Hemorrhagic complications of anticoagulant therapy. Hemorrhagic syndrome caused by heparin Hemorrhagic complications associated with heparin therapy when used

Heparin, if used incorrectly and insufficiently controlled, can cause both hemorrhagic and thrombotic complications.

Heparin-induced bleeding can be divided into local, occurring at the injection sites, and generalized, associated with its effect on the entire hemostatic system.

Local hemorrhages are formed only with subcutaneous or intramuscular injection of the drug, and with intravenous they are not formed (except for cases of through vein piercing).

With intramuscular injections of the drug, the resulting hemorrhages due to the greater blood supply (vascularization) of the tissue are much larger (although less noticeable) than with subcutaneous ones.

The absorption of heparin from the muscle occurs 2 times faster than from the subcutaneous tissue, but with the formation of a hematoma in the injection area, it slows down sharply. It is very difficult to dose the drug and create controlled hypocoagulation when injected intramuscularly.

Subcutaneous administration of heparin is quite common in the treatment of thrombosis, as well as in the treatment of disseminated intravascular coagulation syndromes.

There is an individual intolerance to heparin: subcutaneous administration of the drug is accompanied by acute pain, the development of hemorrhages and even necrosis of the skin above them.

The generalized hemorrhagic effect of heparin is caused either by its overdose, or by unrecognized background hemostasis disorders, in which the administration of heparin is contraindicated.

The dosage of heparin in units per kilogram of body weight is purely indicative, suitable only for calculating the initial test dose.

In some cases, it is useful to additionally introduce hematopreparations containing antithrombin III into the body (for example, frozen plasma), or to remove acute phase proteins and paraproteins from the patient's blood (plasmapheresis). These effects restore the sensitivity of the hemostasis system to heparin, with them it is no longer possible to increase the dose of the drug.

With prolonged intravenous administration of heparin, it is easier to control its hypocoagulation effect. With good monitoring supervision, this route of administration gives the least number of hemorrhagic complications. Intravenous injections of heparin every 4 hours are much less effective and more dangerous when there are large changes in hemocoagulation - from almost complete incoagulability of blood to hypercoagulation (the half-life of heparin from the circulation is 70-100 minutes, and by the end of 3-4 hours it almost completely absent in the blood). Hemorrhagic and thrombotic complications with such intermittent administration are 7 times more frequent than with prolonged administration. To mitigate these drops, combined methods of administration of the drug (subcutaneous and intravenous) are used.

Adequacy of control over the action of heparin by global (whole blood clotting time, thromboelastography, activated partial thromboplastin time, autocoagulation test) and partial methods is of decisive importance.

Hemorrhagic syndrome during treatment with heparin occurs much less frequently and is, as a rule, much easier than with treatment with indirect anticoagulants. This is due to the fact that heparin does not disrupt the synthesis of coagulation factors, but only blocks their activated forms, acts for a short time and is quickly eliminated from the bloodstream.

This drug poses a serious danger in patients with existing, although perhaps undetected, bleeding or in other processes (vascular, destructive), easily complicated by bleeding. For example, it can provoke profuse bleeding in case of peptic ulcer disease, erosive gastritis, acute erosions and ulcers.

Quite often, the use of heparin provokes pulmonary bleeding in patients with bronchiectasis, in case of stagnation in the pulmonary circulation, bleeding from the veins of the esophagus in cirrhosis of the liver, and cerebral hemorrhage in patients with essential hypertension.

Extensive and multiple hemorrhages are observed mainly with a very significant overdose of heparin or with a secondary decrease in the patient's platelet count in the blood (some patients develop the so-called heparin thrombocytopenia).

A decrease in the dose of heparin or its cancellation quickly normalizes hemostasis; in addition, you can enter a small dose of protamine sulfate, a drug that inhibits heparin. For every 100 units of heparin injected over the last 4 hours, 0.5-1 mg of protamine sulfate in a 1% solution is injected intravenously. If the effect was insufficient, then

additionally introduce another 0.25 mg of the drug. An overdose of protamine sulfate should be avoided, since when administered excessively, it itself causes hypocoagulation, which doctors often mistakenly interpret as heparin.

Typical injection sites are the outer shoulder. The outer surface of the thigh. Subscapular region. The anterior abdominal wall.

Possible complications:

Infiltration is the most common complication of subcutaneous and intramuscular injections. It is characterized by the formation of a seal at the injection site, which is easily detected by palpation.

An allergic reaction is an increased sensitivity of the body to the introduction of a particular drug. It manifests itself as a rash, edema, itching, fever.

An abscess is a purulent inflammation of soft tissues with the formation of a cavity filled with pus.

Anaphylactic shock - (allergic reaction) develops within a few seconds or minutes from the moment the drug is administered.

Hematoma.

Medical embolism (Greek Embolia - throw-in) is a blockage of a vessel with a medicinal solution, for example, with the introduction of oil solutions.

Features of the use of heparin.

Heparin is a direct anticoagulant: it inhibits the formation of thrombin, prevents blood clotting.

Doses are set individually: 5,000 units after 4-6 hours are injected intravenously or intramuscularly, it is possible s / c deeply, in the epigastric region - to stimulate the production of endogenous heparin.

Complications. When using heparin, hemorrhagic complications may occur:

* hematuria (blood in

* joint hemorrhage,

gastrointestinal bleeding,

* hematomas at the injection site s / c and i / m.

Allergic reactions are possible:

* urticaria,

* lacrimation.

In case of an overdose of heparin, 5 ml of a 1% solution of protamine sulfate, 1-2 ml of dicinone intravenously or intramuscularly are administered intravenously as its antagonist.

single use 1-2 ml syringe; needle 20 mm, cross-section 0.4 mm.

Excessive doses of drugs, especially in the case of impaired renal function, play a decisive role, since the risk of bleeding increases exponentially with decreasing creatinine clearance (Table 16.11).

Table 16.11. Multivariate model for extensive bleeding in patients with myocardial infarction without ST-segment elevation

Specified Risk Ratio (OR)

Age (10 years increase)

History of bleeding

Mean blood pressure (increase by 20 mm Hg)

Low molecular weight heparin only

Low molecular weight heparin and unfractionated heparin

Glycoprotein IIb / IIIa inhibitors only

Glycoprotein IIb / IIIa inhibitors and thrombolytics

Class IV inotropic agents

Right heart catheterization

It has been shown that massive bleeding is associated with a fourfold increase in the risk of death, a fivefold increase in the risk of recurrence of acute myocardial infarction, and is also accompanied by a threefold increase in the risk of stroke within 30 days. Several factors leading to a worse prognosis were discussed. Withdrawal of antiplatelet and antithrombotic drugs can play an important role, and prothrombotic and pro-inflammatory consequences of bleeding can also occur.

Hemorrhagic complications when prescribing indirect anticoagulants

Hemorrhagic complications

• violation of cardiac and respiratory activity;
• the need for surgical or angiographic intervention;
• serious blood loss with a decrease in SBP less than 90 mm Hg, hematocrit less than 20%, or requiring a transfusion of at least 3 doses of erythromass;
• development of MI, stroke, blindness or hemothorax on the background of bleeding.

• Gastrointestinal bleeding, obvious or latent, revealed by endosconic examination;
• severe hematuria lasting more than 2 days or requiring cystoscopy or intravenous urography;
• hemoptysis;
• bleeding that required a transfusion of at least 2 doses of erythromass.

There are the following types of drug interactions.

The general principles of prescribing medicines for the elderly do not differ from those for other age groups, but the use of the drug in lower doses is usually required.

Vasopressor drugs become the drugs of choice in situations where attempts to increase the stroke volume of blood by using drugs with a positive inotropic effect and correction of fluid volumes do not lead to the maintenance of adequate organ perfusion. As a rule, vasopressors are used in rhea.

Video about Atlantida Spa Hotel, Rogaska Slatina, Slovenia

Only a doctor diagnoses and prescribes treatment in a face-to-face consultation.

Scientific and medical news about the treatment and prevention of diseases of adults and children.

Foreign clinics, hospitals and resorts - examination and rehabilitation abroad.

When using materials from the site, the active reference is obligatory.

Hemorrhages - what is it? Types, causes and treatment. Subcutaneous hemorrhages. Bruise after injection

Hemorrhages are hemorrhages in different parts of the body, differing in severity. The reasons for their occurrence include internal and external pathologies of the body. Often hemorrhages are manifested by the accumulation of blood in the tissues, but sometimes the blood comes out.

Causes of hemorrhages

In fact, these are complications after injections, but this is not always the case.

Very often, the cause of bleeding lies in the high permeability of the vessel walls or their violation. The integrity of the vessel is violated in the event of a mechanical injury. And the reasons for the leakage of blood through the vessel wall are as follows: dermatological diseases, for example, chronic dermatosis or psoriasis; acquired pathologies of the circulatory system (disseminated intravascular coagulation syndrome, hemorrhagic vasculitis or bleeding disorders, thrombocytopathy); congenital genetic pathology, for example, hemophilia. Hemorrhages of almost all types are closely associated with the use of hormonal drugs, depression or psychological stress.

Hemorrhages are hemorrhages, which are divided into the following types, depending on the causes of their occurrence:

• bleeding caused by violations of the integrity of the walls of a blood vessel due to exposure to an infection or a chemical;
• bleeding resulting from the fact that there was a decrease in the thickness of the walls of blood vessels;
• bleeding resulting from mechanical damage to blood vessels. This is how a bruise appears after an injection.

Depending on the location, the types of hemorrhages can be:

• capillary (bleeding from small vessels);
• internal (hemorrhages in tissues and organs);
• venous (bleeding from damaged veins);
• external;
• arterial (intense bleeding from the arteries);
• parenchymal (bleeding of the tissues that form the organs).

The main symptoms of internal bleeding

How hemorrhages appear depends on the location and type of bleeding. Although external bleeding is easily detected, internal bleeding is often not felt. Internal bleeding can be detected by several specific symptoms, for example:

• to lower blood pressure;
• tachycardia;
• drowsiness and apathy;
• unnatural pallor of the skin;
• fainting and dizziness;
• general malaise.

