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Основные современные принципы профилактики венозных тромбоэмболических осложнений в акушерстве
Шмаков Р.Г., Каримова Г.Н., Полушкина Е.С. Основные современные принципы профилактики венозных тромбоэмболических осложнений в акушерстве. Consilium Medicum. 2017; 19 (6): 32–36. DOI: 10.26442/2075-1753_19.6.32-36
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Shmakov R.G., Karimova G.N., Polushkina E.S. Modern principles of venous thromboembolic events prevention in obstetrics. Consilium Medicum. 2017; 19 (6): 32–36. DOI: 10.26442/2075-1753_19.6.32-36
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Аннотация
Венозные тромбоэмболические осложнения (ВТЭО) – одна из ведущих причин материнской заболеваемости и смертности во всем мире. Основными методами тромбопрофилактики являются ранняя активизация, борьба с дегидратацией, эластическая и пневмокомпрессия, а также антикоагулянтная терапия. В связи с высокой безопасностью предпочтительно использование низкомолекулярных гепаринов (НМГ). Среди НМГ, в настоящее время используемых для профилактики ВТЭО в акушерстве, наиболее изучены бемипарин и эноксапарин, которым посвящены многочисленные исследования. Таким образом, в качестве эффективной тромбопрофилактики по всем современным протоколам необходимо назначение НМГ после родоразрешения согласно факторам риска, что существенно поможет снизить частоту тромбоэмболии в послеродовом периоде.
Ключевые слова: послеродовый период, тромбопрофилактика, низкомолекулярные гепарины, венозные, тромбоэмболические осложнения.
Ключевые слова: послеродовый период, тромбопрофилактика, низкомолекулярные гепарины, венозные, тромбоэмболические осложнения.
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Venous thromboembolic events (VTE) are one of the leading causes of maternal morbidity and mortality all over the world. The main methods of thromboprophylaxis include early mobilization of patients, dehydration treating, applying elastic and pneumocompression and using anticoagulant therapy. It is preferable to use low molecular heparins (LMH) due to their safety. Considering the amount of studies conducted, bemiparin and enoxaparin are the better studied LMH to be used in VTE prophylaxis. It is known that all current treatment protocols recommend using VTE after childbirth to lower the frequency of thromboembolic events in postpartum period.
Key words: postpartum period, thromboprophylaxis, low molecular heparins, venous, thromboembolic events.
Полный текст
Список литературы
1. James AH, Tapson VF, Goldhaber SZ. Thrombosis during pregnancy and the postpartum period. Am J Obstetrics Gynecol 2005; 193 (1): 216–9.
2. Alalaf SK, Jawad RK, Muhammad PR. Bemiparin versus enoxaparin as thromboprophylaxis following vaginal and abdominal deliveries: a prospective clinical trial. BMC Pregnancy Childbirth 2015; Mar 28.
3. Wu P, Poole TC, Pickett JA et al. Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine? Eur J Obstet Gynecol Reprod Biol 2013; 168: 7–11.
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8. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation. 2006; 114: e42–7.
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11. McLintock C, Brighton T, Chunilal S et al. Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 2012; 52: 14–22.
12. Scottish Intercollegiate Guidelines Network (SIGN) Prophylaxis of Venous Thromboembolism. Guideline; 2002.
13. Romero A. Risk of venous thromboembolic disease in women. A qualitativ systematic review. Eur J Obstet Gynecol Reprod Biol 2005; 121 (1): 8–1715.
14. Bates SM, Greer IA, Pabinger I et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133 (Suppl. 6).
15. Royal Collegue of Physicians. National Clinical Guideline Centre-Acute and Chronic Conditions. Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital. 2010.
16. Gerhardt A, Scharf RE, Beckmann MW et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000; 342 (6): 374–80.
17. Conard J, Horellou MH, Samama MM. Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc 2009; 34 (5): 300–13.
18. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359 (19): 2025–203329.
19. Bazzan M, Donvito V. Low-molecular-weight heparin during pregnancy. Thrombosis Research. 2001; 101 (1): V175–V186.
20. Phillips OP. Venous thromboembolism in the pregnant woman. J Reprod Med Obstet Gynecol 2003; 48 (Suppl. 11): 921–29.
21. Danilenko-Dixon DR, Heit JA, Silverstein MD et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or postpartum: a population-based, case-control study. Am J Obstet Gynecol 2001; 184 (2): 104–10.
22. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RDT. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. Br J Obstet Gynecol 2001; 108 (1): 56–60.
