ENDOTHELIAL DYSFUNCTION AND SPECIFICS OF THE VENOUS THROMBOEMBOLIC COMPLICATIONS IN SURGICAL PATIENTS AT EXTREMELY HIGH RISK Endothelial dysfunction and specifics of the venous thromboembolic complications in surgical patients at extremely high risk

Published in Medical Bulletin of the Ministry of Internal Affairs · Volume 2026, Issue 3 · Pages 13–17 · Rubric: Surgery
DOI: https://doi.org/10.52341/20738080_2026_142_3_13
Received: 01.07.2026 Accepted: 07.07.2026 Published: 07.07.2026 Language of publication: RUS
The study deals with clinical risk factors, analyzes their role in occurrence and clinical specifics of the clinical course of postoperative period in surgical patients at extremely high risk of venous thromboembolic events (VTE) on the Caprini scale. The results obtained demonstrate presence of the biological substrate of hemodynamic instability, more pronounced oxidative stress, delayed proliferation of endothelium with initial preoperational high risk of thrombosis or DIC syndrome development in comorbid patients with endothelial dysfunction. This increases the risk of sepsis, VTE and limits the possibility to increase the doses of coagulants in standard preventive therapy.
venous thromboembolic events, endothelial dysfunction, proliferation of endothelium, anticoagulants, standard preventive therapy
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1. Bagnenko S.F., Boyarincev V.V., Pasechnik I.N. Rukovodstvo po skoroy medicinskoy pomoschi pri ostryh zabolevaniyah, travmah i otravleniyah / Pod obsch. red. D.N. Verbovogo. – Moskva – Sankt-Peterburg: Foliant. – 2023.

2. Barinov V.E., Boyarincev V.V., Brehov E.I., Lobastov K.V., Schastlivcev I.V., Caplin S.N. Integral faktorov riska kak prediktor razvitiya venoznyh tromboembolicheskih oslozhneniy // Kremlevskaya medicina. Klinicheskiy vestnik. – 2013. – № 3. – S. 115–120.

3. Barinov V.E. Optimizaciya metodov profilaktiki ostryh venoznyh trombozov u hirurgicheskih pacientov s vysokim riskom tromboembolicheskih oslozhneniy: avtoref. dis. d-ra med. nauk // Moskva, Gos. nauch. centr lazer. mediciny. – 2014. – 53 s.

4. Bokeriya L.A., Zatevahin I.I., Kirienko A.I., Andriyashkin A.V., Andriyashkin V.V., Arutyunov G.P. i dr. Rossiyskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhneniy (VTEO) // Flebologiya. – 2015. - № 9(4– 2). – S. 1–52.

5. Zolkin V.N., Tolstov P.A., Sitnikov A.V., Marov K.B., Godyaev M.Ya., Emel'yanov A.I. Tromboemboliya legochnoy arterii i ostryy venoznyy tromboz – taktika lecheniya // Moskovskaya medicina. – 2016. – № S1(12). – S. 116.

6. Zubairova L.D. Patofiziologiya razvitiya tromboembolicheskih oslozhneniy / L.D. Zubairova, B.G. Ziatdinov, R.F. Sharafutdinov // Sovremennoe iskusstvo mediciny. – 2011. – № 2(2). – S. 94–100.

7. Il'ina Ya.Yu., Fot E.V., Kuz'kov V.V., Kirov M.Yu. Sepsis-inducirovannoe povrezhdenie endotelial'nogo glikokaliksa (obzor literatury) // Vestnik intensivnoy terapii imeni A.I. Saltanova. – 2019; (2):32–39. Doi:https://doi.org/10.21320/1818-474X-2019-2-32-39.

8. Kairov, G.T. Diagnostika, lechenie i profilaktika trombozov i tromboemboliy: uchebnoe posobie / Tomsk. – 2011. S. 33–36.