This is how damage to large vessels manifests itself.

These symptoms are common to internal bleeding, but there is also a list of symptoms that are characteristic of different types of hemorrhages.

Hemorrhage at the injection site. What is it?

Often, complications can occur during the course of therapy after the injection. Hemorrhages that occur after intramuscular injection are called local bleeding, which occurs due to tissue damage.

Usually, over time, the blood stain heals on its own, but sometimes a specialist may prescribe water-soluble drugs. Intravenous injections can cause bleeding when the vessel is pierced through and may not be as pronounced as with intramuscular injections.

Causes of skin hemorrhages

Hemorrhages are a pathology that occurs on the skin due to the leakage of blood into the skin tissue through the walls of blood vessels or hemorrhages. They look like blood spots on the skin. Throughout the time, hemorrhages tend to change color, ranging from bright red to greenish-yellow. There is no special treatment in such cases, these spots dissolve on their own over time. Especially complications after injections.

Cutaneous hemorrhages also include hematomas.

Subcutaneous hematomas form under the skin layer and look more like bruises. They can be formed due to various diseases (lupus erythematosus, scarlet fever, syphilis, tuberculosis) or trauma. Patients with hemophilia often suffer from such hematomas. Spots on the skin of such people occur with any damage to the vessels. There are three degrees of subcutaneous hematomas.

Signs of mild hematoma appear gradually, about a day after the injury, and with all this, it does not affect the functioning of the organ on which it was formed. If there are painful sensations, then they are mild. And also if the resulting hematoma is not complicated, then it will go away on its own without treatment. The formation of a moderate hematoma occurs after three to four hours, and such a hematoma can partially disrupt the work of the organ on which it appeared.

Edema of soft tissues and slight swelling are formed around such hematomas. It is necessary to apply cold and a pressure bandage to the hematoma, and then seek medical help from a doctor. Serious injury can cause severe hematoma that can disrupt organ function. Hemorrhage forms quickly enough, within an hour it will already be possible to notice a blue spot that has appeared. Basically, this is a subcutaneous hematoma visible to the naked eye. After a while, such a hematoma may intensify and develop into an intramuscular hematoma, and then the patient will experience painful sensations in the muscles and numbness. With this type of hematoma, it is imperative to consult a doctor for a follow-up treatment. If not treated, a severe hematoma can seriously harm the human body. And just a bruise after an injection is rather unpleasant.

What is the danger of hemorrhage?

The severity of such an insidious phenomenon as hemorrhage depends directly on the area of ​​damage and how intense the bleeding is. Despite the fact that usually such small injuries resolve on their own, exceptions occur, which are characterized by suppuration of the site of hemorrhage and the need for surgical intervention. In some cases, hemorrhages lead to tissue destruction, which also leads to serious consequences. In such cases, hemorrhages in the heart, brain and lungs are considered the most dangerous. Hemorrhages of the eye also occur.

Which specialist should I contact?

No matter how complex the nature of the hemorrhage, it is very important to determine the cause of its occurrence as soon as possible. A local therapist and highly specialized doctors, such as an infectious disease specialist, hematologist, dermatologist or endocrinologist, will help to solve this problem.

Diagnostics

After the examination, a specialist can make an initial diagnosis, but it will still be necessary to pass a coagulogram (a general blood test to study it for coagulability) for an accurate diagnosis. In some cases, it is possible to prescribe a bacteriological blood test, on the basis of which the issue of therapy will be decided.

First aid for bleeding

It was previously found that hemorrhages are hemorrhages from blood vessels due to their damage. Therefore, the first thing that a person can do with a slight hemorrhage is to apply cold to the injured area, which will reduce the intensity of bleeding. Follow-up care should be taken considering the type of hemorrhage. It is quite easy to determine venous bleeding by the color of the blood, which will have a burgundy or bright red color, and by a continuous but slow flow. With such an injury, in order to carry out first aid, you need to apply a tourniquet below the wound and a tight bandage. A mandatory point is the time stamp when the tourniquet was applied. With a small wound, a bandage is wrapped around it, since the venous vessels can self-tighten and subside.

Arterial bleeding

Arterial bleeding from venous bleeding differs in that bright red blood will gush from the wound with a fountain. In this case, you need to immediately apply a tourniquet, because if the bleeding is not stopped, the person may die. In this case, a tourniquet is applied above the wound, and a bandage is applied to it. The tourniquet is left for one or two hours, and after this time it needs to be lowered a little for 5 minutes in order for the blood to circulate along the limb, otherwise toxins will accumulate in the stagnant blood, and after removing the tourniquet, a person may die of shock.

If we talk about such a phenomenon as subcutaneous hemorrhages, then they do not pose a serious danger, if such bleeding is not in a person with poor clotting. Then you need to bandage and treat the wound. Such bleeding can be stopped by means of modern hemostatic agents such as "Hemostop" and "Celox". Powder granules help coagulate blood, making it appear like a jelly, but it can be difficult to heal such a wound. Internal bleeding is one of the most severe, in which case it is necessary to see a doctor. At the scene of the accident, the victim can only apply cold and immediately send him to the hospital or call an ambulance. Until the doctors arrive, the patient should be at rest and practically motionless.

How to get rid of hemorrhages?

Hemorrhages are treated after a thorough examination. When prescribing treatment and establishing a diagnosis, the doctor needs to take into account that some of the forms of hemorrhages lead to the development of complications. This is the reason why it is necessary to consult a doctor at every stage of treatment. If complications arise, inflammatory processes can begin, which can sometimes be fatal. It is necessary to find out the exact condition of the patient, the clinical form of hemorrhage and the tendency to complications in order to carry out the correct treatment. For example, minor injuries do not require medication. But if the cutaneous hemorrhage is large, then usually treatment is used with the application of "Troxevasin" or "Heparin" ointment on the injured area 2 times a day.

We examined what hemorrhages are. Their causes and treatment are also described.

Complication of hemorrhagic vasculitis

What is hemorrhagic vasculitis, causes, symptoms, complications

Hemorrhagic vasculitis (Shenlein-Henoch disease, capillary toxicosis, anaphylactic purpura) is a hemorrhagic vasopathy caused by microthrombovasculitis, mainly of the vessels of the skin, large joints, abdominal cavity and kidneys.

Causes of hemorrhagic vasculitis

Hemorrhagic vasculitis occurs after an infection (tonsillitis, pharyngitis, influenza), the administration of vaccines, serums, cooling, due to drug intolerance as a nonspecific hyperergic vascular reaction. It is more common in children and adolescents than in adults.

A single immunoallergic pathogenesis of the disease is associated with the effect on the vessels of circulating immune complexes, leading to damage to the endothelium, plasmorrhages, necrosis of the vascular wall and disseminated intravascular coagulation (thrombohemorrhages).

Symptoms of hemorrhagic vasculitis

The detailed clinical picture of the disease is usually characterized by symptoms: high body temperature (degrees), pinpoint, sometimes merging hemorrhagic skin rashes, arthralgia or arthritis of large joints. abdominal and renal syndrome. The severity of symptoms in different patients is different.

Skin rashes are predominantly located symmetrically on the extensor surfaces of the limbs, have an erythematous, papular or urticarial character, later becoming hemorrhagic, accompanied by itching, sometimes soreness. Rashes can appear in the lower abdomen, on the buttocks, and torso. The lower extremities are more often affected.

Skin changes are often accompanied by articular syndrome. manifested by joint swelling, soreness and limited mobility. Some patients have skin manifestations over the affected joint.

Abdominal syndrome can occur in parallel with hemorrhagic skin rashes, often has an independent course, manifested by suddenly developed intestinal colic, vomiting mixed with blood, bloody stools. There is bloating, tenderness on palpation, and some tension in the abdominal wall. Pain can be localized around the navel, simulate appendicitis, perforation, intussusception. Patients, as a rule, lie on their side, pressing their legs to the stomach, rushing about.

Complications of hemorrhagic vasculitis

A severe complication of hemorrhagic vasculitis is kidney damage of the type of diffuse hypertensive or mixed glomerulonephritis.

In the analysis of blood - leukocytosis, a shift to the left, especially in the abdominal form. In the hemostasiogram - changes corresponding to I and II stages of DIC, with massive bleeding - stage III.

As a syndrome, hemorrhagic vasculitis occurs in infective endocarditis, collagenoses, liver diseases, tuberculosis, drug disease, food allergies, etc. It can be acute, in the form of fulminant purpura, or chronically relapse.