23. Orme ML, Lewis PJ, de Swiet M et al. NICE 2004 National Collaborating Centre for Women’s and Children’s Health, Commissioned by NICE. Caesarean section. London: RCOG Press; 2004.
24. Cruz M, Fernández-Alonso AM, Rodríguez I et al. Postcesarean thromboprophylaxis with two different regimens of bemiparin. Obstet Gynecol Int 2011; 2011: 548327.
25. Blondon M, Perrier A, Nendaz M et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103: 129–37.
26. Galambosi PJ, Gissler M, Kaaja RJ, Ulander VM. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort-study. Acta Obstet Gynecol Scand 2017; 96 (7): 852–61. Epub 2017 May 8.
27. Hill J, Treasure T. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ 2010; 340: c95. DOI: 10.1136/bmj.c958
28. Cosmi B, Palareti G. Old and new heparins. Thromb Res 2012; 129: 388–91. DOI: 10.1016/j.thromres.2011.11.008
29. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. М.: Медиа Сфера, 2010. / Rossiiskie klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike venoznykh tromboembolicheskikh oslozhnenii. M.: Media Sfera, 2010. [in Russian]
30. Ведение родильниц после абдоминального родоразрешения. Клинические рекомендации. М.: ФГБУ «НЦАГиП им. акад. В.И.Кулакова», 2013. / Vedenie rodil'nits posle abdominal'nogo rodorazresheniia. Klinicheskie rekomendatsii. M.: FGBU “NTsAGiP im. akad. V.I.Kulakova”, 2013. [in Russian]
31. Blondon M, Perrier A, Nendaz M et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103: 129–37.
32. Segal S, Sadovsky E, Weinsten D, Polishk WZ. Prevention of postpartum venous thrombosis with low doses of heparin. Eur J Obstet Gynecol Reprod Biol 1975; 5: 273–6.
33. Heit JA, Kobbervig CE, James AH et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Int Med 2005; 143: 697–706.
34. O’Connor DJ, Scher LA, Gargiulo N.J et al. Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: acontemporary series. Ann Vasc Surg 2011; 25: 9–14.
35. Barbour LA, Pickard J. Controversies in thromboembolic disease during pregnancy: a critical review. Obstet Gynecol 1995; 86: 621–33.
36. Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: An 11-year review. Am J Obstet Gynecol 1991; 164: 286.
2. Alalaf SK, Jawad RK, Muhammad PR. Bemiparin versus enoxaparin as thromboprophylaxis following vaginal and abdominal deliveries: a prospective clinical trial. BMC Pregnancy Childbirth 2015; Mar 28.
3. Wu P, Poole TC, Pickett JA et al. Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine? Eur J Obstet Gynecol Reprod Biol 2013; 168: 7–11.
4. Bates SM, Greer IA, Pabinger I et al. American College of Chest Physicians Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 844S–86.
5. Bain E, Wilson A, Tooher R et al. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2014; 2: CD001689. [PubMed]
6. Royal College of Obstetricians and Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium 2009 (Green-top Guideline; No. 37).
7. Dizon-Townson DS, Nelson LM, Jang H et al. The incidence of the factor V Leiden mutation in an obstetric population and its relationship to deep vein thrombosis. Am J Obstet Gynecol 1997; 176: 883–6. DOI: 10.1016/S0002-9378(97)70615-X
8. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation. 2006; 114: e42–7.
9. Ian A. Greer. Pregnancy Complicated by Venous Thrombosis. N Engl J Med 2015; 373: 540–7.
10. Bates SM, Greer IA, Middeldorp S et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence – Based Clinical Practice Guidelines. Chest 2012.
11. McLintock C, Brighton T, Chunilal S et al. Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 2012; 52: 14–22.
12. Scottish Intercollegiate Guidelines Network (SIGN) Prophylaxis of Venous Thromboembolism. Guideline; 2002.
13. Romero A. Risk of venous thromboembolic disease in women. A qualitativ systematic review. Eur J Obstet Gynecol Reprod Biol 2005; 121 (1): 8–1715.
14. Bates SM, Greer IA, Pabinger I et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133 (Suppl. 6).
15. Royal Collegue of Physicians. National Clinical Guideline Centre-Acute and Chronic Conditions. Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital. 2010.
16. Gerhardt A, Scharf RE, Beckmann MW et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000; 342 (6): 374–80.
17. Conard J, Horellou MH, Samama MM. Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc 2009; 34 (5): 300–13.
18. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359 (19): 2025–203329.
