, and generalized, associated with its effect on the entire hemostasis system.

Local hemorrhages are formed only with subcutaneous or intramuscular administration of the drug, and with intravenous administration they do not form (with the exception of cases of penetrating a vein).

With intramuscular injections of the drug, the resulting hemorrhages due to the greater blood supply (vascularization) of the tissue are much larger (although less noticeable) than with subcutaneous ones.

The absorption of heparin from the muscle occurs 2 times faster than from the subcutaneous tissue, but with the formation of a hematoma in the injection area, it slows down sharply. It is very difficult to dose the drug and create controlled hypocoagulation when administered intramuscularly.

Subcutaneous injections of heparin are quite common in the treatment of thrombosis, as well as in the treatment of disseminated intravascular coagulation syndromes.

There is an individual intolerance to heparin: subcutaneous administration of the drug is accompanied by acute pain, the development of hemorrhages and even necrosis of the skin over them.

The generalized hemorrhagic effect of heparin is due either to its overdose or unrecognized background hemostasis disorders, in which heparin administration is contraindicated.

Dosing of heparin in units per kilogram of body weight is purely indicative, suitable only for calculating the initial trial dose.

In some cases, it is useful to additionally introduce blood preparations containing antithrombin III into the body (for example, frozen plasma), or to remove acute phase proteins and paraproteins from the patient's blood (plasmapheresis). These effects restore the sensitivity of the hemostasis system to heparin, with them it is no longer possible to increase the dose of the drug.

With prolonged intravenous administration of heparin, it is easier to control its hypocoagulable effect. With good monitoring observation, this method of administration gives the least number of hemorrhagic complications. Significantly less effective and more dangerous are intravenous heparin injections every 4 hours, when large fluctuations in hemocoagulation occur - from almost complete blood incoagulability to hypercoagulation (the half-life of heparin from circulation is 70-100 minutes, and by the end of the 3-4th hour it almost completely absent in the blood. Hemorrhagic and thrombotic complications with such intermittent administration are 7 times more common than with long-term administration. To mitigate these differences, use combined methods of drug administration (subcutaneous and intravenous).

Of decisive importance is the adequacy of monitoring the action of heparin by global (whole blood clotting time, thromboelastography, activated partial thromboplastin time, autocoagulation test) and partial methods.

Hemorrhagic syndrome in the treatment of heparin occurs much less frequently and is, as a rule, much easier than in the treatment of indirect anticoagulants. This is due to the fact that heparin does not disrupt the synthesis of coagulation factors, but only blocks their activated forms, acts for a short time and is quickly removed from the bloodstream.

This drug poses a serious danger in patients with existing, although perhaps undiagnosed, bleeding or other processes (vascular, destructive) that are easily complicated by bleeding. For example, it can provoke profuse bleeding with peptic ulcer, erosive gastritis, acute erosions and ulcers.

Quite often, the use of heparin provokes pulmonary bleeding in patients with bronchiectasis, in case of stagnation in the pulmonary circulation, bleeding from the veins of the esophagus in liver cirrhosis, cerebral hemorrhage in patients with hypertension.

Extensive and multiple hemorrhages are observed mainly with a very significant overdose of heparin or with a secondary decrease in the patient's platelet count in the blood (some patients develop the so-called heparin thrombocytopenia).

Reducing the dose of heparin or its cancellation quickly normalizes hemostasis; in addition, you can enter a small dose of protamine sulfate - a drug that inhibits heparin. For every 100 units of heparin administered over the last 4 hours, 0.5-1 mg of protamine sulfate in a 1% solution is administered intravenously. If the effect is insufficient, then

additionally, another 0.25 mg of the drug is administered. An overdose of protamine sulfate should be avoided, since with excessive administration it itself causes hypocoagulation, which doctors often erroneously interpret as heparin.

Excessive doses of drugs, especially in the case of impaired renal function, play a decisive role, since the risk of bleeding increases exponentially with a decrease in creatinine clearance (Table 16.11).

Table 16.11. Multivariate Model for Major Bleeding in Patients with Non-ST Elevation Myocardial Infarction

Assigned Risk Ratio (OR)

Age (increase by 10 years)

History of bleeding

Mean BP (20 mmHg increase)

Only low molecular weight heparin

Low molecular weight heparin and unfractionated heparin

Glycoprotein IIb/IIIa inhibitors only

Glycoprotein IIb/IIIa inhibitors and thrombolytics

Class IV inotropic agents

Right heart catheterization

It has been shown that major bleeding is associated with a fourfold increase in the risk of death, a fivefold increase in the risk of recurrent acute MI, and is also accompanied by a threefold increase in the risk of stroke within 30 days. Some of the factors leading to worse prognosis were discussed. Withdrawal of antiplatelet and antithrombotic drugs may play an important role, and prothrombotic and proinflammatory effects of bleeding may also occur.

Hemorrhagic complications in the appointment of indirect anticoagulants

Hemorrhagic complications

• violation of cardiac and respiratory activity;
• the need for surgical or angiographic intervention;
• severe blood loss with a decrease in SBP less than 90 mm Hg, hematocrit less than 20%, or requiring a transfusion of at least 3 doses of erythromass;
• development against the background of bleeding MI, stroke, blindness or hemothorax.

• gastrointestinal bleeding, overt or latent, detected during endoscopic examination;
• severe hematuria lasting more than 2 days or requiring cystoscopy or intravenous urography;
• hemoptysis;
• bleeding requiring transfusion of at least 2 doses of erythromass.

There are the following types of drug interactions.

The general principles for prescribing drugs to the elderly do not differ from those for other age groups, however, the use of the drug in lower doses is usually required.

Vasopressor drugs become the drugs of choice in situations where attempts to increase stroke volume using drugs with a positive inotropic effect and correction of fluid volumes do not lead to the maintenance of adequate organ perfusion. As a rule, vasopressors are used in rea.

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Hemorrhages - what is it? Types, causes and treatment. Subcutaneous hemorrhages. Bruise after injection

Hemorrhages are hemorrhages in different parts of the body, differing in severity. The causes of their occurrence include internal and external pathologies of the body. Often, hemorrhages are manifested by the accumulation of blood in the tissues, but sometimes the blood comes out.

Causes of hemorrhages

In fact, these are complications after injections, but this is not always the case.

Very often, the cause of bleeding lies in the high permeability of the walls of blood vessels or their violation. The integrity of the vessel is broken when a mechanical injury occurs. And the causes of blood seepage through the vessel wall are as follows: dermatological diseases, for example, chronic dermatosis or psoriasis; acquired pathologies of the circulatory system (DIC, hemorrhagic vasculitis or bleeding disorders, thrombocytopathy); congenital genetic pathology, for example, hemophilia. Hemorrhages of almost all types are closely related to the use of hormonal drugs, depression or psychological stress.

Hemorrhages are hemorrhages, which are divided into the following types depending on the causes of their occurrence:

• bleeding caused by violations of the integrity of the walls of the blood vessel due to exposure to an infection or chemical;
• bleeding due to the fact that there was a decrease in the thickness of the walls of blood vessels;
• bleeding resulting from mechanical damage to blood vessels. This is how a bruise appears after an injection.