"What is hemorrhagic vasculitis, causes, symptoms, complications" and other articles from the section Changes in blood counts

Hemorrhagic vasculitis and abdominal pain

Hemorrhagic vasculitis (Schönlein-Henoch purpura) is most common in young children, although it sometimes occurs in adults. Hemorrhagic vasculitis is a disease of unknown etiology, although, most likely, its development is associated with autoimmune disorders of the IgA complex and damage to small vessels. Hemorrhagic vasculitis is often accompanied by abdominal pain, petechial rashes on the skin, which gradually merge and form extensive palpable hemorrhages (which, in fact, are called purpura), as well as small hemorrhages in various tissues, most often in the joints and kidneys. In many patients, approximately 2-3 weeks before the onset of clinical symptoms, acute upper respiratory tract infections are noted, which are a kind of harbingers of the disease. Hemorrhagic vasculitis is self-limiting and is associated with very low mortality. Deaths from the disease are most often associated with severe kidney damage. Cutaneous manifestations occur in almost all patients with hemorrhagic vasculitis, although sometimes they may not occur from the very onset of the disease. The rash usually occurs on the buttocks and lower extremities. The second most frequent clinical symptom of hemorrhagic vasculitis, which occurs in approximately 85% of patients, is arthralgia. In this case, one joint is most often affected (the so-called monoarticular lesion) and most often it is the knee and ankle joints. Orchitis occurs in 2-38% of men with hemorrhagic vasculitis. In this case, edema and hemorrhage in the testicle develops. The clinical picture of the disease in such cases resembles testicular torsion. Symptoms from the gastrointestinal tract in patients with hemorrhagic vasculitis are quite common, in about 75% of cases, although complications requiring surgery are rare - in 2-6% of patients. The disease is often accompanied by nausea and vomiting. Abdominal pain often occurs before purpura, and in such cases the clinical picture resembles the clinical picture of acute appendicitis, exacerbation of gastric or duodenal ulcer or Crohn's disease (Crohn). Sometimes patients with hemorrhagic vasculitis perform unnecessary surgical interventions. Abdominal pain in patients with hemorrhagic vasculitis usually begins suddenly and is severe, cramping in nature. They are sometimes accompanied by bloody diarrhea. Such a clinical picture often leads doctors to think about the possible development of intussusception, which is the most common surgical complication of hemorrhagic vasculitis. In patients with hemorrhagic vasculitis, perforation of the gastrointestinal tract, most often of the stomach or small intestine, may also occur. Sometimes bowel perforation develops as a complication of intussusception. Submucosal and subserous hemorrhages and swelling of the bowel wall, which develop as a result of vasculitis, often cause abdominal pain. In laboratory studies, thrombocytosis is detected in almost 90% of patients with hemorrhagic vasculitis. A petechial rash most often helps the clinician to make a correct diagnosis, since in its absence the clinical picture in such patients often resembles the clinical picture of acute surgical diseases of the abdominal organs. Laparotomy in patients with hemorrhagic vasculitis reveals that the wall of the small intestine is edematous and reddish in color due to multiple submucosal hemorrhages.

EFFICIENCY OF FRESH FROZEN PLASMA APPLICATION IN TREATMENT OF HEMORRHAGIC VASCULITIS

The lightest AR-15 rifle was assembled in the USA

Experts from the American gun store Guns & Tactics managed to assemble the lightest version of the AR-15 self-loading rifle. The resulting weapon weighs only 4.5 pounds (2.04 kilograms). For comparison, the mass of a standard production AR-15 averages 3.1 kilograms, depending on the manufacturer and version.

Robot fingers with variable stiffness are created

Researchers at the Technical University of Berlin have developed a variable stiffness actuator. The results of the work were demonstrated at the ICRA 2015 conference, the text of the report was published on the university website.

What is hemorrhagic complications?

Why is chickenpox dangerous? | Complications

Chickenpox or chickenpox is a highly contagious infectious disease caused by the herpes virus type 3 Varicella Zoster. Transmitted: by airborne droplets; by contact; from a pregnant fetus. The disease manifests itself with fever, intoxication and the appearance on the skin, including on the scalp, on the mucous membranes of specific vesicular rashes (stages of the rash - spot, vesicle, crust). Varicella Zoster virus affects mainly children, more often at the age of 4-6.

APS - complications after childbirth. A child from birth to one year

My diagnosis is antiphospholipid syndrome. All pregnancy on prednisone. And now a month after childbirth, a complication - hemorrhagic cystitis - hemorrhage in the bladder. Terrible! tell me, please, if you have experience, was there anything you were treated with. (I took off the attack of no-spa and that's it, I didn't drink anything else - I'm nursing). And most importantly - should we expect any more nasty things later? Maybe you know a good specialist? Thank you in advance. And I apologize in advance if I don't answer right away - you understand, feeding, etc.

What prophylaxis is carried out for hepatitis?

Hepatitis A, B, C, D are more common at the moment. Hepatitis A is considered the most infectious and easily transmitted. First of all, the patient must be isolated, provided with separate personal accessories and utensils. Hepatitis B, C and D are transmitted through the blood, as well as through any body secretions (saliva, semen, etc.). High risk of contracting hepatitis through blood.

There is also vaccination against hepatitis A, but it is not mandatory, at the request of the parents and the doctor's recommendation - before traveling to Asian countries, for example.

Hepatitis: how to detect the disease in time

Chronic hepatitis is often detected by chance: by the presence of an enlarged liver when examining a child in a polyclinic or during a preventive examination of contact children in the outbreak of viral hepatitis A. Upon examination and further examination of children with an enlarged liver, an increase in the level of transaminases (ALT, AST), the presence of markers of viral hepatitis are found , changes in ultrasound. As a rule, in such cases, chronic hepatitis is a consequence of erased and anicteric forms of the disease, when acute.

We treat ARVI in children: work on mistakes

While treating a child's cold, mothers may come across erroneous recommendations that not only will not help the baby recover, but sometimes even are dangerous to his health. We propose to consider the most common mistakes and misconceptions in the treatment of respiratory infections in children. "The temperature must be brought down urgently." An increase in body temperature is a protective reaction of the child's body, the purpose of which is to destroy the infection. Knocking down the temperature already at.

In our case (adenoids), the drug helped very well, after a week the daughter began to breathe well at night, her nose stopped pawing.

What are the syndromes of hepatitis manifestation?

There are the main clinical syndromes of hepatitis: hepatomegaly, asthenovegetative syndrome, dyspeptic syndrome, icteric syndrome, hemorrhagic, enlarged spleen. Hepatomegaly, the main syndrome of chronic hepatitis, may be the only sign of hepatitis. With hepatomegaly, the liver is enlarged, painful on palpation, in most cases there is a uniform increase in the left and right lobes. Asthenovegetative syndrome is manifested by weakness and fatigue, emotional.

increased fatigue, nausea and stool disturbances can also accompany hepatitis.

Impact of viral hepatitis B on pregnancy?

The effect of viral hepatitis on the course of pregnancy depends on the degree of activity of the infectious process and the severity of liver damage at different stages of gestation. In the acute form of hepatitis, pregnant women must be hospitalized, regardless of the gestational age, for complex therapeutic measures aimed at reducing the severity of the manifestation of hepatitis and its effect on the body of the mother and fetus. As a therapeutic measure, antiviral therapy is prescribed, for example.

Flu shot - we protect ourselves from the flu in winter

Something about the elder's illness inspired me. I thought it was time for the flu. Are pregnant women getting flu shots? And after all this is such a disgusting infection and nafig we do not need now.

Diet for weight loss of Elena Malysheva.

Lena Malysheva is not only a TV presenter, but also a certified nutritionist. HER diets are popular all over the planet. Still, in reality, Lena Malysheva's diet is by no means a diet. This is what Malysheva herself says. Rather, it is the concept of nutrition, a style of life, which must be adhered to for a long time, and with the intention to be always slim and throughout life. However, for the comfort of all followers, this concept of nutrition is still referred to as a diet. Lena Malysheva's diet grants a chance for.

Girls, we were given a pair of whooping cough. Cough - parapertussis was coughing

Girls, we were given a pair of whooping cough. We have been coughing for 2 weeks already. But now the vomiting has also gone. They started drinking an antibiotic. Help someone with what they can. Who was sick with this. With our neurology, we only lacked whooping cough. And so he could vomit if he choked.

Your task now is to reduce the number of seizures to a minimum, notice what causes seizures in you and avoid these situations. Limit all types of activity (if possible), avoid bright lights, loud noises. The room in which the child should be quiet, even during the day you can curtain the windows, bother the child less, prevent outbursts of anger in him, you can even sacrifice educational principles at this time and go completely on the child's lead, just to be less nervous. Feed, drink in very small portions, but more often, no irritating food.

I don’t want to upset you, but complications occur mainly on the part of the respiratory system and on the part of the brain. But I want to please you mainly complications occur in infants (up to one year old). I do not want to scare anyone, personally I have not yet vaccinated the child against whooping cough (we had contraindications and we did it after a year), I did not go anywhere with the child. There are no vaccinations against parapertussis, but after a year it is no longer so dangerous.

Each paroxysm is a hypoxia of the brain (to one degree or another), even in children "without neurology", seizures can develop - often in infants, rarely in older children. I ask you again, do not be alarmed, you are already older, these complications are mainly in infants, but after severe paroxysms, hemorrhage in the brain, eyes, skin and mucous membranes may develop. I will not further describe all the horrors and what complications there are from the respiratory tract, but you must clearly understand what your efforts should be directed to - to reduce the frequency of paroxysms. In my opinion, you made all the appointments correctly, but you still need to consult with the treating neuropathologist, maybe something will tell you.

Hold on and get well quickly, your recovery stage will begin soon and it will be easier, the paroxysms will still remain, but they will not end with vomiting. Recover!

We really need a proven hematologist. Pediatric medicine

The child was diagnosed with hemorrhagic vasculitis. I read in the internet - I came to some confusion. need a consultation with a good specialist. A pediatrician from Semashko (an acquaintance) said that they had no good specialist.

Hematological Research Center of the Russian Academy of Medical Sciences

There is also a paid admission.

And yet - if you have been "diagnosed", then it is necessary not to consult, but to be treated. And in general, you should have been given an urgent referral to the hematology center.

Errors in the treatment of colds.

Unfortunately, most people underestimate a common illness such as the common cold, believing that it is caused by climate change. Meanwhile, cooling the body only temporarily weakens the immune system, making the body more receptive, which allows the virus to penetrate. Lovers of self-medication for colds make gross mistakes that can cause complications. The first and most common mistake is taking antibiotics when you have a cold. Antibiotics are antibacterial.

Vacuum extractor - http://conf.7ya.ru/fulltext-thread.aspx?cnf=care.

Who knows what it is, what are the consequences of the application and where can you read about it?

Caesarean then is no longer done, because the opening is complete and the head is already at the exit from the pelvis.

much better than forceps

complications are rare. inconvenience - the mother receives an episiotomy, they first cut the perineum with scissors, then sew it up, and the child gets a large subcutaneous hematoma on the head. which can bleed

of rare complications - subdural hematoma with neurological disorders.

mode after removal of adenoids - at sea after removal.

