Current principles of correction of impaired antithrombogenic activity of the vascular wall in perimenopause
Authors:   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation, Panevina A.S. ,   Center for Diagnosis, Prevention and Treatment “Endomedlab”, Moscow, Russian Federation, Davydov A.I. ,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Panevin T.S. ,   V.A.Nasonova Research Institute of Rheumatology, Moscow, Russian Federation, Popova L.V. ,   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Barinova A.Yu. ,   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation,   I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Parfenova O.A. ,   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation,   Peoples' Friendship University of Russia (RUDN), Moscow, Russian Federation, Bubnova M.M. ,   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation,   A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation, Makarov O.E. ,   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation, Stuklov N.I. ,   Peoples' Friendship University of Russia (RUDN), Moscow, Russian Federation,   P.A.Hertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological Centre, Moscow, Russian Federation, Khanykin V.S. ,   A.A.Schmidt and B.A.Kudryashov All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology, Moscow, Russian Federation,   A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
Published: January 2023

Hormonal changes during perimenopause cause impairment of the antithrombogenic activity of the vascular wall (ATAVW), which is one of the factors leading to the development of atherosclerosis. Pharmacological and non-pharmacological methods of treatment contribute to the restoration of ATAVW. Objective. To study the effect of complex treatment including intravenous laser blood irradiation (ILBI) and combined hormone replacement therapy (HRT) with low and ultra-low doses of estrogen on ATAVW in patients with secondary cardiomyopathy (SCM) during perimenopause. Patients and methods. This study included 90 perimenopausal women diagnosed with SCM who had decreased ATAVW and received different treatment to relieve menopausal symptoms. Patients were divided into three groups depending on the choice of treatment: group 1 (control) was treated with a multivitamin complex, group 2 – with low-dose combined HRT based on 1 mg estradiol + ILBI, group 3 – with ultra-low-dose combined HRT based on 0.5 mg estradiol + ILBI. The follow-up period was 3 years. ATAVW was assessed during screening, at 6, 12, and 36 months after inclusion in the study. At each visit we determined ATAVW, anti-aggregation activity with graphical registration, anticoagulant, and fibrinolytic activity. Results. In the groups with HRT + ILBI, positive dynamics were achieved in all parameters of AAVW: an increase in the antiaggregation, anticoagulant, and fibrinolytic activity of the vascular wall both before and after compression test during the whole period of follow-up. The positive statistically significant (p < 0.001) dynamics of these ATAVW parameters were noted after 6 months of treatment and persisted throughout the entire follow-up and treatment period. Conclusion. The use of ILBI in combination with low-dose or ultra-low-dose HRT in perimenopausal patients with SCM and decreased ATAVW led to the improvement of ATAVW, which resulted in the increase in anticoagulant, anti-aggregation, and fibrinolytic activity. Key words: endothelium, antithrombogenic activity, vascular wall, secondary cardiomyopathy in perimenopause, intravenous laser blood irradiation, hormone replacement therapy