Anticoagulant therapy in a hemodialysis patient at high risk of thrombotic and hemorrhagic complications. Case report
- Authors: Orudzheva S.A.1, Kudryavtsev A.N.1, Demidova V.S.1, Ushakov A.A.1, Magomedova S.D.1, Mitish V.A.1,2,3, Kuprin A.V.1, Bozheva E.I.1
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Affiliations:
- Vishnevsky National Medical Research Center of Surgery
- Research Institute of Emergency Pediatric Surgery and Traumatology
- People’s Friendship University of Russia (RUDN University)
- Issue: Vol 25, No 1 (2023): Cardiovascular diseases
- Pages: 39-45
- Section: Articles
- URL: https://journals.rcsi.science/2075-1753/article/view/131637
- DOI: https://doi.org/10.26442/20751753.2023.1.201951
- ID: 131637
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Abstract
An attempt to preserve the knee joint in a patient on hemodialysis with stage IV lower limb ischemia with a high risk of thrombotic and hemorrhagic complications is presented. Multifocal atherosclerosis and extensive occlusion of the arteries of the lower leg ruled out the technical possibility of revascularization. The patient refused the proposed hip amputation. An attempt was made to perform amputation at the level of the lower leg. Required therapy aimed at the treatment and prevention of thrombotic complications, and optimization of microcirculation in the ischemic limb. For this purpose, a prolonged blockade of the sciatic and femoral nerves, combined anticoagulant therapy, and treatment with alprostadil were performed. Therapy with antithrombotic and vasoactive drugs was not effective and was complicated by the state of persistent hypocoagulation with an episode of bleeding. Amputation of the limb at the level of the thigh was performed according to vital indications after correction of hypocoagulation. The lack of clinical recommendations on anticoagulant therapy for critical lower limb ischemia in patients with stage 5 chronic kidney disease requires an individual approach to the choice of antithrombotic drugs and their doses, monitoring the state of blood coagulation using an integral method for assessing the hemostasis system – thromboelastography.
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##article.viewOnOriginalSite##About the authors
Saida A. Orudzheva
Vishnevsky National Medical Research Center of Surgery
Author for correspondence.
Email: Osaida@rambler.ru
ORCID iD: 0000-0002-0212-5742
D. Sci. (Med.)
Russian Federation, MoscowAnton N. Kudryavtsev
Vishnevsky National Medical Research Center of Surgery
Email: Osaida@rambler.ru
ORCID iD: 0000-0002-6149-189X
Cand. Sci. (Med.)
Russian Federation, MoscowValentina S. Demidova
Vishnevsky National Medical Research Center of Surgery
Email: Osaida@rambler.ru
ORCID iD: 0000-0003-3187-4408
D. Sci. (Biol.)
Russian Federation, MoscowAlexandr A. Ushakov
Vishnevsky National Medical Research Center of Surgery
Email: Osaida@rambler.ru
ORCID iD: 0000-0002-1858-9744
Surgeon
Russian Federation, MoscowSamera D. Magomedova
Vishnevsky National Medical Research Center of Surgery
Email: Osaida@rambler.ru
ORCID iD: 0000-0002-7068-7421
Surgeon
Russian Federation, MoscowValery A. Mitish
Vishnevsky National Medical Research Center of Surgery; Research Institute of Emergency Pediatric Surgery and Traumatology; People’s Friendship University of Russia (RUDN University)
Email: Osaida@rambler.ru
ORCID iD: 0000-0001-6411-0709
Cand. Sci. (Med.)
Russian Federation, Moscow; Moscow; MoscowAlexey V. Kuprin
Vishnevsky National Medical Research Center of Surgery
Email: Osaida@rambler.ru
ORCID iD: 0000-0002-5017-9745
Cand. Sci. (Med.)
Russian Federation, MoscowElena I. Bozheva
Vishnevsky National Medical Research Center of Surgery
Email: Osaida@rambler.ru
ORCID iD: 0000-0003-2126-8885
Surgeon
Russian Federation, MoscowReferences
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