Hello everyone! In the near future, my daughter will have 4.5 g of adenoids removed. Dad is eager to take her to the Red Sea (Egypt) after the operation. But it seems to me that it is impossible to get on the plane after the operation. Or am I not right? What do the doctor's say?

a week - a calm home regime and you can't go to a hot bath, a month - minimizing contacts and no sports activities and you can't hang upside down, you can't fly on an airplane for two months and change the climate drastically.

but it is better to ask the surgeon who will operate and observe in the postoperative period. The doctor told us that the postoperative period is very individual and takes from two weeks to a couple of months.

Childbirth with pyelonephritis - childbirth with pyelonephritis

Childbirth with pyelonephritis During pregnancy, the load on the kidneys increases significantly, diseases appear that were previously asymptomatic. One of the most common diseases in obstetric practice is infectious and inflammatory diseases of the urinary tract (pyelonephritis, cystitis, urolithiasis). The combination of pregnancy and diseases of the urinary system is very often accompanied by a number of complications: - miscarriage (spontaneous miscarriages.

Who knows about the diagnosis - organic aciduria - organic.

Write what you know. If a child (girl) is 6 years old, they do a lot, there is progress, but there are problems too. To clarify the diagnosis, it is recommended to go to Moscow. Where, to whom, what complications, what to pay attention to? Maybe you know the name of the analysis in full and the addresses, attendance not only in Moscow.

Measles / rubella / mumps vaccine for allergy sufferers - measles vaccination.

Girls, good afternoon! Share your experience, pliz, would you do / give this vaccine to a child with allergies? Allergy to many products, the boy is 1.1 years old. We are not going to the garden in the next year, there will be a nanny. We are in the region, unfortunately, we cannot find a good immunologist, or just a pediatric immunologist. Allergy "shot" after 2 vaccinations with pentaxime at 5.5 months. Is it possible to get infected from freshly vaccinated children in a sandbox, for example, if you do not get vaccinated? I'm afraid of a pig especially, because.

About mumps - my husband was sick with mumps at the age of 28, got infected from his nephews, had orchitis as a complication. He has two children :), i.e. the mumps did not affect the ability to conceive.

Therefore, in your case, I would still wait with this vaccine, it is not clear what to expect from allergies :(

I think if this time you do it in accordance with all the rules, then the risk is small.

Against the background of antihistamines (three days before and three days after), on an empty stomach (if possible), drink a lot, diet a week after and five days before - everything lightens the load on the system. I still did an enema with mine before vaccinations. It helps too.

And also make a test (you can also at home) and if you are allergic to protein, tell your doctor. There are protein-free vaccine options.

Good afternoon everyone! I ask for advice from everyone who has encountered this disaster! My grandmother is 91 years old, she suffers from senile dementia (marasmus), physically grandmother is strong, she will give a head start to the young, but her head is in complete trouble, she does not recognize anyone, she confuses everything, constantly asks to let her go home (although she is in the house where she already lives 70 years old), does not sleep at night, becomes aggressive, it constantly seems to her that we want to poison her. kill. in general, complete horror. My grandmother lives in the village, of course she is the only one.

Why do children of the first days of life die? One of the most.

All 9 months, a baby is growing under your heart, which is surrounded not only by your love and affection, but also by reliable protection from the amniotic membranes and amniotic fluid. The fetal bladder forms an airtight reservoir with a sterile environment that protects the baby from infection. Normally, rupture of membranes and rupture of amniotic fluid occurs before childbirth (when the cervix is ​​fully open) or directly during childbirth. If the integrity of the bubble has been broken before, this is.

With a massive rupture, it is not difficult to diagnose. But, unfortunately, in almost half of the cases, doctors of even leading clinics doubt the diagnosis if they rely only on examination data and old research methods.

Ultrasound examination makes it possible to tell whether a woman has oligohydramnios or not. But the cause of low water can be not only rupture of the membranes, but also impaired renal function of the fetus and other conditions. On the other hand, there are cases when a small rupture of the membranes occurs against the background of polyhydramnios, for example, with kidney pathology of a pregnant woman. Ultrasound examination is an important method of monitoring the condition of a woman who has a premature rupture of the membranes, but does not answer the question of whether the membranes are intact.

Indeed, there is such a method for determining amniotic fluid, based on determining the acidity of the vaginal environment. This is called the nitrazine test or amniotest. Normally, the vaginal environment is acidic, and the amniotic fluid is neutral. Therefore, the ingress of amniotic fluid into the vagina leads to the fact that the acidity of the vaginal environment decreases. But, unfortunately, the acidity of the vaginal environment also decreases in other conditions, for example, with infection, urine, semen. Therefore, unfortunately, a test based on determining the acidity of the vagina gives a lot of both false positive and false negative results.

Vaginal discharge containing fetal water, when applied to a glass slide and dried, forms a pattern resembling fern leaves (fern phenomenon). Unfortunately, the test also gives a lot of inaccurate results. In addition, in many hospitals, laboratories are open only during the day and on weekdays.

15. What are the modern methods for diagnosing premature rupture of the membranes?

Modern methods for diagnosing premature rupture of the membranes are based on the determination of specific proteins, which are abundant in the amniotic fluid and are not normally contained in the vaginal discharge and other body fluids. To detect these substances, an antibody system is developed that is applied to the test strip. The way these tests work is similar to a pregnancy test. The most accurate test is a protein-detecting test called placental alpha microglobulin. The commercial name is Amnishur (AmniSure®).

The accuracy of the Amnishur test is 98.7%.

Yes, unlike all other research methods, the Amnishur test does not require examination in mirrors and a woman can put it at home. Everything you need for the test is included in the kit. This is a tampon, which is inserted into the vagina to a depth of 5-7 cm and held there for 1 min, a test tube with a solvent, in which the tampon is washed for 1 minute and then discarded, and a test strip, which is inserted into the test tube. The result is read after 10 minutes. In case of a positive result, as with a pregnancy test, 2 strips appear. If the result is negative, one strip.

If the test is positive, you need to call an ambulance or go to the hospital if the pregnancy is more than 28 weeks and to the gynecological department of the hospital if the pregnancy is less than 28 weeks. The sooner treatment is started, the greater the chances of avoiding complications.

If the test is negative, you can stay at home, but at the next visit to the doctor, you need to talk about the troubling symptoms.

No, if more than 12 hours have passed since the alleged rupture and the signs of water leakage have stopped, then the test may show an incorrect result.

True premature rupture of the membranes occurs in about every tenth pregnant woman. However, almost every fourth woman experiences certain symptoms that can be confused with premature rupture of the membranes. This is a physiological increase in vaginal secretion, and a slight urinary incontinence in later pregnancy and abundant discharge during infection of the genital tract.

If a massive rupture of the membranes has occurred, then it cannot be confused with anything: a large amount of clear liquid, odorless and colorless, is immediately released. However, if the gap is small, doctors also call it subclinical or high lateral tear, then it can be very difficult to make a diagnosis.

There are 3 types of complications that can lead to premature rupture of the membranes. The most frequent and severe complication is the development of an ascending infection, up to the sepsis of the newborn. In a premature pregnancy, premature rupture of the membranes can lead to premature birth with all the consequences of the birth of a premature baby. With massive outpouring of water, mechanical injury to the fetus, prolapse of the umbilical cord, placental abruption is possible.

Risk factors for premature rupture of the membranes are infection of the genital organs, overstretching of the membranes as a result of polyhydramnios or with multiple pregnancies, abdominal trauma, incomplete closure of the uterine pharynx. Premature rupture of membranes during a previous pregnancy is an important risk factor. However, in almost every third woman, rupture of the membranes occurs in the absence of any significant risk factors.

This is largely determined by the gestational age. In full-term pregnancies, half of women experience spontaneous labor within 12 hours and more than 90% within 48 hours. With a premature pregnancy, it is possible to maintain the pregnancy for a week or longer if the infection does not join.

Normally, the membranes are airtight and no, even the smallest, penetration of amniotic fluid into the vagina occurs. For leakage of amniotic fluid, women often mistake increased vaginal secretion or mild urinary incontinence.

Premature rupture of the membranes is indeed a very dangerous complication of pregnancy, but with timely diagnosis, hospitalization and early treatment, premature pregnancy can often be prolonged if no infection occurs. With a full-term pregnancy and close to full-term, as a rule, the onset of labor is stimulated. Modern methods of diagnosis and treatment, in this case, allow you to smoothly prepare a woman for childbirth.

8. If there is a premature rupture of the membranes, but the mucous plug has not come off, does it protect against infection?

The mucous plug really protects against infection, but when the membranes are ruptured, one protection by the mucous plug is not enough. If treatment is not started within 24 hours of the rupture, serious infectious complications can occur.

Fertile waters are indeed divided into anterior and posterior, but no matter where the rupture occurs, it is the gateway for infection.

By itself, the rupture of the membranes is painless and without any precursors.

FREE courses for young parents.

Girls, for information! Looking for free and QUALITY courses for young parents? You are here: [link-1] ADVANTAGES: The courses are organized by the Moscow maternity hospital No. 16, everyone can attend them, regardless of registration at the place of residence, without an appointment, starting at 15:00, but come at least half an hour earlier, otherwise it may not enough places. The preparatory course consists of 7 lectures, the schedule is posted on the website, covers all topics of interest to the expectant mother (change.

Complications of multiple pregnancies.

The most common complications associated with twin / triple pregnancy are: Premature birth. Low birth weight. Delayed intrauterine development of the fetus. Preeclampsia. Gestational diabetes. Placental abruption. Cesarean section. Premature birth. Childbirth before the 37th week of pregnancy is considered premature. The duration of multiple pregnancies decreases with each additional child. On average, pregnancy with one baby lasts 39 weeks.

Do you need vaccinations? - Certainly. The question is to whom.

The money earned on vaccinations and, most importantly, the sale of products reliably guaranteed by the state, stimulate pharmaceutical companies to throw more and more new vaccines onto the market and increase the number of vaccinations already available. The usual story is that when a new vaccine appears on the market, we are told that it is highly effective, "one shot and your baby is protected." However, very soon it turns out that not one, but several vaccinations are required, and they all immediately find a place for themselves in.