Depending on the location, types of hemorrhage can be:

• capillary (bleeding from small vessels);
• internal (hemorrhages in tissues and organs);
• venous (bleeding from damaged veins);
• external;
• arterial (intense bleeding from the arteries);
• parenchymal (bleeding of tissues that form organs).

The main symptoms of internal bleeding

How hemorrhages manifest themselves depends on the location and type of bleeding. Although external bleeding is easy to detect, internal bleeding is often not felt. You can identify internal bleeding by several specific symptoms, for example:

• to lower blood pressure;
• tachycardia;
• drowsiness and apathy;
• unnatural pallor of the skin;
• fainting and dizziness;
• general malaise.

This is how damage to large vessels manifests itself.

These symptoms are common for internal bleeding, but there is also a list of signs that are characteristic of various types of hemorrhages.

Hemorrhages at the injection site. What's this?

Often, complications can occur during therapy after an injection. Hemorrhages that occur after intramuscular injection are called local bleeding, which appear due to tissue damage.

Usually, over time, the blood spot goes away on its own, but sometimes a specialist may prescribe water-soluble drugs. Intravenous injections can cause bleeding when the vessel is pierced through and be not as pronounced as with intramuscular injections.

Causes of skin hemorrhages

Hemorrhage is a pathology that occurs on the skin due to blood seepage into the skin tissues through the walls of blood vessels or hemorrhage. They look like blood spots on the skin. During the whole time, hemorrhages tend to change color, starting from bright red and ending with greenish-yellow. There is no special treatment in such cases, these spots resolve on their own with time. Especially complications after injections.

Skin hemorrhages also include hematomas.

Subcutaneous hematomas form under the skin layer and look more like bruises. They can be formed as a result of various diseases (lupus erythematosus, scarlet fever, syphilis, tuberculosis) or injuries. Patients with hemophilia often suffer from such hematomas. Spots on the skin of such people occur with any damage to blood vessels. There are three degrees of subcutaneous hematomas.

Signs of a mild hematoma appear gradually, about a day after the injury, and with all this, it does not affect the functioning of the organ on which it was formed. If there is pain, then it is mild. And also if the resulting hematoma is not complicated, then it will pass by itself without treatment. The formation of a moderate hematoma occurs after three to four hours, and such a hematoma can partially disrupt the work of the organ on which it appeared.

Around such hematomas, soft tissue edema and slight swelling are formed. It is necessary to apply cold and a pressure bandage to the hematoma, and then seek help from a doctor. A serious injury can cause the formation of a severe hematoma, which will disrupt the functioning of the organs. The hemorrhage is formed quickly enough, within an hour it will already be possible to notice the blue spot that has appeared. Basically, it is a subcutaneous hematoma visible to the naked eye. After some time, such a hematoma can intensify and develop into an intramuscular one, and then the patient will experience pain in the muscles and numbness. With this type of hematoma, you should definitely consult a doctor for the appointment of further treatment. If left untreated, a severe hematoma can seriously harm the human body. And just a bruise after an injection is quite unpleasant.

What is the danger of hemorrhage?

The severity of such an insidious phenomenon as hemorrhage depends directly on the area of ​​\u200b\u200bdamage and how intense the bleeding is. Despite the fact that usually such small injuries resolve on their own, there are exceptions that are characterized by suppuration of the hemorrhage site and the need for surgical intervention. In some cases, hemorrhages lead to tissue destruction, which also leads to serious consequences. In such cases, hemorrhages in the heart, brain and lungs are considered the most dangerous. There are also hemorrhages of the eye.

Which specialist to contact?

No matter how complex the nature of hemorrhage may be, it is very important to determine the cause of its occurrence as soon as possible. A district therapist and highly specialized doctors, such as an infectious disease specialist, hematologist, dermatologist or endocrinologist, will help to resolve such a problem.

Carrying out diagnostics

After the examination, the specialist can make a primary diagnosis, but it will still be necessary to pass a coagulogram (a general blood test to examine it for coagulability) for an accurate diagnosis. In some cases, it is possible to prescribe a bacteriological blood test, on the basis of which the issue of therapy will be decided.

First aid for bleeding

Previously, it was found that hemorrhages are hemorrhages from blood vessels due to their damage. Therefore, the first thing a person can do with a slight hemorrhage is to apply cold to the injured area, which will reduce the intensity of bleeding. Follow-up care should be carried out, taking into account the type of hemorrhage. Quite easily, venous bleeding is determined by the color of the blood, which will have a burgundy or bright red color, and by a continuous but slow flow. With such an injury, in order to carry out first aid, you need to apply a tourniquet below the wound and a tight bandage. A mandatory point is the time stamp when the tourniquet was applied. With a small wound, it is wrapped with a bandage, since the venous vessels can self-tighten and subside.

arterial bleeding

Arterial bleeding differs from venous bleeding in that bright red blood will spurt out of the wound in a fountain. In this case, a tourniquet should be applied immediately, because if the bleeding is not stopped, the person may die. In this case, the tourniquet is applied above the wound to us, and a bandage is applied to it. The tourniquet is left for one to two hours, and after this time it needs to be slightly lowered for about 5 minutes in order for blood to circulate through the limb, otherwise toxins will accumulate in the stagnant blood, and after removing the tourniquet, a person may die from shock.

If we talk about such a phenomenon as subcutaneous hemorrhages, then they do not pose a serious danger if such bleeding is not in a person with poor clotting. Then you need to bandage and treat the wound. Such bleeding can be stopped with modern hemostatic agents such as Hemostop and Celox. Powdered pellets help clot the blood, making it look like a jelly, but it can be difficult to treat such a wound. Internal bleeding is one of the most severe cases in which it is necessary to consult a doctor. At the scene of the accident, the victim can only apply cold and immediately send him to the hospital or call an ambulance. Until the doctors arrive, the patient should be at rest and practically without movement.

How to get rid of hemorrhages?

Hemorrhages are treated after a thorough examination. When prescribing treatment and establishing a diagnosis, the doctor must take into account that some of the forms of hemorrhages lead to the development of complications. This is the reason why it is necessary to consult a doctor at each stage of treatment. If complications occur, inflammatory processes can begin, which can sometimes lead to death. It is necessary to accurately determine the patient's condition, the clinical form of hemorrhage and the tendency to complications in order to conduct the correct treatment. For example, for minor injuries, medical treatment is not required. But if the skin hemorrhage is large, then treatment is usually used with the application of "Troxevasin" or "Heparin" ointment to the injured area 2 times a day.

We examined what hemorrhages are. Their causes and treatment are also described.

Complication of hemorrhagic vasculitis

What is hemorrhagic vasculitis, causes, symptoms, complications

Hemorrhagic vasculitis (Schonlein-Genoch disease, capillary toxicosis, anaphylactic purpura) is a hemorrhagic vasopathy caused by microthrombosculitis mainly of the vessels of the skin, large joints, abdominal cavity and kidneys.

Causes of hemorrhagic vasculitis

Hemorrhagic vasculitis occurs after an infection (tonsillitis, pharyngitis, influenza), administration of vaccines, serums, cooling, due to drug intolerance as a nonspecific hyperergic vascular reaction. It occurs more often in children and adolescents than in adults.

