CURRENT PRINCIPLES IN THE MANAGEMENT OF PATIENTS WITH THROMBOPHILIA IN THE CONTEXT OF EVIDENCE-BASED MEDICINE
Objective. To choose an optimal package of therapeutic and diagnostic measures for patients with thrombophilia, by keeping in mind the pattern of hemostasiological disorders and the priority role of endogenous intoxication syndrome in the pathogenesis of gestational thrombogenic complications. Subjects and methods. A randomized study was conducted in 671 patients diagnosed as having thrombophilia of different genesis and associated hemostasiological disorders detected using the integral coagulation index (ICI) that reflected total coagulopathic changes in all the components of the hemostatic system in this contingent of patients. The efficiency and tolerability of therapy were evaluated from the changes in the clinical and laboratory manifestations of thrombophilia: the state of the hemostatic system (ICI) and the pattern of circulation in the mother-placenta-fetus system, which were monitored before and 2—3 weeks after treatment. The pattern and severity of gestational complications were assessed during pregnancy. Results. A combination of heparinoids and carbohemosorption is the optimal multimodality therapy option, which makes it possible not only to substantially reduce the proportion of complications of gestation, but also to prolong its time at delivery. Conclusion. The findings permitted the authors to write clinical management protocols for patients during both pregravid and pregnancy.