9. Kalinin R.E. Eksperimental'nyy venoznyy tromboz kak model' sostoyaniya endotelital'noy disfunkcii i vozmozhnosti ee ispol'zovaniya v eksperimental'noy farmakologii / R.E. Kalinin, I.A. Suchkov, A.S. Pshennikov, A.N. Novikov // Eksperimental'naya i klinicheskaya farmakologiya: nauchnye chteniya: sb. tez. Vseros. nauch. konf., posvyasch. 90-letiyu so dnya rozhdeniya prof. A.A. Nikulina. – Ryazan'. – 2013. – 241 s. – S. 65–68.

10. Kamaev A.A., Kalinin R.E., Mzhavanadze N.D., Povarov V.O., Yanykina K.V., Suchkov I.A. Vliyanie sulodeksida na funkciyu endoteliya i kachestvo zhizni pacientov s varikoznoy bolezn'yu // Flebologiya. – 2024; 18(4):308–316.

11. Karpenko A.A., Shilova A.N. Tromboz // Sovremennye dannye o patogeneze venoznogo tromboza, gemostaz i reologiya. – 2016. – № 2 (66). – S. 12–18. Doi:https://doi.org/10.21320/1818-474X-2019-2-32-39.

12. Karsanov A.M., Sazhin V.P., Maskin S.S., Remizov O.V., Korovin A.Ya. Sepsis / FGBOU VO SOGMA Minzdrava Rossii. – Vladikavkaz: IPC IP Copanova A.Yu. – 2017. – 196 s.

13. Krylov A.Yu. Puti povysheniya effektivnosti i bezopasnosti antikoagulyantnoy terapii u bol'nyh trombozami glubokih ven nizhnih konechnostey / A.Yu. Krylov, A.M. Shulutko, I.I. Serebriyskiy, F.Yu. Verholomova, S.E. Hmyrova, I.G. Manukyan, E.G. Osmanov, A.A. Petrovskaya, K.V. Koshatnikov // Moskovskiy hirurgicheskiy zhurnal. – 2013. – № 5(33). – S. 4–13.

14. Kuznecov N.A., Rodoman G.V., Shalaeva T.I., Dynzhinova T.V. Korrekciya disfunkcii endoteliya pri sepsise // Vestnik Rossiyskogo gosudarstvennogo medicinskogo universiteta. – 2008. – № 6. – S. 11–15.

15. Leont'ev S.G., Lebedev I.S. Pervichnaya i vtorichnaya profilaktika ostrogo venoznogo tromboza: komu i kak ee provodit'? // Consilium Medicum. – 2007. – T. 9. – № 7. – S. 95–97.

16. Lobastov K.V., Barinov V.E., Schastlivcev I.I., Laberko L.A. Shkala Caprini kak instrument dlya individual'noy stratifikacii riska razvitiya posleoperacionnyh venoznyh tromboemboliy v gruppe vysokogo riska // Hirurgiya. Zhurnal im. N. I. Pirogova. – 2014. – № 12. – S. 16–23.

17. Lobastov K.V., Barinov V.E., Laberko L.A. Na puti k individual'nomu podhodu v ocenke riska i profilaktike posleoperacionnyh venoznyh tromboembolicheskih oslozhneniy // Flebologiya. – 2015. – T. 8, № 1. – S. 41–51.

18. Lobastov K.V., Urbanek T., Stepanov E. i dr. Porogovye znacheniya shkaly Kaprini, svyazannye s povyshennym riskom venoznoy tromboembolii, v razlichnyh oblastyah hirurgii: sistematicheskiy obzor // Annaly hirurgii. – 2023.

19. Ob utverzhdenii otraslevogo standarta «Protokol vedeniya bol'nyh. Profilaktika tromboembolii legochnoy arterii pri hirurgicheskih i inyh invazivnyh vmeshatel'stvah» [Elektronnyy resurs]: prikaz Minzdrava Rossii ot 09.06.2003 № 233 // Zakon Prosto. http: //www.zakonprost.ru/content/base/

20. Savel'ev V.S., Chazov E.I., Gusev E.I. i dr. Rossiyskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhneniy // Flebologiya. – 2010. – T. 4, № 2–1. – S. 2–37.