A single immunoallergic pathogenesis of the disease is associated with the effect of circulating immune complexes on the vessels, leading to endothelial damage, plasmorrhagia, necrosis of the vascular wall and DIC (thrombotic hemorrhages).

Symptoms of hemorrhagic vasculitis

The detailed clinical picture of the disease is usually characterized by symptoms: high body temperature (up to degrees), small-point, sometimes merging hemorrhagic rashes on the skin, arthralgia or arthritis of large joints. abdominal and renal syndrome. The severity of symptoms varies from patient to patient.

Skin rashes are predominantly located symmetrically on the extensor surfaces of the extremities, have an erythematous, papular or urticarial character, then becoming hemorrhagic, accompanied by itching, sometimes pain. Rashes can appear in the lower abdomen, on the buttocks, torso. The lower extremities are most commonly affected.

Skin changes are often accompanied by articular syndrome. manifested by swelling of the joints, soreness and limitation of mobility. Skin manifestations occur over the affected joint in some patients.

Abdominal syndrome can occur in parallel with hemorrhagic rashes on the skin, often has an independent course, manifesting itself as suddenly developed intestinal colic, vomiting with blood, bloody stools. Bloating, pain on palpation, some tension of the abdominal wall are noted. Pain can be localized around the navel, simulate appendicitis, perforation, intussusception. Patients, as a rule, lie on their side, pressing their legs to their stomach, rushing about.

Complications of hemorrhagic vasculitis

A severe complication of hemorrhagic vasculitis is kidney damage in the form of diffuse hypertensive or mixed glomerulonephritis.

In the blood test - leukocytosis, shift to the left, especially in the abdominal form. In the hemostasiogram - changes corresponding to stages I and II of DIC, with massive bleeding - stage III.

As a syndrome, hemorrhagic vasculitis occurs with infective endocarditis, collagenoses, liver diseases, tuberculosis, drug disease, food allergies, etc. It can be acute, in the form of fulminant purpura, or chronically recur.

"What is hemorrhagic vasculitis, causes, symptoms, complications" and other articles from the section Changes in blood counts

Hemorrhagic vasculitis and abdominal pain

Hemorrhagic vasculitis (Schönlein-Henoch purpura) is most common in young children, although it occasionally occurs in adults. Hemorrhagic vasculitis is a disease of unknown etiology, although it is most likely associated with autoimmune disorders of the IgA complex and small vessel disease. Hemorrhagic vasculitis is often accompanied by abdominal pain, petechial rashes on the skin, which gradually merge and form extensive palpable hemorrhages (which, in fact, are called purpura), as well as small hemorrhages in various tissues, most often in the joints and kidneys. In many patients, acute upper respiratory tract infections are noted approximately 2-3 weeks before the onset of clinical symptoms, which are a kind of harbinger of the disease. Hemorrhagic vasculitis tends to be self-limiting and has a very low mortality rate. Fatal outcomes of the disease are most often associated with severe kidney damage. Skin manifestations occur in almost all patients with hemorrhagic vasculitis, although sometimes they may not occur from the very beginning of the disease. The rash usually occurs on the buttocks and lower extremities. The second most common clinical symptom of hemorrhagic vasculitis, which occurs in approximately 85% of patients, is arthralgia. In this case, one joint is most often affected (the so-called monoarticular lesion) and most often these are the knee and ankle joints. Orchitis occurs in 2-38% of men with hemorrhagic vasculitis. At the same time, edema and hemorrhage develop in the testicle. The clinical picture of the disease in such cases resembles testicular torsion. Symptoms from the gastrointestinal tract in patients with hemorrhagic vasculitis are quite common, in approximately 75% of cases, although complications requiring surgical intervention develop rarely - in 2-6% of patients. Often the disease is accompanied by nausea and vomiting. Abdominal pain often occurs before purpura, and in such cases the clinical picture resembles the clinical picture of acute appendicitis, exacerbation of peptic ulcer of the stomach or duodenum, or Crohn's disease (Crohn). Sometimes patients with hemorrhagic vasculitis perform vain surgical interventions. Abdominal pain in patients with hemorrhagic vasculitis usually begins suddenly and is severe, cramping. Sometimes they are accompanied by bloody diarrhea. Such a clinical picture often leads doctors to think about the possible development of intussusception, which is the most common surgical complication of hemorrhagic vasculitis. Patients with hemorrhagic vasculitis may also experience perforation of the gastrointestinal tract, most commonly the stomach or small intestine. Sometimes intestinal perforation develops as a complication of intussusception. The cause of abdominal pain is often submucosal and subserous hemorrhages and swelling of the intestinal wall, which develop as a result of vasculitis. In laboratory studies, thrombocytosis is detected in almost 90% of patients with hemorrhagic vasculitis. Petechial rash most often helps the clinician to make the correct diagnosis, since in its absence the clinical picture in such patients often resembles the clinical picture of acute surgical diseases of the abdominal organs. At laparotomy in patients with hemorrhagic vasculitis, it is found that the wall of the small intestine is edematous and reddish in color due to multiple submucosal hemorrhages.

THE EFFICACY OF FRESH FROZEN PLASMA IN THE TREATMENT OF HEMORRHAGIC VASCULITIS

In the US, assembled the lightest rifle AR-15

Specialists from the American gun shop Guns & Tactics managed to assemble the lightest version of the AR-15 self-loading rifle. The mass of the resulting weapon is only 4.5 pounds (2.04 kilograms). For comparison, the mass of a standard serial AR-15 averages 3.1 kilograms, depending on the manufacturer and version.

Created robotic fingers with variable stiffness

Researchers at the Technical University of Berlin have developed an actuator with variable stiffness. The results of the work were demonstrated at the ICRA 2015 conference, the text of the report was published on the university website.

What are hemorrhagic complications?

Why is windmill dangerous? | Complications

Chickenpox or chickenpox is a highly contagious infectious disease caused by the herpesvirus type 3 Varicella Zoster. Transmitted: by airborne droplets; by contact; from a pregnant fetus. The disease manifests itself with fever, intoxication and the appearance on the skin, including the scalp, on the mucous membranes of specific bubble rashes (stages of the rash - spot, vesicle, crust). Varicella zoster virus affects mainly children, more often at the age of 4-6.

APS - complications after childbirth. A child from birth to one year

My diagnosis is antiphospholipid syndrome. All pregnancy on prednisone. And in a month after childbirth, a complication - hemorrhagic cystitis - hemorrhages in the bladder. Terrible! Tell me, please, if you have experience, was it, what were treated. (I took off the attack with no-shpoy and that’s it, I didn’t drink anything else - I’m breastfeeding). And most importantly - do you expect any more nasty things later? Maybe you know a good specialist? Thank you in advance. And I apologize in advance if I don’t answer right away - you yourself understand, feeding, etc.

What is the prevention of hepatitis?

Hepatitis A, B, C, D are more common at the moment. Hepatitis A is considered the most contagious and easily transmitted. The source of infection is the patient himself, so it is necessary to carefully prevent the spread of infection. First of all, the patient must be isolated, provided with separate personal belongings and utensils. Hepatitis B, C and D are transmitted through the blood, as well as through any body secretions (saliva, semen, etc.). High risk of contracting hepatitis through the blood.