Children with problems after vaccinations - problems after vaccinations

Girls, I am writing here for the first time. On the site for a long time. Those who have kids with problems after vaccinations have such a thing. there is an opportunity to give this case wide publicity, after which we will seek compensation for the treatment of children. I need to collect a database (without names). The question will be raised at a high level. It is necessary to write the child's age, the vaccination, the consequences, the diagnosis that they received thanks to our vaccinations, what the doctors said to all questions and, in general, their reactions to statements that the trouble and the diagnosis.

Vaccinations. Adoption

Girls, what about your vaccinations? We had a medical appointment for up to 5 months, and it was oral, the doctors did not indicate it in the discharge. The neuropathologist and pediatrician at the clinic believe that there is no reason not to. There is only hepatitis from the genus. at home and that's it. Start vaccination or delay for at least another year? Does anyone have any opinions?

Cryotherapy pros and cons. - cryo therapy for tonsillitis

Moderators, please don’t remove my Temko. I know that we have a lot of specialists and just experienced people on our forum, who are also very concerned. So, we have: a 5-year-old girl, chronic tonsillitis, ENT suggests removing tonsils. I do not agree. I read and heard reviews about cryotherapy for tonsillitis. They don’t do this in our republic. If I decide, I have to go somewhere. I really want to hear yours. advice and your experience, is it worth it or not to torment the child, whether there will be a positive result. Thank you all in advance.

I will not advise anything, just a personal cry. Until this summer, she did not suffer from sore throats at all.

Stroke: when the brain needs help. Diseases of the cardiovascular.

How a stroke occurs Hemorrhagic stroke is usually a complication of hypertension. Unable to withstand the increased blood pressure on the wall, the vessel ruptures. The resulting hemorrhage compresses the tissue, causes edema - and the brain area dies. In the case of ischemic stroke, the vessel retains its integrity, but the blood flow through it stops due to spasm or blockage by a thrombus, that is, a blood clot that has formed on the wall of a vessel affected by atherosclerosis. Stress, fluctuations in atmospheric pressure, overwork, bad habits: alcohol and smoking, sharp fluctuations in sugar levels.

Where does the bruise come from? About disease

Doctor! Urgently! Child health up to a year

The appearance of more frequent, noisy, shortness of breath with retraction of the intercostal spaces, jugular fossa or sternum on inspiration is a serious symptom related to signs of respiratory or cardiovascular failure. One of the common causes of shortness of breath is aspiration - the ingress of foreign bodies (food, small objects) into the bronchi. Also, the cause of shortness of breath is often complications of infectious diseases in the form of laryngeal edema (false croup) and narrowing of the bronchial lumen (broncho-obstructive syndrome). Dyspnea may be accompanied by pneumonia (pneumonia), bronchiolitis (inflammation of the small bronchi). Shortness of breath is also a symptom of an allergic reaction from the respiratory tract (allergic laryngeal edema, bronchial obstruction), as well as one of the first symptoms of anaphylactic shock. In addition, shortness of breath is accompanied by an increase in heart rate.

Hemorrhagic syndrome Hemorrhagic syndrome is the appearance of spontaneous hemorrhages in the skin (from the smallest rash (petechiae) to extensive foci), hemorrhages in the mucous membranes or bleeding (from the nose, mouth, rectum, umbilical wound), which, of course, requires immediate examination a doctor. There are many reasons for the development of hemorrhagic syndrome. These can be various blood diseases that occur with clotting disorders, as well as severe infections. A child with hemorrhagic syndrome will need examination and treatment in a hospital. Trauma Unfortunately, falls and injuries to children under 1 year old are not uncommon. Most often, falls are with a blow to the head, since this is the most.

Vaccinations: on the question of safety. Vaccination (vaccinations)

Large fruit. Features of pregnancy and childbirth. Medical.

Big kid. Possible complications of pregnancy and childbirth

There is also a tendency for a large fetus to form during the second and subsequent pregnancies. According to statistics, the second child is 20-30% larger than the first. It can be assumed that this is determined by several factors. One of them is psychological, that is, when carrying a second baby, the expectant mother is calmer, since she is already familiar with pregnancy and childbirth firsthand. Another reason may be that during the second pregnancy, the mother's body is already trained in bearing a baby, blood circulation in the uteroplacental and fetal-placental vessels obes.

Measles vaccine. Measles vaccinations: contraindications.

Patients receiving treatment with drugs that weaken the immune system. Administration of blood products (whole blood, plasma, immunoglobulin) within the last 8 weeks before the intended vaccination. Some cancers. Child's health after vaccination Adverse reactions are infrequently caused by the measles vaccine, complications in vaccinated people are also very rare. A small part of the vaccinated may have mild adverse reactions in the form of an increase in temperature up to 38 ° C, sometimes conjunctivitis and an abundant rash occur. The listed symptoms are possible in the period from 5-6 to (different sources give different periods) a day; they last 2-3 days. This is the natural course of the vaccination process.

Anemia and pregnancy. Medical aspects of pregnancy

Traumatic brain injury. Injuries, first aid

Outflow of pure blood speaks more of an ear or nose injury than a skull fracture. In addition, a fracture of the base of the skull can damage the cranial nerves. Depending on the location of the fracture, there may be violations of smell, vision, hearing, facial asymmetry. Among the complications of a fracture of the base of the skull, complications associated with infection from the nasopharynx, middle ear or paranasal sinuses into the skull cavity are very dangerous: abscesses (abscesses) of the brain and meningitis. Skull fractures are usually associated with various brain injuries. There is no direct correlation between the severity of brain damage and the type of fracture. However, as a rule, depressed fractures are accompanied by more severe damage than linear ones; they often develop epi- and subdural hematomas, whereas with linear fractures.

Two weeks ago, my brother got into an accident, a traumatic brain injury, now he is conscious, talking. The neurosurgeon advised me to take him home, because they could not be transferred to the ward, the psychotherapist did not let him through and all the necessary treatment was done to him. As the article indicated the drug Milgamma compositum, he also drank it, I wonder how often you can drink it?

Immunity vs. pregnancy. Infertility

The introduction of immunoglobulin is necessary to prevent the exacerbation of a viral infection, to suppress the production of autoantibodies. At the same time, protection (passive immunity) is formed in the body of a pregnant woman against chronic infection and autoantibodies circulating in the blood, and indirectly, protection of the fetus from them. With the introduction of immunoglobulin, there can be complications in the form of allergic reactions, headaches, sometimes there are cold symptoms (runny nose, etc.). To prevent these complications, it is necessary to check the immune, interferon status with the determination of immunoglobulins of the IgG, IgM, and IgA classes in the blood (IgM and IgA antibodies are produced when an infectious agent enters the body for the first time and during an exacerbation of the infectious process, IgG remain in the body after an infection). At low ur.

Spam, flooding, provocations, obtrusive messages

After 5 violations, you will be transferred to reading mode!

"Beyond Plan" vaccinations: vaccination against meningitis. Vaccination.

In this case, the vaccination is carried out 2-4 weeks after recovery. 1 Immunoglobulin is a drug made on the basis of the blood of a person who has been ill or vaccinated against a particular infection and has developed antibodies - protective proteins against the causative agent of the infection. A permanent contraindication is a severe allergic reaction to the components of the drug and complications that have arisen after the previous administration. Vaccination against meningococcal infection Another cause of purulent meningitis is meningococci. This is a large group of pathogens that cause more than 60% of meningitis in children and adults. They, in turn, are also subdivided into a number of groups - A, B, C, W135, Y, etc. The disease is transmitted by airborne droplets from person to person.

Meningococcus can affect various organs - the pharynx, nose, lungs, heart, joints, and not just the lining of the brain. The whole body can be affected - blood poisoning (sepsis). Meningococcal infection is characterized by a high rise in temperature, severe headache, and repeated vomiting. The main distinguishing feature is the appearance of a stellate type of small hemorrhagic rash (hemorrhages in the skin, small dots and "stars"; moreover, if you stretch the skin near the element of the rash, the rash, unlike other, non-hemorrhagic types, will not disappear). A rash in the form of single elements begins to appear on the abdomen, buttocks, heels, legs and in a matter of hours spreads throughout the body. For meningococcal infection, a rapid course is characteristic.

Look "from the inside". Analyzes and studies during pregnancy

Invasive prenatal diagnosis. The risk of developing chromosomal and genetic diseases. Contraindications to invasive research. How the research is done.

I had an amneocentesis - in fact, everything is not as scary as it might seem when you read the article. Only this analysis is not cheap.

Hemorrhoids are a secret disease. Complications of pregnancy

Women are embarrassed to tell the doctor about the manifestations of this disease and seek medical help only as a last resort when complications arise, since many believe that hemorrhoids are normal during pregnancy. Hemorrhoids are enlarged veins in the anus. The development of this disease is facilitated by the anatomical and physiological features of the rectum. Under its mucous membrane there are numerous veins forming plexuses, the walls of these veins are very thin.

Coagulogram. Analyzes and studies during pregnancy

Platelet consumption is increased in patients with DBS syndrome. A coagulogram should be taken once a trimester, and if there are deviations in hemostasis indicators, more often, as prescribed by a doctor. The balance between the coagulation and anticoagulant systems is maintained through the interaction of platelets, coagulation factors and the process of fibrinolysis. A violation affecting any of these links can cause serious complications of pregnancy. Among these complications, the most dangerous is disseminated intravascular coagulation (disseminated intravascular coagulation) syndrome. This syndrome develops due to the activation of the coagulation system, on the one hand, and the fibrinolysis system, on the other. DIC syndrome in pregnant women can be caused by various reasons. Among them: premature detachment.

"Dossier" of the future mother. What is an "exchange card"?

