Effective prevention of thromboembolism is essential for patients with mechanical prosthetic heart valves. For this group of patients, vitamin K antagonists (VKAs) remain the drug group of choice despite the widespread use of new anticoagulants in other diseases. As a consequence, warfarin resistance remains a serious challenge for physicians. The current report describes a 65-year-old male patient that had a mechanical prosthetic aortic valve implanted due to severe aortic insufficiency after infective endocarditis. Despite consistent increases in his warfarin dose, the level of international normalized ratio (INR) remained very low. The patient was considered to have warfarin resistance. Warfarin was successfully replaced by another VKA, acenocoumarol, which resulted in a stable INR observed over 1 year of follow-up. Achieving the target INR in patients with mechanical prosthetic heart valves using VKAs is the main goal of thromboprophylaxis. Although the genetic changes that cause warfarin resistance are understood, the options to overcome these pharmacogenetic issues remain limited. Based on the success with this current patient, physicians with similar patients with warfarin resistance might wish to consider replacing warfarin with acenocoumarol.

the prevalence of kidney stone disease (KSD) and osteoporosis (OP) increases every year. In the prevention of osteoporosis, it is important to consume a sufficient amount of calcium-rich foods in the daily diet, as well as the use of calcium. One of the important reasons for the insufficient use of calcium-containing products and medicines is the anxiety not only of patients, but, very importantly, of doctors as much as possible. This has serious justification, as nephrolithiasis occurs in approximately 5% of the population, and the risk of developing kidney stones during life is 8-10%. It is believed that secondary hyperparathyroidism, which is caused by hypocalcemia due to insufficient consumption of calcium-containing products and impaired renal function, leads to increased bone resorption, formation of kidney stone disease. It is important to consider that against the background of hypertensive, atherosclerotic kidney disease, tubulo-interstitial lesions of the kidneys with decreasing glomerular filtration rate decreases the synthesis of 1α-hydroxylase - an enzyme by which 25-hydroxycholecalciferol (25 (OH) active D3, calcium) form of vitamin D3–1.25 dihydroxycholecalciferol (1.25 (OH) 2D3, calcitriol - D-hormone) and secondary hyperparathyroidism develops. In this case, the purpose of correction along with the treatment of urolithiasis (spa treatment, given the attendance of the presence of KSD, to carry out the distance lithotripsy), intake of active metabolites of vitamin D (should be started with low doses, independent of the initial PTH concentration, and then titrated based on the PTH response) conducting X-ray densitometry.

Introduction. The problem of cardiovascular morbidity and mortality remains an urgent issue of modern medicine, and arterial stiffness is its independent predictor. Lively discussions about the correct approach to the prevention and treatment of comorbid conditions – increased vascular stiffness as an influential factor of the cardiovascular events and decreased bone mineral density (osteoporosis), primarily arise against the background of the need and safety of calcium and vitamin D supplements. The purpose was to search for literature data as for possible common pathogenetic links in the progression of arterial stiffness and the development of osteoporosis in order to assess the safety of the use of drugs to prevent osteoporotic fractures. Results. Analysis of literature sourses had showed that possible osteogenic factors affecting arterial stiffness may be: secondary hyperparathyroidism, disbalance of the RANK/RANKL/OPG system, inhibition of vitamin K-dependent matrix proteins (Gla-protein), osteopontin, etc. Conclusions. Today, there are many hypotheses confirming the possible influence of osteogenic factors on vascular stiffness and arterial calcification. Therefore, the search for sensitive markers and the development of screening protocols for the patients with risk factors for both osteoporosis and vascular changes are extremely relevant. A special issue is the possibility of using monotherapy for these comorbid pathologies, which can safely and efficiently influence the prevention of complications – both low-energy osteoporotic fractures and cardiovascular catastrophes. This will be the focus of our further research.

Arteritis Takayasu (AT) belongs to the group of systemic vasculitis with a predominant lesion of vessels of large diameter. This disease is characterized by granulomatous inflammation of the aorta and its main branches. Complications of AT can be myocardial infarction, strokes, heart failure, which develop in young people with intact vessels. AT is a difficult for diagnosis and treatment disease. And, since its progression can lead to a fatal outcome, timely diagnosis and adequate therapy improves prognosis. Therefore, the presented clinical case may be of interest to clinicians.

Епідеміологічні докази взаємозв’язку розвитку остеопорозу та серцево-судинних захворювань в менопаузі активно дискутуються. Метою дослідження було визначення змін структурно-функціонального стану кісткової системи, рівня остеопротегерину в жінок з ішемічною хворобою серця в постменопаузі.Проведено обстеження 148 пацієнток у постменопаузі, їх розподілено на групи залежно від наявності ішемічної хвороби та остеопорозу (середній вік 63,5 ± 5,9 року, тривалість постменопаузи в середньому — 6,10 ± 0,65 року). Усім було проведено денситометричне обстеження, визначення маркерів резорбції та формування кісток, остеопротегерину. Результати показали, що в пацієнток у постменопаузі з ішемічною хворобою серця при поєднанні з остеопорозом було визначено більш значне зниження показників Т-індексу, рівнів остеокальцину та остеопротегерину.