There is also vaccination against hepatitis A, but it is not mandatory, at the request of the parents and the doctor's recommendation - before traveling to Asian countries, for example.

Hepatitis: how to detect the disease in time

Often, chronic hepatitis is detected by chance: by the presence of an enlarged liver when examining a child in a clinic or during a preventive examination of contact children in the focus of viral hepatitis A. During examination and further examination of children with an enlarged liver, an increase in the level of transaminases (ALT, AST), the presence of markers of viral hepatitis , changes on ultrasound. As a rule, in such cases, chronic hepatitis is a consequence of erased and anicteric forms of the disease, when acute.

We treat SARS in children: work on mistakes

When treating a child with a cold, mothers may come across erroneous recommendations that not only do not help the baby recover, but sometimes even are dangerous for his health. We propose to consider the most common mistakes and misconceptions in the treatment of respiratory infections in children. "The temperature must be brought down urgently" An increase in body temperature is a protective reaction of the child's body, the purpose of which is to destroy the infection. Knocking down the temperature already at.

In our case (adenoids), the drug helped very well, after a week the daughter began to breathe well at night, her nose stopped stuffing up.

What are the symptoms of hepatitis?

There are main clinical syndromes of hepatitis: hepatomegaly, asthenovegetative syndrome, dyspeptic syndrome, icteric syndrome, hemorrhagic, enlarged spleen. Hepatomegaly, the main syndrome of chronic hepatitis, may be the only sign of hepatitis. With hepatomegaly, the liver is enlarged, painful on palpation, in most cases there is a uniform increase in the left and right lobe. Asthenovegetative syndrome is manifested by weakness and fatigue, emotional.

Fatigue, nausea, and stool disorders can also accompany hepatitis.

Effect of viral hepatitis B on pregnancy?

The effect of viral hepatitis on the course of pregnancy depends on the degree of activity of the infectious process and the severity of liver damage at various gestational ages. In the acute form of hepatitis, pregnant women are necessarily hospitalized, regardless of the duration of pregnancy, for complex therapeutic measures aimed at reducing the severity of the manifestation of hepatitis and its impact on the body of the mother and fetus. Antiviral therapy is prescribed as therapeutic measures, for example.

Influenza vaccination - winter flu prevention

Something here with the elder's illness was inspired. I thought it was flu season. Do pregnant women get flu shots? Otherwise, this is such a vile infection and what for we don’t need it now.

Diet for weight loss Elena Malysheva.

Lena Malysheva is not only a TV presenter, but also a certified nutritionist. HER diets are popular all over the planet. Still, in reality, Lena Malysheva's diet is by no means a diet at all. So says Malysheva herself. Rather, this is the concept of nutrition, a style of being, which should be followed for a long time, and with the intention to be always slim and all my life. However, for the comfort of all followers, this concept of nutrition is still called a diet. The diet of Lena Malysheva gives a chance for.

Girls, we were given para-whooping cough. Cough - parapertussis coughed

Girls, we were given para-whooping cough. We've been coughing for 2 weeks now. But now - even and vomiting has gone. Started taking antibiotics. Help in any way you can. Who was sick. With our neurology, we only lacked whooping cough. And so he could vomit if he choked.

Now your task is to reduce the number of paroxysms to a minimum, notice what causes seizures in you and avoid these situations. Limit all types of activity (if possible), avoid bright lights, loud sounds. The room in which the child should be quiet, even during the day you can curtain the windows, disturb the child less, prevent outbursts of anger in him, you can even give up educational principles for this time and go completely on about the child, if only he was less nervous. Feed, drink very small portions, but more often, no irritating food.

I don’t want to upset you, but complications occur mainly in the respiratory system and in the brain. But I want to please you, mostly complications occur in infants (up to a year). I don’t want to scare anyone, personally, I haven’t vaccinated my child against whooping cough yet (we had contraindications and we got it after a year), I didn’t go anywhere with the child. There is no vaccination against parapertussis, but after a year it is no longer so dangerous.

Each paroxysm is brain hypoxia (to one degree or another), even in children “without neurology”, convulsions can develop - often in infants, rarely in older ones. I ask again, do not be afraid, you are already older, these complications occur mainly in the chest, but after severe paroxysms, hemorrhage in the brain, eyes, skin and mucous membranes may develop. I will not describe further all the horrors and what are the complications of the respiratory tract, but you must clearly understand what your efforts should be aimed at - to reduce the frequency of paroxysms. In my opinion, all the appointments were made correctly for you, but you still need to consult with the treating neurologist, maybe they will tell you something.

Hold on and get well soon, your recovery stage will begin soon and it will be easier, the paroxysms will still remain, but they will no longer end with vomiting. Get well!

I really need a certified hematologist. Children's medicine

The child was diagnosed with hemorrhagic vasculitis. I read on the Internet - came to some dumbfounded. need advice from a good specialist. A pediatrician from Semashko (an acquaintance) said that they did not have a good specialist.

Hematological Research Center of the Russian Academy of Medical Sciences

There is also a paid admission.

And one more thing - if you have been “diagnosed”, then it is necessary not to consult, but to be treated. And actually, you should have been given an urgent referral to a hematology center.

Mistakes in the treatment of colds.

Unfortunately, most people underestimate such a common disease as the common cold, believing that it is due to climate change. Meanwhile, cooling the body only temporarily weakens the immune system, making the body more susceptible, which allows the virus to infiltrate. Fans of self-treatment of colds make gross mistakes that can cause complications. The first, most common mistake is taking antibiotics during a cold. Antibiotics are antibacterial.

Vacuum extractor - http://conf.7ya.ru/fulltext-thread.aspx?cnf=care.

Who knows what it is, what are the consequences of the application and where you can read about it?

then they don’t do a cesarean anymore, because the disclosure is complete and the head is already at the exit from the pelvis.

much better than tongs

complications are rare. inconvenience - the mother receives an episiotomy, they first cut the perineum with scissors, then sew it up, and the child receives a large subcutaneous hematoma on the head. that can bleed

a rare complication is subdural hematoma with neurological impairment.

mode after removal of adenoids - at sea after removal.

Welcome everyone! In the near future, my daughter 4.5 g will have adenoids removed. Dad is eager to take her to the Red Sea (Egypt) after the operation. And it seems to me that you can’t go on a plane after the operation. Or am I wrong? What do the doctor's say?

a week of calm home regimen and no hot baths, a month of minimizing contacts and no sports activities and you can’t hang upside down, you can’t fly an airplane for two months and change the climate dramatically.

and it is better to ask the surgeon who will operate and observe in the postoperative period. The doctor told us that the postoperative period is very individual and takes from two weeks to a couple of months.

Childbirth with pyelonephritis - childbirth with pyelonephritis

Childbirth with pyelonephritis During pregnancy, the load on the kidneys increases significantly, diseases that had previously been asymptomatic appear. One of the most common diseases in obstetric practice are infectious - inflammatory diseases of the urinary tract (pyelonephritis, cystitis, urolithiasis). The combination of pregnancy and diseases of the urinary system is often accompanied by a number of complications: - miscarriage (spontaneous miscarriages.

Who knows about the diagnosis - organic aciduria - organic.