Section to be filled out in the antenatal clinic This section contains information about the antenatal clinic about a pregnant woman. FULL NAME. Age. Pregnant women under 18 and over 30 have more complications during pregnancy and childbirth. Address. Naturally, it is necessary for emergency cases, when contact with a pregnant woman is difficult or impossible, to find relatives and friends and receive from them the necessary information about the woman. Postponed general, gynecological diseases, operations. Hereditary and chronic diseases in women are of interest because they can adversely affect the development of the fetus, the course of pregnancy and childbirth. Important information.

Dangerous changes: gestosis of pregnant women. Toxicosis

Severe complications of gestosis (bleeding, premature detachment of a normally located placenta, fetal death) are largely due not to high blood pressure, but to its sharp fluctuations. The presence of protein in the urine (proteinuria) is one of the most characteristic signs of preeclampsia. A progressive increase in protein in the urine indicates a worsening of the course of the disease. Simultaneously with the presence of the listed symptoms in pregnant women, the volume of urine excreted decreases. The daily amount of urine decreases doml and less. The less.

Fibroids and pregnancy. Pregnancy planning

Today I visited a reproductologist. We are planning pregnancy for almost a year. Identified a lump in the uterus (fibroids). The size is small - 3.5 cm. More precisely, I have had it for several years, but all gynecologists previously simply stated its presence. All 5 years - she did not grow, but did not bother. Gynecologists said that fibroids are not a hindrance to pregnancy. But today the reproductologist says that in fact all the troubles are in her. And that it interferes with the normal conception, and even if I get pregnant, it may be.

In the hospital I saw a bunch of girls who gave birth with fibroids - only one had problems: during pregnancy, the fibroids began to grow, grew to the size of a child, BUT - the child was born absolutely normal, the pregnancy, according to her, was proceeding normally - taking into account her diagnosis ...

Frequent advice here in the conference is to go to another doctor, in particular, to a reproductive specialist, and to begin with, calm down and do not be discouraged. Everything will be fine!

Features of the use of medicines during.

Heparin and low molecular weight heparins (Fraxiparine) do not cross the placenta and do not adversely affect the fetus. Long-term (more than 6 months) use of heparin in therapeutic doses during pregnancy predisposes to reversible osteoporosis and fractures. Fraxiparine has several advantages: the absence of hemorrhagic complications in the mother and newborns and clinical signs of osteoporosis. Diuretics are not considered potentially teratogenic for the human fetus, however, the fetotoxic effect of diuretics of various chemical groups is not excluded. With prolonged use of large doses of thiazides by pregnant women, hyponatremia and thrombocytopathy may develop in newborns. Under the influence of ethacrynic acid, weakening and loss are noted.

Helio Bacter - 5 Helio Bacter

Is there any other way to treat this microbe besides antibiotics? They found it in my mother's stomach, prescribed strong antibiotics, but she is weak, underwent breast surgery (grade 2 cancer) two years ago, still cannot fully recover, and it will not provoke an antibiotic, killing all microbes, even useful ones. stomach cancer or something else? Maybe there are more lenient remedies?

Treatment is prescribed in a number of cases:

1. With an ulcer of the stomach or duodenum.

2. With atrophic gastritis, histologically confirmed, especially with symptoms of metaplasia and dysplasia.

2. After surgery for stomach cancer.

3. Relatives of a patient with stomach cancer.

Effective treatment regimens involve combinations of antibiotics in high doses with all the attendant side effects and complications, so that if there is no indication for treatment, prescribing a regimen will do more harm than good.

It is necessary to treat not a microbe, but a person :) Health to your mother!

There is evidence that stomach cancer is associated with the presence of Helicobacter pylori.

There are no beneficial microbes in the stomach. They are in the intestines, well, after a while after treatment, you can drink bacterial drugs, of the best - Bifiform.

In addition, EGD with biopsy is not done for everyone. Apparently your mom had any complaints? This means that it is really necessary to be treated, and there is nothing wrong with that.

Complications from vaccinations for DPT. Other children

Complications from vaccinations on DPT Galina Petrovna CHERVONSKAYA, virologist, member of the Russian National Committee for Bioethics (RNKB) RAS and the International Society for Human Rights (ISHR) Complications on DPT - local reactions: infiltrates, abscesses (phlegmon, etc.); - damage to the central nervous system: persistent piercing cry, encephalitic reactions, encephalopathy, post-vaccination encephalitis; - damage to the kidneys, joints, heart, gastrointestinal tract; - allergic complications.

©, 7ya.ru, Mass media registration certificate El No. FS.

Reprinting messages from conferences is prohibited without specifying a link to the site and the authors of the messages themselves. Reprinting materials from other sections of the site is prohibited without the written consent of ALP-Media and the authors. The opinion of the editorial board may not coincide with the opinion of the authors. The rights of authors and the publisher are protected. Technical support and IT outsourcing is carried out by KT-ALP.

7ya.ru is an information project on family issues: pregnancy and childbirth, raising children, education and career, home economics, recreation, beauty and health, family relations. The site has thematic conferences, blogs, ratings of kindergartens and schools, articles are published daily and contests are held.

If you find errors, problems, inaccuracies on the page, please let us know. Thanks!

Out of 5000 primary or recurrent strokes diagnosed in the Republic of Belarus annually, 80% are cerebral infarctions... The selection of adequate treatment for ischemic cerebrovascular diseases depends on the accuracy of determining the causes of stroke. Heterogeneous brain infarction structure currently implies the following variants of the disease:

• strokes due to stenosis or occlusion of large arterial vessels of the carotid or vertebral basin;
• blockage of small cerebral arteries;
• cardiogenic embolism;
• infarctions of areas of adjacent blood supply (the so-called hemodynamic);
• vasculopathy of non-atherosclerotic genesis (dissection of arteries, cerebral vasculitis, fibromuscular dysplasia, moyamoya disease, etc.);
• strokes due to hypercoagulant conditions;
• ischemic strokes of unknown etiology.

In international scientific research distribution of subtypes of ischemic stroke performed according to the TOAST criteria: atherothrombotic, cardioembolic, lacunar and mixed / unspecified.

Most patients with cerebral infarction have atherosclerosis of the main and intracerebral arteries and arterial hypertension... Local cerebral ischemia develops as a result of atherothrombotic vascular occlusion, arterio-arterial embolism by detached atherosclerotic plaques, or hypoperfusion hemodynamic disorders.

In addition to a clinical neurological examination and a thorough history taking, the main methods of confirming the diagnosis of ischemic stroke serves as a computed and magnetic resonance imaging of the brain, since intracerebral hemorrhages in some cases can give clinical symptoms similar to those of a cerebral infarction. To identify the pathology of the extra- and intracranial arteries, to clarify the state of the heart, an ultrasound examination of the heart and blood vessels is performed.

Patients admitted to the intensive care unit are given basic stroke therapy... After the exclusion of intracranial hemorrhages, differentiated drug therapy begins, the main direction of which is the use of antithrombotic agents the following groups: anticoagulants, fibrinolytic agents and antiplatelet agents.

It should be emphasized that, according to modern scientific literature, there are no generally accepted anticoagulant therapy regimens in the acute period of cerebral infarction... Anticoagulants inactivate thrombin, prevent the formation of fibrin filaments of an intravascular thrombus.

The most widespread both in our country and in foreign neurological clinics received anticoagulant therapy with heparin.

Heparin is the main representative of direct anticoagulants. This endogenous substance is synthesized in the human body in the liver, lungs, intestinal mucosa, muscles; is a mixture of heterogeneous fractions of glycosaminoglycans, consisting of sulfated residues of D-glucosamine and D-glucuronic acid, with different polymer chain lengths and molecular weights from 2000 to 50,000 daltons. For clinical use, the drug is obtained from the intestinal mucosa of pigs, as well as from the lungs of cattle.

Angioneurologists use the leading action of heparin, which manifests itself in thrombin inhibition- the main enzyme of blood coagulation. To implement the anticoagulant effect of heparin, its coenzyme is required - antithrombin III... Heparin, by changing the conformation of the antithrombin III molecule, significantly accelerates the binding of the coenzyme to the active centers of a number of factors of the blood coagulation system. Inhibition of thrombus formation develops as a result of inactivation of the IXa, XIa, XIIa coagulation factors, kallikrein, thrombin and factor Xa. The drug inhibits the aggregation and adhesion of platelets, erythrocytes, leukocytes, reduces the permeability of the vascular wall, thereby improving collateral blood circulation, inhibits lipoprotein-lipase, which is accompanied by a moderate decrease in serum cholesterol and triglycerides.

The main complications of drug therapy with heparin are bleeding, thrombocytopenia, as well as osteoporosis, alopecia and hyperkalemia with prolonged use. It is believed that high blood pressure levels significantly increase the risk of hemorrhage in patients with stroke. TAIST studies on the treatment of patients with cerebral infarction with heparin have shown that the incidence of intracerebral hemorrhage reaches 1-7%. At the same time, the risk of hemorrhagic complications correlates with the size of the infarction focus.

The second dangerous complication of heparin therapy in 1-2% of patients is heparin-induced thrombocytopenia due to increased platelet aggregation. In this regard, in stroke departments, the administration of heparin to patients should be carried out against the background of a systematic (every 2 days) control of the number of platelets in the general blood test... This is due to the fact that in some cases, on the 6-8th day of anticoagulant therapy with heparin, thrombocytopenia of immune origin caused by immunoglobulins IgG and IgM.

Contraindications to the administration of heparin bleeding of any localization, hemophilia, hemorrhagic diathesis, increased vascular permeability, bleeding ulcerative lesions of the gastrointestinal tract, subacute bacterial endocarditis, severe liver and kidney dysfunction, acute and chronic leukemia, acute aneurysm of the heart, venous gangrene, allergic reactions.

Requires caution carrying out heparin therapy, prescribed for health reasons, with high blood pressure (200/120 mm Hg), pregnancy, esophageal varices, in the immediate postpartum and postoperative period.