21. Savel'ev V.S. Posleoperacionnye venoznye tromboembolicheskie oslozhneniya: fatal'naya neizbezhnost' ili kontroliruemaya opasnost'? // Hirurgiya. – 1999. – № 6. – S. 60–63.

22. Savel'ev V.S., Gologorskiy V.A., Kirienko A.I. i dr. Profilaktika venoznyh tromboembolicheskih oslozhneniy. Flebologiya: rukovodstvo dlya vrachey // Moskva. – 2001. – S. 390–408.

23. Savel'ev V.S., Gologorskiy V.A., Kirienko A.I. Rossiyskie klinicheskie rekomendacii po diagnostike, lecheniyu i profilaktike venoznyh tromboembolicheskih oslozhneniy (VTEO) // Flebologiya. – 2015. – T. 9. – № 4. – S. 1–57.

24. Savel'ev V.S., Kirienko A.I., Andriyashkin V.V. i dr. Territoriya bezopasnosti ot venoznyh tromboembolicheskih oslozhneniy: promezhutochnye itogi vtorogo etapa proekta // Flebologiya. – 2013. – № 7 (4). – S. 4–8.

25. Savchenko Yu. P., Malyshko V. V., Golikov I. V., Scherba S. N. Prichiny razvitiya ranevoy infekcii v posleoperacionnom periode i ee profilaktika // Kubanskiy nauchnyy medicinskiy vestnik. – 2013.

26. Sapicheva Yu.Yu., Lihvancev V.V., Petrovskaya E.L., Lopatin A.F. Taktika vedeniya pacientov s sepsisom i septicheskim shokom v mnogoprofil'nom stacionare» // Uchebnoe posobie. – 2015.

27. Nikonov V.V., Sokolov A.S., Fes'kov A.E. Sepsis ot drevnosti do sovremennosti. Vzglyad skvoz' veka. – 2017.

28. Hizriev S.M., Mihaylichenko V.Yu., Caturyan A.B., Gumenyuk L.N., Butyrskiy A.G., Puchkina G.A., Drevetnyak A.A., Samarin S.A. Vliyanie kompleksnogo lecheniya na posleoperacionnuyu dinamiku plazmennyh biomarkerov okislitel'nogo gomeostaza pri varikoznoy bolezni ven nizhnih konechnostey klinicheskih klassov S4–S6 // TMBV. – 2022. – № 2.

29. Hripun A.I., Shurygin S.N., Mironkov A.B. Profilaktika i lechenie tromboembolicheskih oslozhneniy u pacientov s vnutricherepnymi krovoizliyaniyami // Hirurgiya. Zhurnal im. N. I. Pirogova. – 2010. – № 12. – S. 4–8.

30. Shevchenko Yu.L., Mel'kumyanc A.M., Stoyko Yu.M., Yashkin M.N., Chernyago T.Yu., Gudymovich V.G. Pervye rezul'taty vizualizacii i strukturnoy ocenki glikokaliksa endoteliocitov pri varikoznoy bolezni // Vestnik Nacional'nogo mediko-hirurgicheskogo Centra im. N. I. Pirogova. – 2023. – № 4.

31. Creager M.A., Barnes G.D. et al. AHA / ACC / ACCP / ACEP / CHEST / SCAI / SHM / SIR / SVM / SVN. New Guideline 2026. Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines // Circulation. – 2026.

32. Andreozzi G.M., Bignamini AA, Davì G. et al. Sulodexide for the Prevention of Recurrent Venous Thromboembolism: The Sulodexide in Secondary Prevention of Recurrent Deep Vein Thrombosis (SURVET) Study: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial // Circulation. – 2015.

33. Arabi Y.M., Al-Hameed F., Burns K.E.A. et al. Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis // The New England Journal of Medicine. – 2019.