Write what you know. If a child (girl) is 6 years old, they do a lot, there is progress, but there are problems too. To clarify the diagnosis, it is recommended to go to Moscow. Where, to whom, what complications, what to pay attention to? Maybe you know the name of the analysis in full and the addresses, the appearances are not only in Moscow.

Measles/rubella/mumps vaccination Allergic - measles vaccination.

Girls, good afternoon! Share your experience, pliz, would you do / did this vaccination for a child with allergies? Allergy to many products, the boy is 1.1 years old. In the next year we are not going to the garden, there will be a nanny. We are in the region, unfortunately we cannot find a good immunologist, and just a pediatric immunologist. The allergy "shot" after 2 vaccinations with Pentaxim at 5.5 months. Is it possible to get infected from freshly vaccinated children in the sandbox, for example, if you do not get vaccinated? I'm especially afraid of pigs, because.

About mumps - my husband had mumps at the age of 28, got infected from his nephews, had orchitis as a complication. He has two children :), i.e. mumps did not affect the ability to conceive.

Therefore, in your case, I would still wait with this vaccine, it is not clear what to expect from allergies :(

I think if this time to do following all the rules, then the risk is small.

Against the background of antihistamines (three days before and three days after), on an empty stomach (if possible), drink a lot, diet a week after and five days before - everything eases the load on the system. I also gave mine an enema before vaccinations. It helps too.

And also do a test (you can do it at home) and if you are allergic to protein, tell your doctor. There are options for protein-free vaccines.

Good afternoon everyone! I ask advice from all who faced this trouble! My grandmother is 91 years old, she suffers from senile dementia (marasmus), physically her grandmother is strong, she will give young people a head start, but she’s in complete trouble with her head, doesn’t recognize anyone, confuses everything, constantly asks to let her go home (although she is in the house where she already lives 70 years old), does not sleep at night, becomes aggressive, it constantly seems to her that we want to poison her. kill. in general, a complete horror. My grandmother lives in the village, she is alone of course.

Why do children die in the first days of life? One of the most.

All 9 months, a baby is growing under your heart, which is surrounded not only by your love and affection, but also by reliable protection from amniotic membranes and amniotic fluid. The fetal bladder forms a sealed reservoir with a sterile environment, thanks to which the child is protected from infection. Normally, the rupture of the membranes and the outflow of amniotic fluid occurs before childbirth (when the cervix is ​​​​fully open) or directly during childbirth. If the integrity of the bladder has been compromised before, it is.

With a massive rupture, it is not difficult to make a diagnosis. But, unfortunately, in almost half of the cases, doctors even at leading clinics doubt the diagnosis if they rely only on examination data and old research methods.

An ultrasound examination makes it possible to tell whether a woman has oligohydramnios or not. But the cause of oligohydramnios can be not only a rupture of the membranes, but also a violation of the function of the kidneys of the fetus and other conditions. On the other hand, there are cases when a small rupture of the membranes occurs against the background of polyhydramnios, for example, in the pathology of the kidneys of a pregnant woman. Ultrasound is an important method for monitoring the condition of a woman who has had a premature rupture of the membranes, but does not answer the question of whether the membranes are intact.

Indeed, there is such a method for determining amniotic fluid, based on determining the acidity of the vaginal environment. It is called the nitrazine test or amniotest. Normally, the vaginal environment is acidic, and the amniotic fluid is neutral. Therefore, the entry of amniotic fluid into the vagina leads to the fact that the acidity of the vaginal environment decreases. But, unfortunately, the acidity of the vaginal environment also decreases in other conditions, such as infection, urine, sperm. Therefore, unfortunately, a test based on determining the acidity of the vagina gives a lot of both false positive and false negative results.

Vaginal discharge containing fetal water, when applied to a glass slide and dried, forms a pattern resembling fern leaves (fern phenomenon). Unfortunately, the test also gives a lot of inaccurate results. In addition, in many medical institutions, laboratories work only during the day and on weekdays.

15. What are the modern methods for diagnosing premature rupture of membranes?

Modern methods for diagnosing premature rupture of the membranes are based on the determination of specific proteins, which are abundant in the amniotic fluid and are not normally found in the vaginal discharge and other body fluids. To detect these substances, an antibody system is developed, which is applied to the test strip. The principle of operation of such tests is similar to a pregnancy test. The most accurate test is a test based on the detection of a protein called placental alpha microglobulin. The commercial name is Amnishur (AmniSure®).

The accuracy of the Amnishur test is 98.7%.

Yes, unlike all other research methods, the Amnishur test does not require examination in the mirrors and a woman can put it at home. Everything you need to set up the test is included in the kit. This is a tampon that is inserted into the vagina to a depth of 5-7 cm and held there for 1 minute, a test tube with a solvent, in which the tampon is washed for 1 minute and then a test strip is thrown out, which is inserted into the test tube. The result is read after 10 minutes. In the case of a positive result, as with a pregnancy test, 2 strips appear. With a negative result - one strip.

If the test turned out to be positive, you need to call an ambulance or go to the maternity hospital if the pregnancy is more than 28 weeks and to the gynecological department of the hospital if the pregnancy is less than 28 weeks. The sooner treatment is started, the greater the chance of avoiding complications.

If the test is negative, you can stay at home, but at the next visit to the doctor, you need to talk about the disturbing symptoms.

No, if more than 12 hours have passed since the alleged rupture and the signs of outflow of water have stopped, then the test may show an incorrect result.

True premature rupture of membranes occurs in about one in ten pregnant women. However, almost every fourth woman experiences some kind of symptoms that can be confused with premature rupture of the membranes. This is a physiological increase in vaginal secretion, and slight urinary incontinence in later pregnancy and profuse discharge during genital tract infections.

If a massive rupture of the membranes has occurred, then it cannot be confused with anything: a large amount of a clear, odorless and colorless liquid is immediately released. However, if the gap is small, which doctors also call a subclinical or high lateral gap, then it can be very difficult to make a diagnosis.

There are 3 types of complications that can lead to premature rupture of the membranes. The most frequent and severe complication is the development of an ascending infection, up to sepsis of the newborn. In preterm pregnancy, premature rupture of the membranes can lead to premature birth with all the consequences of having a premature baby. With a massive outflow of water, mechanical injury to the fetus, prolapse of the umbilical cord, placental abruption is possible.

Risk factors for premature rupture of the membranes are infection of the genital organs, overstretching of the membranes due to polyhydramnios or multiple pregnancies, abdominal trauma, incomplete closure of the uterine os. An important risk factor is premature rupture of the membranes during a previous pregnancy. However, in almost every 3rd woman, rupture of the membranes occurs in the absence of any significant risk factors.

This is largely determined by the duration of pregnancy. At full-term pregnancy, half of the women spontaneous labor occurs within 12 hours and more than 90% within 48 hours. With a premature pregnancy, it is possible to keep the pregnancy for a week or longer if the infection does not join.

Normally, the fetal membranes are airtight and no, even the smallest penetration of amniotic fluid into the vagina occurs. Women often mistake increased vaginal secretion or slight urinary incontinence for leakage of amniotic fluid.

Premature rupture of the membranes is indeed a very dangerous complication of pregnancy, but with timely diagnosis, hospitalization and timely treatment, premature pregnancy can often be prolonged if no infection occurs. With a full-term pregnancy and close to full-term, as a rule, they stimulate the onset of labor. Modern methods of diagnostics and treatment in this case allow you to smoothly prepare a woman for childbirth.

