Цитата:
Сообщение от Annabella
был больной с тромбофлебитом (у нас их много почему-то)...
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Это вот фрагмент, почему у ваших пациентов может быть повышен риск тромбоза:
Robson et al. research study suggested that elevated plasma fibrinogen, impaired fibrinolysis coupled with decreased levels of antithrombin III and reactive thrombocytosis appeared to favour the development of DVT in pulmonary TB [11].
Similar observations were made by Turken et al. in a case-control study, regarding these haemostatic disturbances in 45 patients with active pulmonary TB. Moreover, it stated that these changes improved with ATT within 4 weeks [10]. On the other hand, there is also data supporting a relationship between this prothrombotic phase and a high frequency of antiphospholipid antibodies and protein S deficiency [3].
However, thrombosis can also result from venous compression by lymph nodes in ganglionar forms of TB, as retroperitoneal adenopathies may cause inferior vena cava thrombosis in the absence of any haemostatic abnormalities [6].
These haemostatic changes improve during the first month of ATT [10] and for this reason, it should be immediately started in addition to anticoagulant therapy. Frequently, a higher dose of warfarin is necessary to achieve therapeutic INR levels, because of rifampin effects on cytochrome P450 [13]. Additionally, this drug may also contribute to the hypercoagulable state by decreasing production and increasing clearance of anticoagulant hepatic proteins. Consequently, the initial phase of treatment may result in a higher risk for development of DVT [9].
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