Liver cirrhosis is accompanied by complex hemostatic disorders with an increase in the risk of both hemorrhagic and thrombotic complications. Reduced coagulation protein synthesis, such as factors II, VII, IX, X and thrombocytopenia are associated with an increased risk of bleeding. Reducing the synthesis of such anticoagulants as protein C, protein S, antithrombin III is accompanied by increased generation of thrombin, which leads to procoagulant status, increased risk of venous thrombosis, pulmonary embolism, and portal vein thrombosis. Activation of the coagulation cascade increases the risk of thrombosis, and also plays an important role in liver damage, contributing to the progression of fibrosis. Cirrhosis increases the risk of thromboembolic complications of atrial fibrillation.Anticoagulants are necessary for the prevention of thrombosis and thromboembolic complications. However, there are no large prospective studies. There is insufficient data on the safety of anticoagulant therapy in cirrhosis. There are difficulties in monitoring anticoagulation in the application of vitamin K antagonists and low molecular weight heparins.The review presents the available data on the use of warfarin, unfractionated heparin, low molecular weight heparins and direct oral anticoagulants in patients with liver cirrhosis, indicating the need for prevention of venous thrombosis in patients with risk factors, the possibility of preventing decompensation of cirrhosis, reducing the frequency of cardioembolic strokes in patients with atrial fibrillation.
Primary aldosteronism is characterized by autonomous hypersecretion of aldosterone which is not associated with acti-vation of the renin-angiotensin system. Activation of mineralocorticoid receptors causes hypertension, hypokalemia, and increases the risk of cardiovascular and kidney disease and death. Present knowledge suggests that the prevalence of primary aldosteronism is much higher than they previously thought, and that milder forms of renin-independent aldosterone secretion are not detected. The review discusses the features of screening, the reasons for the low detection of the disease, the groups of patients with a high probability of primary aldosteronism, and methodological approaches to evaluating the screening results. Attention is drawn to the necessity of genetic testing in young patients with a family history of primary aldosteronism. Various methods for studying renin and aldosterone, the influence of the choice of method on the assessment of the aldosterone-renin ratio, and the reasons for the erroneous interpre-tation of the results are discussed. The indications for confirmatory tests and evaluation of their results are considered. The necessity of identifying unilateral or bilateral lesions of the adrenal glands for determining the choice of treat-ment method is substantiated. The capabilities of computed tomography and comparative selective blood sampling from the adrenal veins in revealing unilateral lesion are compared. The importance of timely diagnosis of primary aldo-steronism and its targeted treatment to reduce the risk of cardiovascular complications associated with aldosterone hypersecretion is emphasized.
A clinical case of radiation induced heart disease in 43 year old female patient after 15 years since radiation therapy of Hodgkin’s lymphoma. During clinical and instrumental investigation, a post-radiation constrictive pericarditis was found, comorbid with lesion of aortic, mitral and tricuspid valves. Surgical treatment of pericarditis was applied. Morphology confirmed the diagnosis.
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