8. If there was a premature rupture of the membranes, but the mucous plug did not come off, does it protect against infection?

The mucous plug does protect against infection, but if the membranes rupture, the protection of the mucous plug alone is not enough. If treatment is not started within 24 hours of the rupture, serious infectious complications may occur.

The fetal waters are indeed divided into anterior and posterior, but no matter where the rupture occurs, it is a gateway for infection.

By itself, the rupture of the membranes occurs painlessly and without any precursors.

FREE courses for young parents.

Girls, for information! Looking for free and QUALITY courses for young parents? Here you are: [link-1] ADVANTAGES: The courses are organized by the Moscow maternity hospital No. 16, everyone can attend them, regardless of registration at the place of residence, without prior appointment, starting at 15:00, but come at least half an hour earlier, otherwise you may not enough places. The preparatory course consists of 7 lectures, the schedule is posted on the website, it covers all the topics of interest to the expectant mother (change.

Complications in multiple pregnancy.

The most common complications associated with twin/twin/triple pregnancy are: Premature birth. Low birth weight. Retardation of intrauterine development of the fetus. Preeclampsia. Gestational diabetes. Placental abruption. C-section. premature birth. Births that occur before the 37th week of pregnancy are considered premature. The duration of a multiple pregnancy decreases with each additional child. On average, a pregnancy with one baby lasts 39 weeks.

Are vaccinations needed? - certainly. The question is to whom.

The money earned on vaccinations and, most importantly, the sales of products reliably guaranteed by the state, stimulate pharmaceutical companies to launch more and more new vaccines on the market and increase the number of vaccinations with existing ones. The usual story is that when a new vaccine comes on the market, we are told that it is highly effective, "one shot and your baby is protected." However, it soon becomes clear that not one, but several vaccinations are required, and all of them immediately find a place for themselves.

Children with problems after vaccinations - problems after vaccinations

Guys, this is my first post here. The site has been on the site for a long time. Those who have kids with problems after vaccinations have such a thing. there is an opportunity to give this case wide publicity, after which we will seek compensation for the treatment of children. I need to collect a database (without surnames). The question will be raised at a high level. It is necessary to write the age of the child, vaccination, consequences, the diagnosis that was received thanks to our vaccinations, what the doctors said to all questions and, in general, their reactions to statements that the trouble was and the diagnosis.

Vaccinations. Adoption

Girls, how are you with vaccinations? We had a medical withdrawal for up to 5 months, moreover, an oral one, the doctors did not indicate it in the extract. The neuropathologist and the pediatrician in the polyclinic believe that there are no reasons not to do it. There is only hepatitis from the genus. at home and all. Should I start vaccination or wait until at least another year? Does anyone have any opinions?

Cryotherapy. Pros and cons. - cryotherapy for tonsillitis

Moderators, please don't remove my thread. I know that we have a lot of specialists and simply experienced people on the forum, and they are also very caring. So, we have: a 5-year-old girl, chronic tonsillitis, ENT suggests removing the tonsils. I don’t agree. advice and your experience, is it worth it or not to torture the child, will there be a positive result. Thank you in advance.

I don't recommend anything, just a personal complaint. Until this summer, she did not suffer from sore throats at all.

Stroke: when the brain needs help. Diseases of the cardiovascular.

How a stroke occurs Hemorrhagic stroke is usually a complication of hypertension. Unable to withstand the increased blood pressure on the wall, the vessel ruptures. The resulting hemorrhage compresses the tissues, causes swelling - and the brain area dies. In the case of an ischemic stroke, the vessel retains its integrity, but the blood flow through it stops due to spasm or blockage by a thrombus, that is, a blood clot that has formed on the wall of a vessel affected by atherosclerosis. Stress, fluctuations in atmospheric pressure, overwork, bad habits: alcohol and smoking, a sharp fluctuation in the level of sugar.

Where is the bruise from? About diseases

Doctor! Urgently! Child health up to a year

The appearance of more frequent, noisy, labored breathing with retraction of the intercostal space, jugular fossa, or sternum on inspiration is a serious symptom related to signs of respiratory or cardiovascular insufficiency. One of the common causes of shortness of breath is aspiration - the ingress of foreign bodies (food, small objects) into the bronchi. Also, the cause of shortness of breath is often complications of infectious diseases in the form of the development of laryngeal edema (false croup) and narrowing of the lumen of the bronchi (bronchial obstructive syndrome). Shortness of breath may be accompanied by pneumonia (pneumonia), bronchiolitis (inflammation of the small bronchi). Shortness of breath is also a symptom of an allergic reaction from the respiratory tract (allergic laryngeal edema, bronchial obstruction), as well as one of the first symptoms of anaphylactic shock. In addition, shortness of breath is accompanied by an increase in heart rate.

Hemorrhagic syndrome Hemorrhagic syndrome is the appearance of spontaneous hemorrhages in the skin (from the smallest rash (petechiae) to extensive foci), hemorrhages in the mucous membranes or bleeding (from the nose, mouth, rectum, umbilical wound), which, of course, requires immediate examination doctor. There are many reasons for the development of hemorrhagic syndrome. These can be various blood diseases that occur with clotting disorders, as well as severe infections. A child with hemorrhagic syndrome will need examination and treatment in a hospital. Trauma Unfortunately, falls and injuries to children under 1 year of age are not uncommon. More often falls are with a blow to the head, as this is the most.

Vaccinations: to the issue of safety. Vaccination (vaccinations)

Large fruit. Features of pregnancy and childbirth. Medical.

Large child. Possible complications of pregnancy and childbirth

There is also a tendency for the formation of a large fetus during the second and subsequent pregnancies. According to statistics, the second child is 20-30% larger than the first. It can be assumed that this is determined by several factors. One of them is psychological, that is, when carrying a second baby, the expectant mother is more calm, since she is no longer familiar with pregnancy and childbirth. Another reason may be that during the second pregnancy, the mother’s body is already trained to carry the baby, blood circulation in the uteroplacental and fetal-placental vessels is obes.

Measles vaccine. Vaccinations against measles: contraindications.

Patients receiving treatment with drugs that weaken the immune system. Introduction of blood products (whole blood, plasma, immunoglobulin) within the last 8 weeks before the proposed vaccination. Some cancers. Child's health after vaccination Adverse reactions to measles vaccine are rare, and complications in vaccinated people are also very rare. In a small part of the vaccinated, mild adverse reactions may occur in the form of an increase in temperature up to 38 ° C, sometimes there is conjunctivitis and a mild rash. The listed symptoms are possible in the period from 5-6 to (different sources give different periods) day; they keep 2-3 days. This is a natural course of the vaccination process.

Anemia and pregnancy. Medical aspects of pregnancy

Traumatic brain injury. Injuries, first aid

The outflow of pure blood speaks more of an ear or nose injury than a skull fracture. In addition, cranial nerves can be damaged if the base of the skull is fractured. Depending on the site of the fracture, there may be disturbances in smell, vision, hearing, and facial asymmetry. Among the complications of a fracture of the base of the skull, complications associated with infection from the nasopharynx, middle ear or paranasal sinuses entering the cranial cavity are very dangerous: abscesses (abscesses) of the brain and meningitis. Skull fractures are usually combined with various brain injuries. There is no direct correlation between the severity of brain damage and the type of fracture. However, as a rule, depressed fractures are accompanied by more severe damage than linear fractures; they often develop epi- and subdural hematomas, while linear fractures do.