19. Bazzan M, Donvito V. Low-molecular-weight heparin during pregnancy. Thrombosis Research. 2001; 101 (1): V175–V186.
20. Phillips OP. Venous thromboembolism in the pregnant woman. J Reprod Med Obstet Gynecol 2003; 48 (Suppl. 11): 921–29.
21. Danilenko-Dixon DR, Heit JA, Silverstein MD et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or postpartum: a population-based, case-control study. Am J Obstet Gynecol 2001; 184 (2): 104–10.
22. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RDT. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. Br J Obstet Gynecol 2001; 108 (1): 56–60.
23. Orme ML, Lewis PJ, de Swiet M et al. NICE 2004 National Collaborating Centre for Women’s and Children’s Health, Commissioned by NICE. Caesarean section. London: RCOG Press; 2004.
24. Cruz M, Fernández-Alonso AM, Rodríguez I et al. Postcesarean thromboprophylaxis with two different regimens of bemiparin. Obstet Gynecol Int 2011; 2011: 548327.
25. Blondon M, Perrier A, Nendaz M et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103: 129–37.
26. Galambosi PJ, Gissler M, Kaaja RJ, Ulander VM. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort-study. Acta Obstet Gynecol Scand 2017; 96 (7): 852–61. Epub 2017 May 8.
27. Hill J, Treasure T. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ 2010; 340: c95. DOI: 10.1136/bmj.c958
28. Cosmi B, Palareti G. Old and new heparins. Thromb Res 2012; 129: 388–91. DOI: 10.1016/j.thromres.2011.11.008
29. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. М.: Медиа Сфера, 2010. / Rossiiskie klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike venoznykh tromboembolicheskikh oslozhnenii. M.: Media Sfera, 2010. [in Russian]
30. Ведение родильниц после абдоминального родоразрешения. Клинические рекомендации. М.: ФГБУ «НЦАГиП им. акад. В.И.Кулакова», 2013. / Vedenie rodil'nits posle abdominal'nogo rodorazresheniia. Klinicheskie rekomendatsii. M.: FGBU “NTsAGiP im. akad. V.I.Kulakova”, 2013. [in Russian]
31. Blondon M, Perrier A, Nendaz M et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103: 129–37.
32. Segal S, Sadovsky E, Weinsten D, Polishk WZ. Prevention of postpartum venous thrombosis with low doses of heparin. Eur J Obstet Gynecol Reprod Biol 1975; 5: 273–6.
33. Heit JA, Kobbervig CE, James AH et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Int Med 2005; 143: 697–706.
34. O’Connor DJ, Scher LA, Gargiulo N.J et al. Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: acontemporary series. Ann Vasc Surg 2011; 25: 9–14.
35. Barbour LA, Pickard J. Controversies in thromboembolic disease during pregnancy: a critical review. Obstet Gynecol 1995; 86: 621–33.
36. Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: An 11-year review. Am J Obstet Gynecol 1991; 164: 286.
________________________________________________
1. James AH, Tapson VF, Goldhaber SZ. Thrombosis during pregnancy and the postpartum period. Am J Obstetrics Gynecol 2005; 193 (1): 216–9.
2. Alalaf SK, Jawad RK, Muhammad PR. Bemiparin versus enoxaparin as thromboprophylaxis following vaginal and abdominal deliveries: a prospective clinical trial. BMC Pregnancy Childbirth 2015; Mar 28.
3. Wu P, Poole TC, Pickett JA et al. Current obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine? Eur J Obstet Gynecol Reprod Biol 2013; 168: 7–11.
4. Bates SM, Greer IA, Pabinger I et al. American College of Chest Physicians Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 844S–86.
5. Bain E, Wilson A, Tooher R et al. Prophylaxis for venous thromboembolic disease in pregnancy and the early postnatal period. Cochrane Database Syst Rev 2014; 2: CD001689. [PubMed]
6. Royal College of Obstetricians and Gynaecologists. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium 2009 (Green-top Guideline; No. 37).
7. Dizon-Townson DS, Nelson LM, Jang H et al. The incidence of the factor V Leiden mutation in an obstetric population and its relationship to deep vein thrombosis. Am J Obstet Gynecol 1997; 176: 883–6. DOI: 10.1016/S0002-9378(97)70615-X
8. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation. 2006; 114: e42–7.
9. Ian A. Greer. Pregnancy Complicated by Venous Thrombosis. N Engl J Med 2015; 373: 540–7.
10. Bates SM, Greer IA, Middeldorp S et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence – Based Clinical Practice Guidelines. Chest 2012.
