cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1462Research ArticleОСТРЫЙ КОРОНАРНЫЙ СИНДРОМACUTE CORONARY SYNDROMEСравнительная лабораторная эффективность низкомолекулярных гепаринов у больных с острым коронарным синдромом без подъема сегмента STComparative laboratory effectiveness of low molecular weight heparins in patients with acute coronary syndrome and no ST segment elevationЛинчакР. М.LinchakR. M.

главный кардиолог, профессор кафедры внутренних болезней

Москва

ruslanlinchak@mail.ruПоповВ. С.PopovV. S.

кардиолог палаты интенсивной терапии кардиологического отделения

Москва

КимК. Ф.KimK. F.

заведующая экспресс-лабораторией

Москва

Национальный медико-хирургический Центр им. Н.И. ПироговаN.I. Pirogov National Medico-Surgical Centre2011200220111015358Copyright © Линчак Р.М., Попов В.С., Ким К.Ф., 20112011Линчак Р.М., Попов В.С., Ким К.Ф.Linchak R.M., Popov V.S., Kim K.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1462

Цель. Изучить сравнительную анти-Ха активность плазмы у больных с острым коронарным синдромом без подъема ST (ОКС↓ST), леченных эноксапарином, надропарином или дальтепарином. Материал и методы. Обследованы 90 пациентов с ОКС↓ST, разделенных на группы (гр.) по 30 больных по приему изучаемых низкомолекулярных гепаринов (НМГ). Пациенты были сопоставимыми по возрасту, полу, индексу массы тела и величине клиренса креатинина. Определение активности ингибирования Ха фактора проводилось пациентам при поступлении и через 6 ч после первой инъекции НМГ. Результаты. Во всех гр. через 6 ч от введения первой дозы НМГ отмечалось достоверное увеличение антиХа активности. Динамика этого показателя в гр. эноксапарина составила 0,73±0,11 МЕ/мл к концу периода наблюдения при исходных значениях 0,07±0,05 МЕ/мл, в гр. дальтепарина — 0,52±0,12 МЕ/мл 0,05±0,03 МЕ/мл, надропарина — 0,61±0,10 МЕ/мл и 0,06±0,05 МЕ/мл, соответственно. Доля лиц,  которых был достигнут терапевтический уровень анти-Ха активности (≥ 0,6 МЕ/мл), оказался максимальным в гр. эноксапарина (93 %), что достоверно выше, чем в гр. дальтепарина (63 %) и надропарина 77 %). Заключение. Применение эноксапарина, дальтепарина и надропарина у больных с ОКС↓ST сопровождается достоверным увеличением анти-Ха активности плазмы во всех гр., однако терапевтический уровень того показателя наиболее часто достигается при использовании эноксапарина.

Aim. To compare anti-Xa plasma activity levels in patients with acute coronary syndrome (ACS) and no ST segment elevation (non-STE ACS), receiving enoxaparin, nadroparin, or dalteparin. Material and methods. In total, 90 patients with non-STE ACS were divided into three groups (n=30 in each group), by the type of low molecular weight heparin (LMWH) administered. All groups were comparable by age and gender structure, body mass index, and creatinine clearance levels. Anti-Xa activity was measured at admission and 6 hours after the first LMWH injection. Results. In all groups, anti-Xa activity was significantly increased at 6 hours after the first LMWH injection. At the end of the follow-up period, the change in this parameter was 0,73±0,11 IU/ml, with baseline level of 0,07±0,05 IU/ml, in the enoxaparin group. In the dalteparin group, the respective values were 0,52±0,12 and 0,05±0,03 IU/ ml, and in the nadroparin group, they were 0,61±0,10 and 0,06±0,05 IU/ml, respectively. The percentage of patients with achieved therapeutic anti-Xa activity (≥0,6 IU/ml) was maximal in the enoxaparin group (93%), being significantly higher than in the dalteparin and nadroparin groups (63% and 77%, respectively). Conclusion. Enoxaparin, dalteparin, and nadroparin therapy in non-STE ACS patients was associated with significantly increased plasma anti-Xa activity. However, the percentage of the patients with achieved therapeutic levels of anti-Xa activity was maximal in the enoxaparin group.

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The authors declare that there are no conflicts of interest present.