Heparin solutions are injected intravenously or under the skin (in the umbilical fatty tissue of the abdomen). Doses and methods of using heparin are selected individually, depending on the pathogenetic variant of cerebral infarction, clinical and laboratory parameters, the results of neuroimaging, the presence of concomitant diseases.

With the intravenous method of heparin therapy, 5000 U of the drug is injected intravenously in a stream, after which they switch to intravenous stream administration at a rate of 800-1000 U / h. With intravenous administration of heparin, the anticoagulant effect develops immediately and lasts 4-5 hours. With subcutaneous injection of heparin, the anticoagulant effect begins after 4060 minutes and lasts up to 8 hours.

The activity of heparin is expressed in units of action and is determined spectrophotometrically or by the ability to lengthen partial thromboplastin clotting time(APTT). To achieve a therapeutic effect, the APTT is maintained at a level 1.5-2 times higher than the normal values ​​of the indicator. When titrating the dose of heparin, blood sampling for the determination of APTT is carried out every 6 hours, then every day during the entire period of heparin therapy.

The heparin antagonist is protamine sulfate... With the development of hemorrhages against the background of heparin therapy, 5 ml of 1% protamine is diluted in 20 ml of saline sodium chloride solution and slowly injected intravenously. The maximum dose of protamine should not exceed 50 mg over a 10-minute administration time or 200 mg over 2 hours.

In the 1980s. developed low molecular weight heparins(LMWH) are special drugs that differ from unfractionated heparin (UFH) by the constancy of molecular weight (4000-5000 daltons) and have high antithrombotic activity. LMWH, to a greater extent than unfractionated heparin, inactivate factor Xa, at the same time, LMWH, to a lesser extent than UFH, inactivate thrombin, therefore the risk of hemorrhagic complications during their use is reduced... In addition, thrombocytopenia and osteoporosis are not observed. The half-life of LMWH is 1.5-4.5 hours, which allows them to be prescribed 1-2 times a day.

One of the main representatives of NMG is Fraxiparine(calcium nadroparin). It is a glycosaminoglycan with an average molecular weight of 4300 daltons and is characterized by high anti-Xa-factor activity, which persists for about a day after drug administration. Fraxiparine is distinguished by high bioavailability (98%), rapid development of anticoagulant action and its prolonged effect, complex mechanism of action, less connection with blood proteins, endothelium and macrophages.

At present, the results of international studies TAIST, HAEST, TOPAS have been published, convincingly evidence of effective use of fraxiparine in the acute period of ischemic stroke... The drug can be prescribed already in the first 24 hours of the disease. In a multicenter randomized trial FISS (Fraxiparine in Ischemic Stroke Study), it was found that in the group of people treated with fraxiparine for cerebral infarction, the proportion of people with a fatal outcome or severe neurological deficit was 20% less than in the group of patients who received placebo.

A significant advantage of fraxiparine and other drugs from the LMWH group (clexane, fragmin, etc.) is their more selective influence on the process of blood clot formation... Compared to UFH, they have a lesser effect on the content of platelets and thrombin and, accordingly, less often provoke thrombocytopenia and bleeding. Therefore, fraxiparin is currently recommended for use in patients with heparin-induced thrombocytopenia, who should receive direct anticoagulant therapy for cerebral infarction. The high bioavailability and long half-life of LMWH compared to UFH have been confirmed in the prevention and treatment of venous thrombosis in patients with stroke.

The results have been published so far. randomized controlled trial on the use of fraxiparine in acute cerebral infarction. The first point was an unfavorable outcome - overall mortality and inability to self-care within 6 months after randomization. As a second point, an unfavorable outcome was established over the next 3 months. After 6 months, there was a significant dose-dependent decrease in the incidence of unfavorable outcomes of ischemic stroke in patients treated with fraxiparine.

In January 2006, the results of the PROTECT trial were reported to the general medical community, in which patients with ischemic stroke were prescribed a new low molecular weight heparin, Certoparin, to prevent thrombotic and embolic complications.

When analyzing lethal cases caused by cerebral infarction, it was shown that 20% of patients die within the first 30 days... Moreover, in half of the deaths, the cause of death is potentially curable medical causes. The incidence of pneumonia, deep vein thrombosis and pulmonary embolism is 30%, 10%, and 5%, respectively. In the studies of foreign neurologists, it was found that in the treatment of patients with stroke, fraxiparin is significantly better than UFH in preventing the development of deep vein thrombosis and pulmonary embolism.

A multicenter trial of the heparinoid organon 10 172 in cerebral infarction is under way. The results of the first and second phases of research have been published. In the course of treatment, several patients had hemorrhagic complications, but in general, the drug was recognized as safe; within 3 months, patients showed positive dynamics of clinical symptoms of stroke.

Large randomized trials have reduced the indication for the treatment of ischemic stroke with UFH. It is believed that immediately after the diagnosis of ischemic stroke, the patient should be prescribed acetylsalicylic acid(aspirin) 50-325 mg once daily.

With a small or medium size of cerebral infarction, antithrombotic therapy begins with immediate intravenous administration of heparin or fraxiparine, if there is a threat of a significant increase in the primary neurological deficit. In 2004, the recommendations of the VII International Conference on Antithrombotic and Thrombolytic Therapy for the treatment of patients with acute cerebral infarction were published. All patients are offered to be stratified according to the degree of risk of thromboembolic complications. For prophylactic purposes at a high risk of embolism (Grade 1A), subcutaneous administration of UFH, LMWH or heparinoid is indicated.

O.D Wiebers et al. (2005) major indications for the appointment of direct anticoagulants think:

• condition after a transient ischemic attack (TIA);
• increased frequency of TIA, increased duration and severity;
• progressive stroke with stenosis of large arteries;
• the presence of a blood clot in the lumen of the main or intracerebral arteries;
• during operations on the arteries of the head and neck;
• cerebral venous sinus thrombosis;
• strokes due to hypercoagulability.

At cardioembolic ischemic stroke the effectiveness of heparin has not yet been proven. Moreover, in 1994, the American Heart Association's Stroke Board recommended avoiding the use of heparin for cardioembolic stroke. At the same time, there are data on the relative safety of heparin use in patients with small and medium-sized cerebral embolic infarctions, the main condition for which should be careful control of APTT. In the case of extensive cardioembolic cerebral infarction (which captures the entire area of ​​blood supply to the middle cerebral or internal carotid arteries), intravenous heparin treatment is not used in the first days of stroke. A few days later, a second computed tomographic scan of the brain is performed. In the absence of hemorrhagic transformation of the infarction, intravenous administration of heparin at a dose of 1000 mg / h is started, ensuring careful monitoring of APTT.

In Russian neurology along with the infusion drip of heparin, subcutaneous injections of heparin at a dose of 5000 IU 2-4 times a day or fraxiparin subcutaneously 1 time a day at a dose of 0.3-0.6 ml for 10 days are used, which corresponds to 2850-5700 IU of anti- Ha factor.

From 10-14 days after cardioembolic stroke, in the absence of contraindications, treatment with indirect anticoagulants (warfarin) is prescribed. The feasibility of pre-prescribing LMWH within 5-7 days before prescribing warfarin is currently the subject of clinical studies. Primary and secondary prevention of stroke in patients with atrial fibrillation without valvular disease, rheumatic valvular disease or prosthetic heart valves involves the use of direct and indirect anticoagulants. When taking oral anticoagulants in an adult patient, the average dose of warfarin is 5.0-7.5 mg in the first 2 days, then 2.5-5.0 mg per day. Supervised daily international normalized ratio(INR). The recommended INR level for primary or re-prophylaxis of cerebral infarction is 2.0 to 3.0 units. With a high risk of repeated cardioembolic stroke in patients with artificial heart valves, repeated cardiogenic embolisms - from 3.0 to 4.5 INR units. Heparin administration is continued for 5-7 days while taking warfarin until therapeutic INR values ​​are reached. During the first week of warfarin therapy, coagulation indicators are monitored daily or every other day, with the INR indicator stabilizing - once a month. In the case of long-term treatment with anticoagulants, the risk of developing hemorrhagic complications is 0.5-1.5% per year. Exceeding the recommended levels of hypocoagulation, advanced age of patients and high blood pressure values ​​increase the risk of hemorrhage in the presence of warfarin.

In the study European Atrial Fibrillation Trial (1994), it was demonstrated that in patients with minor strokes or TIA against the background of atrial fibrillation anticoagulants are 62% more effective in reducing the risk of re-cerebral infarction than aspirin.

Experimental methods for normalizing blood flow in occluded cerebral vessels in ischemic stroke include thrombolysis using urokinase, streptokinase, tissue plasminogen activator, use of fibrinolytic drugs (ancrod), neutrophil migration / adhesion inhibitors (anti-MMA antibodies), thrombin inhibitors (ximegalatran). Multicenter trials are investigating the effectiveness of these drugs in cerebral infarction.

Thus, the question of the advisability of prescribing heparin in the acute period of cerebral infarction is still controversial. At the same time, it is recognized that anticoagulant therapy is one of the few real ways to prevent and treat thromboembolic stroke. The established indications for therapy with direct anticoagulants are cases of cerebral infarction, when there is a threat of an increase in neurological deficit. Recent studies are characterized by the use of LMWH (fraxiparine, etc.) in cerebral infarction due to their more selective effect on the mechanism of the hemocoagulation cascade and a low number of hemorrhagic complications. Particular prospects for the use of fraxiparine may be associated with the prevention and treatment of cardioembolic ischemic strokes in patients with cardiac arrhythmias, acute coronary syndrome and congestive heart failure.

Gonchar I.A., Likhachev S.A., Nedzved G.K. Republican Scientific and Practical Center of Neurology and Neurosurgery, Ministry of Health of the Republic of Bashkortostan.
Published: magazine "Medical Panorama" No. 6, December 2006.

Release form: Liquid dosage forms. Injection.

General characteristics. Composition:

Active ingredient: 5000 IU of heparin in 1 ml of solution.