11. McLintock C, Brighton T, Chunilal S et al. Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 2012; 52: 14–22.
12. Scottish Intercollegiate Guidelines Network (SIGN) Prophylaxis of Venous Thromboembolism. Guideline; 2002.
13. Romero A. Risk of venous thromboembolic disease in women. A qualitativ systematic review. Eur J Obstet Gynecol Reprod Biol 2005; 121 (1): 8–1715.
14. Bates SM, Greer IA, Pabinger I et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133 (Suppl. 6).
15. Royal Collegue of Physicians. National Clinical Guideline Centre-Acute and Chronic Conditions. Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital. 2010.
16. Gerhardt A, Scharf RE, Beckmann MW et al. Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium. N Engl J Med 2000; 342 (6): 374–80.
17. Conard J, Horellou MH, Samama MM. Pregnancy and venous thromboembolism. North-American and European guidelines. American College of Chest Physicians. J Mal Vasc 2009; 34 (5): 300–13.
18. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med 2008; 359 (19): 2025–203329.
19. Bazzan M, Donvito V. Low-molecular-weight heparin during pregnancy. Thrombosis Research. 2001; 101 (1): V175–V186.
20. Phillips OP. Venous thromboembolism in the pregnant woman. J Reprod Med Obstet Gynecol 2003; 48 (Suppl. 11): 921–29.
21. Danilenko-Dixon DR, Heit JA, Silverstein MD et al. Risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or postpartum: a population-based, case-control study. Am J Obstet Gynecol 2001; 184 (2): 104–10.
22. Simpson EL, Lawrenson RA, Nightingale AL, Farmer RDT. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. Br J Obstet Gynecol 2001; 108 (1): 56–60.
23. Orme ML, Lewis PJ, de Swiet M et al. NICE 2004 National Collaborating Centre for Women’s and Children’s Health, Commissioned by NICE. Caesarean section. London: RCOG Press; 2004.
24. Cruz M, Fernández-Alonso AM, Rodríguez I et al. Postcesarean thromboprophylaxis with two different regimens of bemiparin. Obstet Gynecol Int 2011; 2011: 548327.
25. Blondon M, Perrier A, Nendaz M et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103: 129–37.
26. Galambosi PJ, Gissler M, Kaaja RJ, Ulander VM. Incidence and risk factors of venous thromboembolism during postpartum period: a population-based cohort-study. Acta Obstet Gynecol Scand 2017; 96 (7): 852–61. Epub 2017 May 8.
27. Hill J, Treasure T. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ 2010; 340: c95. DOI: 10.1136/bmj.c958
28. Cosmi B, Palareti G. Old and new heparins. Thromb Res 2012; 129: 388–91. DOI: 10.1016/j.thromres.2011.11.008
29. Rossiiskie klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike venoznykh tromboembolicheskikh oslozhnenii. M.: Media Sfera, 2010. [in Russian]
30. Vedenie rodil'nits posle abdominal'nogo rodorazresheniia. Klinicheskie rekomendatsii. M.: FGBU “NTsAGiP im. akad. V.I.Kulakova”, 2013. [in Russian]
31. Blondon M, Perrier A, Nendaz M et al. Thromboprophylaxis with low-molecular-weight heparin after cesarean delivery. Thromb Haemost 2010; 103: 129–37.
32. Segal S, Sadovsky E, Weinsten D, Polishk WZ. Prevention of postpartum venous thrombosis with low doses of heparin. Eur J Obstet Gynecol Reprod Biol 1975; 5: 273–6.
33. Heit JA, Kobbervig CE, James AH et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Int Med 2005; 143: 697–706.
34. O’Connor DJ, Scher LA, Gargiulo N.J et al. Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: acontemporary series. Ann Vasc Surg 2011; 25: 9–14.
35. Barbour LA, Pickard J. Controversies in thromboembolic disease during pregnancy: a critical review. Obstet Gynecol 1995; 86: 621–33.
36. Rutherford S, Montoro M, McGehee W, Strong T. Thromboembolic disease associated with pregnancy: An 11-year review. Am J Obstet Gynecol 1991; 164: 286.
Авторы
Р.Г.Шмаков*, Г.Н.Каримова, Е.С.Полушкина
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова» Минздрава России. 117997, Москва, ул. Академика Опарина, д. 4
*mdshmakov@mail.ru
ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова» Минздрава России. 117997, Москва, ул. Академика Опарина, д. 4
*mdshmakov@mail.ru
________________________________________________
R.G.Shmakov*, G.N.Karimova, E.S.Polushkina
V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Akademika Oparina, d. 4
*mdshmakov@mail.ru
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