My brother had an accident two weeks ago, a traumatic brain injury, now he is conscious, he is talking. The neurosurgeon advised me to take him home, because they cannot be transferred to the ward, the psychotherapist does not let him through and he received all the necessary treatment. As the article indicated the drug Milgamma compositum, he also drank it, I wonder how often you can drink it?

immunity against. pregnancy. Infertility

The introduction of immunoglobulin is necessary to prevent exacerbation of a viral infection, to suppress the production of autoantibodies. At the same time, protection (passive immunity) from chronic infection and autoantibodies circulating in the blood is formed in the pregnant woman's body, and indirectly, the protection of the fetus from them. With the introduction of immunoglobulin, there may be complications in the form of allergic reactions, headaches, sometimes there are catarrhal phenomena (runny nose, etc.). To prevent these complications, it is necessary to check the immune, interferon status with the determination of immunoglobulins of the IgG, IgM, and IgA classes in the blood (IgM and IgA antibodies are produced when an infectious agent first enters the body and during an exacerbation of the infectious process, IgG remain in the body after an infection). At a low level

Spam, flooding, provocations, intrusive messages

After 5 violations you will be transferred to the reading mode!

Vaccinations "over plan": vaccination against meningitis. Vaccination.

In this case, the vaccination is carried out 2-4 weeks after recovery. 1 Immunoglobulin - a drug made on the basis of the blood of a person who has been ill or vaccinated against a particular infection and has developed antibodies - protective proteins against the infectious agent. A permanent contraindication is a severe allergic reaction to the components of the drug and complications that have arisen after the previous administration. Vaccination against meningococcal infection Another cause of purulent meningitis are meningococci. This is a large group of pathogens that cause more than 60% of meningitis in children and adults. They, in turn, are also divided into a number of groups - A, B, C, W135, Y, etc. The disease is transmitted by airborne droplets from person to person.

Meningococcus is able to affect various organs - the pharynx, nose, lungs, heart, joints, and not just the membranes of the brain. There may be damage to the whole body - blood poisoning (sepsis). Meningococcal infection is characterized by high fever, severe headache, and recurrent vomiting. The main distinguishing feature is the appearance of a star-shaped appearance of a small hemorrhagic rash (hemorrhages in the skin, small dots and “stars”; at the same time, if you stretch the skin near the rash element, the rash, unlike other, non-hemorrhagic species, will not disappear). A rash in the form of single elements begins to appear on the abdomen, buttocks, heels, legs and spreads throughout the body in a matter of hours. Meningococcal infection is characterized by a rapid course.

A look from within. Tests and investigations during pregnancy

Invasive prenatal diagnosis. The risk of developing chromosomal and genetic diseases. Contraindications for invasive research. How research is done.

I had an amneocentesis - in fact, everything is not as scary as it might seem when you read the article. Only this analysis is not cheap.

Hemorrhoids are a secret disease. Complications of pregnancy

Women are embarrassed to tell the doctor about the manifestations of this disease and seek medical help only as a last resort, when complications arise, as many believe that hemorrhoids during pregnancy are the norm. Hemorrhoids are enlarged veins in the anus. The development of this disease is facilitated by the anatomical and physiological features of the rectum. Under its mucous membrane there are numerous veins that form plexuses, the walls of these veins are very thin.

Coagulogram. Tests and investigations during pregnancy

Platelet consumption is increased in DBS. A coagulogram should be taken once a trimester, and if there are deviations in hemostasis, more often, as prescribed by a doctor. The balance between the coagulation and anticoagulation systems is maintained through the interaction of platelets, coagulation factors and the fibrinolysis process. Violation affecting any of these links can cause serious complications of pregnancy. Among these complications, the most dangerous is DIC (disseminated intravascular coagulation). This syndrome develops due to the activation of the coagulation system, on the one hand, and the fibrinolysis system, on the other. DIC in pregnant women can be caused by various reasons. Among them: premature detachment.

"Dossier" of the expectant mother. What is an "exchange card"?

Section to be completed in the antenatal clinic This section contains information about the pregnant woman from the antenatal clinic. FULL NAME. Age. In pregnant women under 18 years of age and over 30 years of age, complications during pregnancy and childbirth are more often observed. The address. Naturally, it is necessary for emergency cases, when contact with a pregnant woman is difficult or impossible, to find relatives and relatives and obtain from them the necessary information about a woman. Postponed general, gynecological diseases, operations. Hereditary and chronic diseases in a woman are of interest because they can have an adverse effect on the development of the fetus, the course of pregnancy and childbirth. Important information.

Dangerous changes: gestosis of pregnant women. Toxicosis

Severe complications of preeclampsia (bleeding, premature detachment of a normally located placenta, fetal death) are largely due not to high blood pressure, but to its sharp fluctuations. The presence of protein in the urine (proteinuria) is one of the most characteristic signs of preeclampsia. A progressive increase in protein in the urine indicates a worsening of the course of the disease. Simultaneously with the presence of these symptoms in pregnant women, the volume of urine excreted decreases. The daily amount of urine decreases to 1 ml or less. The less.

Myoma and pregnancy. Pregnancy planning

Today I had an appointment with a reproductive specialist. We have been planning pregnancies for almost a year. Revealed a nodule in the uterus (myoma). The size is small - 3.5 cm. More precisely, I have had it for several years, but all gynecologists previously simply stated its presence. All 5 years - she did not grow, respectively, but did not bother. Gynecologists said that pregnancy fibroids are not a hindrance. But today the reproductologist says that actually all the troubles are in her. And that it interferes with normal conception, and even if I get pregnant, maybe.

In the hospital I saw a bunch of girls who gave birth with fibroids - only one had problems: during pregnancy, the fibroids began to grow, grew to the size of a child, BUT - the child was born absolutely normal, the pregnancy, according to her, was normal - taking into account her diagnosis .

Frequent advice here in the conference - go to another doctor, in particular, to a reproductologist, but for starters - calm down and don't get upset. Everything will be fine!

Features of the use of drugs during.

Heparin and low molecular weight heparins (Fraxiparin) do not cross the placenta and do not adversely affect the fetus. Long-term (more than 6 months) use of heparin at therapeutic doses during pregnancy predisposes to reversible osteoporosis and fractures. Fraxiparine has a number of advantages: the absence of hemorrhagic complications in the mother and newborns and clinical signs of osteoporosis. Diuretics are not classified as potentially teratogenic for the human fetus, but the fetotoxic effect of diuretics of various chemical groups is not excluded. With prolonged use by pregnant women of large doses of thiazides in newborns, hyponatremia and thrombocytopathy may develop. Under the influence of ethacrynic acid, weakening and loss are noted.

Helio-bacter - 5 helio-bacter

Is there any other way to treat this microbe other than antibiotics? They found it in my mother’s stomach, prescribed strong antibiotics, but she is weak, underwent surgery on her chest (2nd degree cancer) two years ago, still cannot fully recover, and will not provoke an antibiotic, killing all microbes, even useful ones, stomach cancer or something else? Maybe there are more gentle means?