Pharmacological properties:

Pharmacodynamics. Heparin is a direct-acting anticoagulant. It binds to antithrombin III, causes conformational changes in its molecule and accelerates the complexation of antithrombin III with serine proteases of the coagulation system; as a result, thrombin, the enzymatic activity of factors IX, X, XI, XII, plasmin and kallikrein are blocked. Heparin has no thrombolytic effect. The introduction into the blood of the drug in small doses is accompanied by a slight and inconsistent increase in the fibrinolytic activity of the blood; large doses of heparin cause, as a rule, inhibition of fibrinolysis.

Heparin reduces blood viscosity, prevents the development of stasis. Heparin is able to be sorbed on the surface of endothelial membranes and blood cells, increasing their negative charge, which prevents the adhesion and aggregation of platelets, erythrocytes, leukocytes. Molecules of heparin, which have a low affinity for antithrombin III, cause inhibition of smooth muscle hyperplasia, and also suppress the activation of lipoprotein lipase, which prevents development. Heparin has an anti-allergic effect: it binds some components of the complement system, reducing its activity, prevents the cooperation of lymphocytes and the formation of immunoglobulins, binds histamine, serotonin. Inhibits the activity of hyaluronidase. It has a weak vasodilator effect.

In patients with coronary artery disease (in combination with acetylsalicylic acid) reduces the risk of acute thrombosis of the coronary arteries, myocardial infarction and sudden death. Reduces the frequency of repeated heart attacks and mortality in patients with myocardial infarction. In high doses it is effective in pulmonary embolism and venous thrombosis, in small doses - for the prevention of venous thromboembolism, incl. after surgery.

Heparin acts quickly but is relatively short-lived. With intravenous administration, blood coagulation slows down almost immediately, with intramuscular administration - after 15-30 minutes, with subcutaneous administration - after 40-60 minutes, after inhalation the maximum effect is observed in a day; the duration of the anticoagulation effect, respectively, is 4-5 hours, 6 hours, 8 hours, 1-2 weeks, the therapeutic effect (prevention of thrombus formation) lasts much longer. I in plasma or locally may limit the antithrombotic effect of heparin.

Pharmacokinetics. When administered subcutaneously, bioavailability is low, Cmax is achieved after 2 - 4 hours; T1 / 2 is 1 - 2 hours. In plasma, heparin is mainly associated with proteins; intensively captured by endothelial cells of the mononuclear-macrophage system, concentrated in the liver and spleen; when inhaled, it is absorbed by alveolar macrophages, capillary endothelium, large blood and lymphatic vessels.

It undergoes desulfation under the influence of N-desulfamidase and platelet heparinase. Desulfated molecules under the influence of kidney endoglycosidase are converted into low molecular weight fragments. It is excreted by the kidneys in the form of metabolites, and only with the introduction of high doses is excretion in an unchanged form possible. Heparin poorly crosses the placenta due to its high molecular weight. It is not excreted in breast milk.

Indications for use:

Method of administration and dosage:

Heparin is administered intravenously or intramuscularly (every 4 hours), subcutaneously (every 8-12 hours) and as an intra-arterial infusion, as well as by electrophoresis. In acute myocardial infarction on the first day, the first dose (10,000-15,000 U) is administered intravenously, then the fractional intravenous or intramuscular administration of the drug is continued at a dose of 40,000 U per day, so that the blood clotting time is 2.5-3 times higher than normal magnitudes. Starting from the 2nd day, the daily dose is 600 U / kg of the patient's weight (30,000–60,000 U), so that the blood clotting time is 1.5–2 times higher than the norm. Heparin treatment is continued for 4-8 days. 1-2 days before the abolition of heparin, the daily dose is gradually reduced (daily by 5000-2500 U for each injection without increasing the intervals between them) until the drug is completely discontinued, after which treatment is carried out only with indirect anticoagulants (neodikumarin, phenylin, etc.), which are prescribed from 3-4 days of treatment.

When using heparin in complex conservative therapy of acute venous or arterial obstruction, start with continuous intravenous drip infusion of the drug for 3-5 days. The daily dose of heparin (400-450 U / kg) is diluted in 1200 ml of isotonic sodium chloride solution or Ringer-Locke solution and poured at a rate of 20 drops per minute. Then heparin is administered fractionally at a dose of 600 U / kg per day (100 U / kg per injection). If intravenous administration of heparin is impossible, it is used intramuscularly or subcutaneously at a dose of 600 U / kg per day. Heparin therapy is continued for 14-16 days. 3-4 days before the abolition of heparin, the daily dose is reduced daily by 2500-1250 U for each injection without increasing the intervals between them. After discontinuation of the drug, treatment is carried out with indirect anticoagulants, which are prescribed one day before the first reduction in the dose of heparin.

In the surgical treatment of these diseases during the operation immediately before thrombectomy from the main veins or immediately after embolthrombectomy from the arteries, heparin is administered at a dose of 100 U / kg intravenously or intraarterially. Then, during the first 3-5 days of the postoperative period, heparin is injected intravenously at a rate of 20 drops per minute regionally into the vein from which the thrombus was removed, at a dose of 200-250 U / kg per day or intravenously into the general bloodstream at a dose of 300— 400 U / kg per day. Starting from 4-6 days after surgery, heparin therapy is carried out in the same way as with conservative treatment. After operations for acute arterial obstruction, heparin therapy is continued for 10-12 days, and a decrease in the dose of heparin begins from 6-7 days of treatment.

In ophthalmic practice, heparin is used for all types of retinal vascular occlusion, as well as for all angiosclerotic and dystrophic processes of the vascular tract and retina. In case of acute obstruction of the retinal vessels, the first dose of heparin (5000–10000 U) is administered intravenously. Further, heparin is used fractionally intramuscularly at 20,000-40,000 units per day. Treatment is carried out in accordance with the clinical picture of the disease for 2-7 days. On the second or third day, it is possible to use heparin in combination with indirect anticoagulants.

With direct blood transfusion, heparin is administered to the donor at a dose of 7,500-10,000 IU intravenously.

Application features:

Treatment with heparin must be carried out under close monitoring of the state of hemocoagulation. Studies of the state of blood coagulation are carried out: in the first 7 days of treatment - at least 1 time in 2 days, then 1 time in 3 days; on the first day at least 2 times a day, on the 2nd and 3rd days - at least 1 time per day. With fractional administration of heparin, blood samples for analysis are taken immediately before the injection of the drug.

A sudden cessation of heparin therapy can lead to a violent activation of the thrombotic process, therefore, the dose of heparin should be gradually reduced with the simultaneous administration of indirect anticoagulants. The exceptions are cases of severe hemorrhagic complications and individual intolerance to heparin.

Hemorrhagic complications can occur with any, including with a hypercoagulable state of blood coagulation. The measures to prevent hemorrhagic complications include: the use of heparin only in a hospital setting; limiting the number of injections (subcutaneous and intramuscular), with the exception of injections of heparin itself; careful monitoring of the state of blood coagulation; if threatening hypocoagulation is detected, an immediate decrease in the dose of heparin without increasing the intervals between injections. To avoid the formation of hematomas at the injection sites, it is better to use an intravenous heparin technique.

Side effects:

When heparin is used, headaches can occur, early (2-4 days of treatment) and late (autoimmune), hemorrhagic complications - in the gastrointestinal tract or in the urinary tract, retroperitoneal hemorrhages in the ovaries, adrenal glands (with the development of acute adrenal insufficiency), soft tissue calcification , inhibition of aldosterone synthesis, increase in the level of transaminases in the blood, allergic reactions (fever, rashes, bronchial asthma, anaphylactoid reaction), local irritation, soreness upon administration).

In case of individual intolerance and the appearance of allergic complications, heparin is canceled immediately and desensitizing agents are prescribed. If it is necessary to continue anticoagulant therapy, indirect anticoagulants are used.

Depending on the severity of the hemorrhagic complication that has arisen, either reduce the dose of heparin or cancel it. If, after discontinuation of heparin, bleeding continues, a heparin antagonist, protamine sulfate (5 ml of a 1% solution) is injected intravenously. If necessary, the introduction of protamine sulfate can be repeated.

Interaction with other medicinal products:

The effects of heparin are enhanced by acetylsalicylic acid, dextran, phenylbutazone, ibuprofen, indomethacin, warfarin, dicumarin (increased risk of bleeding), weakened by cardiac glycosides, tetracyclines, antihistamines, nicotinic acid, ethacrynic.

Contraindications:

The use of heparin is contraindicated in case of individual intolerance and the following conditions: bleeding of any localization, with the exception of hemorrhage caused by embolic (hemoptysis) or kidney (hematuria); hemorrhagic diathesis and other diseases, accompanied by a slowdown in blood coagulation; increased vascular permeability, for example, with Werlhof's disease; a history of recurrent bleeding, regardless of their location; subacute bacterial endocarditis; severe violations of liver and kidney function; acute and chronic leukemia, aplastic and hypoplastic anemias; acutely developed heart aneurysm; venous gangrene.

The drug is used with caution in the following cases: with ulcerative and tumor lesions of the gastrointestinal tract, regardless of its etiology, high blood pressure (above 180/90 mm Hg), in the immediate postoperative and postpartum period during the first 3-8 days (except for operations on blood vessels and in cases where heparin therapy is necessary for health reasons).

The risk of adverse effects for pregnant women when using heparin ranges from 10.4% to 21%. In the normal course of pregnancy, it is 3.6%. With the use of heparin, the risk of death is 2.5% and 6.8% and is similar to the risk in the natural population. The consequences of using heparin during pregnancy may include: bleeding, thrombocytopenia, osteoporosis. The risk of thromboembolic complications during pregnancy, removed by the use of heparin, is more life-threatening, therefore, the use of heparin during pregnancy is possible, but only on strict indications, under close medical supervision. Heparin does not cross the placenta and adverse effects on the fetus are unlikely. It can be used during lactation (breastfeeding) according to indications.

Vacation conditions:

On prescription

Package:

Solution for injection 5000 U / ml in vials of 5 ml in packing No. 5