34. Bui T.M., Wiesolek H.L., Sumagin R. ICAM-1: A master regulator of cellular responses in inflammation, injury resolution, and tumorigenesis // J Leukoc Biol. – 2020. – Vol. 108, № 3. – P. 787– 799. Doi:https://doi.org/10.1002/JLB.2MR0220-549R

35. Bikdeli B., Chatterjee S., Kirtane A.J. et al. Sulodexide Versus Control and the Risk of Thrombotic and Hemorrhagic Events: Meta-Analysis of Randomized Trials // Seminars in Thrombosis and Hemostasis. – 2020.

36. Carroll B.J., Piazza G., Goldhaber S.Z. Sulodexide in Venous Disease // Journal of Thrombosis and Haemostasis. – 2019.

37. Coccheri S., Mannello F. Development and Use of Sulodexide in Vascular Diseases: Implications for Treatment // Drug Design, Development and Therapy. – 2013.

38. Creager M.A., Barnes G.D., Giri J. et al. Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines // Journal of the American College of Cardiology. New Guideline. – 2026.

39. Gauer R.L., Abellada A., Stewart M., Kozloski R. Managing Selected Chronic Conditions in Hospitalized Patients // American Family Physician. – 2024.

40. Gould M.K., Garcia D.A., Wren S.M. et al. Prevention of VTE in Nonorthopedic Surgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed / American College of Chest Physicians Evidence-Based Clinical Practice Guidelines // Chest. – 2012.

41. Harenberg J. Review of Pharmacodynamics, Pharmacokinetics and Therapeutic Prop-erties of Sulodexide // Medicinal Research Reviews. – 1998.

42. Henke P.K., Kahn S.R., Pannucci C.J. et al. Call to Action to Prevent Venous Thromboembolism in Hospitalized Patients: A Policy Statement From the American Heart Association // Circulation. – 2020.

43. Ho K.M., Tan J.A. Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients // Circulation. – 2013.

44. Jiang Q.J., Bai J., Jin J., Shi J., Qu L. Sulodexide for Secondary Prevention of Recurrent Venous Thromboembolism: A Systematic Review and Meta-Analysis // Frontiers in Pharmacology. – 2018.

45. Kahn S.R., Lim W., Dunn A.S. et al. Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines // Chest. – 2012.

46. Khan F., Tritschler T., Kahn S.R., Rodger M.A. Venous Thromboembolism // Lancet. – 2021.

47. Kakkos S., Kirkilesis G., Caprini J.A. et al. Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism // The Cochrane Database of Systematic Reviews. – 2022.

48. Murphy P.B., Vogt K.N., Lau B.D. et al. Venous Thromboembolism Prevention in Emergency General Surgery: A Review // JAMA Surgery. – 2018.

49. Obi A.T., Pannucci C.J., Nackashi A. et al. Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients // JAMA Surgery. – 2015.

50. Piazza G. Advanced Mangement of Intermediate- And High-Risk Pulmonary Embolism: JACC Focus Seminar // Journal of the American College of Cardiology. – 2020.

51. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232 // Obstetrics and Gynecology. – 2021. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins // Gynecology. Guideline.

52. Qiao L., Yao Y., Wu D. et al. The Validation and Modification of the Caprini Risk Assessment Model for Evaluating Venous Thromboembolism After Joint Arthroplasty // Thrombosis and Haemostasis. – 2024.

53. Yan K., Yan P., Cao L. et al. Retrospective Analysis of the Effectiveness and Safety of Sulodexide for Venous Thromboembolism Prevention in Neurosurgical Patients // Neurosurgical Review. – 2025.

54. Shkala Caprini. https: //medicalc.pro/caprini

55. Lobastov K.V. Individual'nyy podhod k ocenke riska i profilaktike posleoperacionnyh venoznyh tromboembolicheskih oslozhneniy / avtoref. dis. d-ra med. nauk // FGAOU VO «RNIMU im. N.I. Pirogova Minzdrava Rossii. – 2023. – 48 s.