It is known that use of indirect anticoagulants (IAC) is the main method of treatment and prevention of thrombosis and thromboembolism in patients. Bleeding is the most important and dangerous complication of treatment with indirect anticoagulants. The incidence of bleeding during treatment IAC is 0.9 to 2.7 %, fatal bleeding constitutes 0.07 to 0.7 %, and hemorrhagic strokes account for 2 % of all bleeding. Therefore, the aim of our study was to evaluate quality of therapy with indirect anticoagulants of patients observed in the Northern Branch of the Hematology Research Center (HRC) in Arkhangelsk. According to the results of our study, frequency of hemorrhagic complications (GC) against long-term treatment of NAC was 7.8 % (95 % CI: 7.8 - 9.4) (n = 94), fatal bleeding as a hemorrhagic stroke constituted 0.1 % during 2.5 years of observation. The number of patients who achieved therapeutic hypocoagulation exceeded 60 % (n = 721). Such factors as taking Cordarone (p = 0.019), use of generic coumadin Russia (p = 0.05), ambulatory monitoring of the international normalized ratio (INR) (p = 0.028) as well as dosages of NAC influenced hemorrhage progression statistically significantly, the main factors reflected in bleeding and level of anticoagulation (INR less than 1.6) were the dose of NAC (p = 0.004) as well as control of the INR (p = 0.001). Taking into account the main factors influencing the level of anticoagulation, it is possible to reduce the number of bleeding cases and prediction of NAC doses. This approach will improve commitment to the NAC therapy of different specialists and enhance quality of patients’ life.

Hipergomocystenemia (HHC) is a significant risk factor for cardiovascular deseases. According to research in HHC incidence of acute myocardial infarction (AMI) increases by 3-4 times. There are hereditary and acquired causes of HHC. One of the reasons is the presence of inherited genetic polymorphisms in the MTHFR gene. According to research conducted by us, the level of homocysteine (HC) plasma at the time of admission was higher than the reference values in 75 % of cases (95 % CI: 60-86). On the 14th day of flow above the AMI level of HC reference values was observed in 73 % (95 % CI: 57-84) cases. The level of HC in patients with homozygous MTHFR gene polymorphism was significantly higher than in patients with heterozygous polymorphism, or without it on the first day of flow of AMI (p = 0.028), and on the 14th day course of acute myocardial infarction (p = 0.001.) In assessment of the long-term outcome after coronary flow AMI endpoints (development of re-infarction, unstable angina, stroke, repeat revascularization, death from CHD), there has been established a clear correlation between the presence of genetic polymorphisms in the MTHFR gene and the development of re-infarction (p = 0.04), the need to repeat revascularization (p = 0.003), the development of unstable angina (p = 0.001). In patients with homozygous polymorphism in the gene encoding MTHFR, re-infarction occurred more frequently (p = 0.021). These data suggest HHC, as one of the most important risk factors for AMI, as well as a higher level of HHC and more severe course of acute myocardial infarction in patients with the presence of polymorphisms in the MTHFR gene.