Treatment is prescribed in a number of cases:

1. With a stomach or duodenal ulcer.

2. With atrophic gastritis, confirmed histologically, especially with the phenomena of metaplasia and dysplasia.

2. After surgery for stomach cancer.

3. Relatives of a patient with stomach cancer.

Effective treatment regimens include combinations of antibiotics in high doses, with all the associated side effects and complications, so that if there is no indication for treatment, the prescription of the regimen will do more harm than good.

It is not a microbe that needs to be treated, but a person :) Health to your mother!

There is evidence of a connection between stomach cancer and the presence of Helicobacter pylori.

There are no beneficial microbes in the stomach. They are in the intestines, well, after some time after treatment, you can drink acterial preparations, of the best - Bifiform.

In addition, EGDS with a biopsy is not done by everyone. Obviously, your mother had some complaints? So, you really need to be treated, and there is nothing wrong with that.

Complications from DTP vaccinations. Other children

Complications from DTP vaccinations Galina Petrovna CHERVONSKAYA, virologist, member of the Russian National Committee on Bioethics (RNKB) of the Russian Academy of Sciences and the International Society for Human Rights (ISHR) Complications from DTP - local reactions: infiltrates, abscesses (phlegmon, etc.); - damage to the central nervous system: persistent piercing cry, encephalitic reactions, encephalopathy, post-vaccination encephalitis; - damage to the kidneys, joints, heart, gastrointestinal tract; - complications of allergic.

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1 June 2011

Bleeding and hemorrhage in various organs are a common complication in the treatment of anticoagulants. In therapeutic departments, bleeding is observed in 5-10% of cases, and in surgical and gynecological departments - much less frequently (E. Perlik, 1965). Various localizations of hemorrhagic reactions are described in treatment with anticoagulants: fatal hemorrhages in the pericardial region (M. I. Teodori et al., 1953), intramural, pulmonary hemorrhages, intracranial hematomas, gastrointestinal bleeding (G. A. Raevskaya, 1958), etc. V. P. Romashov (1970 ) out of 400 patients with myocardial infarction, angina pectoris, hypertension, thrombotic cerebral stroke, pulmonary and peripheral vascular embolism treated with heparin, pelentan, syncumar, neodicumarin, phenylin and fibrinolysin, 53 people observed microhemorrhages, manifested by microhematuria, the presence of occult blood in the feces, erythrocytes and streaks of blood in the sputum, hemorrhages in the sclera, short-term nosebleeds. In 14 patients, more severe complications were found: bleeding from the lungs, kidneys, gastrointestinal tract, hemorrhages in the skin and muscles.

These complications are based on hypocoagulation and increased capillary fragility. Concomitant diseases that are detected in patients during the period of anticoagulant use are of great importance. For example, in arterial hypertension, capillary resistance is reduced and their fragility is increased. In addition, depending on the level of blood pressure, the concentrations of blood coagulation factors and, accordingly, tolerance to anticoagulants change. This requires careful adjustment of the doses of the drugs used. Tumors and ulcers of the gastrointestinal tract, strangulated hernias and other diseases contribute to the occurrence of intraperitoneal bleeding. According to E. Perlik (1965), in chronic inflammatory and allergic processes, tolerance to endogenous heparin sharply decreases, and in acute inflammations, relapses of thromboembolism, it does not increase. Liver diseases, accompanied by a violation of the synthesis of coagulation factors, also lead to changes in the coagulation status of the blood. Absolutely proven is the danger of using anticoagulants against the background of hemorrhagic diathesis.

Hemorrhagic complications may also occur due to the additional prescription of other drugs that have a synergistic or antagonistic effect on blood clotting, change the permeability and resistance of capillaries. The anticoagulant effect of anticoagulants may be enhanced by the action of salicylates, some broad-spectrum antibiotics, and phenothiazine derivatives. as they show synergy with respect to coumarins and indandiones.

Nevertheless, the main cause of hemorrhagic complications in the treatment of anticoagulants is their overdose and insufficient control over the coagulation status of the blood.

Clinically, hemorrhagic complications are often manifested by renal syndrome - hematuria, accompanied by renal colic due to blockage of the ureters by blood clots. Women often experience uterine bleeding. In the presence of an ulcerative process in the gastrointestinal tract, bleeding with hematemesis and tarry stools of appropriate localization may occur. Subserous bleeding and hemorrhage sometimes simulate an acute abdomen and lead to unnecessary surgical interventions. Therefore, depending on the location and severity of hemorrhages or bleeding, hemorrhagic complications of anticoagulant therapy may manifest themselves in various clinical syndromes.

Non-allergic complications of pharmacotherapy due to the actual side effects of drugs.

The actual side effect of medicinal substances, not related to their pharmacological (therapeutic) effect, can be observed immediately (from several minutes to several hours) after the first administration of the drug into the body - the next manifestations, and after a long time (weeks, months, years) after repeated injections medicines are distant manifestations.

The first group includes acute intoxication, pathological reflex reactions (cardiac and respiratory arrest), irritant effects of drugs at the site of their administration, etc. Long-term manifestations of the actual side effects of drugs are expressed in chronic intoxication, teratogenicity, tumor growth, most complications of hormone therapy, the occurrence of thromboembolism when treatment with anticoagulants, aspirin ulcers (although in rare cases they can develop as an immediate complication), lesions of the VIII pair of cranial nerves with some antibiotics, etc.

The clinic, diagnosis and treatment of acute drug poisoning are described in detail in clinical toxicology manuals and separate manuals. The list of the nearest adverse reactions of many drugs is given in pharmacological reference books and annotations to drugs, so we do not dwell on them. Remote manifestations of the actual side effects of the main groups of drugs used in the clinic deserve more detailed consideration.

On the same subject

2011-06-01

Medicine is a separate and very important area of ​​human activity, which is aimed at studying various processes in the human body, treating and preventing various diseases. Medicine explores both old and new diseases, developing all new methods of treatment, medicines and procedures.

It has always occupied the highest place in human life, since ancient times. The only difference is that the ancient physicians were based either on personal little knowledge or on their own intuition in the treatment of diseases, and modern physicians are based on achievements and new inventions.

Although many discoveries have already been made over the centuries-old history of medicine, methods of treating diseases that were previously considered incurable have been found, everything is developing - new methods of treatment are being found, diseases are progressing and so on ad infinitum. No matter how many new medicines mankind discovers, no matter how many ways to treat the same disease, no one can guarantee that in a few years we will not see the same disease, but in a completely different, new form. Therefore, humanity will always have something to strive for and activities that can be more and more improved.

Medicine helps people recover from everyday illnesses, helps in the prevention of various infections, but it also cannot be omnipotent. There are still quite a lot of different unknown diseases, inaccurate diagnoses, wrong approaches to curing the disease. Medicine cannot provide 100% reliable protection and assistance to people. But it's not just about underexplored diseases. Recently, many alternative methods of healing have appeared, the terms chakra correction, restoration of energy balance are no longer surprising. Such a human ability as clairvoyance can also be used to diagnose, predict the course of development of certain diseases, complications.