cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2015-4-75-85cardiovascular-250Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMПРОБЛЕМЫ ВЫБОРА АНТИТРОМБОТИЧЕСКОЙ ТЕРАПИИ У БОЛЬНЫХ С НЕКЛАПАННОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ И КОМОРБИДНОЙ ПАТОЛОГИЕЙTHE SELECTION PROBLEMS OF ANTITHROMBOTIC THERAPY IN NONVALVULAR ATRIAL FIBRILLATION WITH COMORBIDITIESКозиоловаН. А.KoziolovaN. A.

д. м.н., профессор, зав. кафедрой пропедевтики внутренних болезней №2

nakoziolova@mail.ruПолянскаяЕ. А.PolyanskayaЕ. А.

к. м.н., доцент кафедры

ГБОУ ВПО "Пермский государственный медицинский университет имени академика Е. А. Вагнера" Минздрава России. Пермь, РоссияSBEI HPE "Perm State Medical University n.a. E. A. Wagner" of the Healthcare Ministry. Perm, Russia2015200820151447585Copyright © Козиолова Н.А., Полянская Е.А., 20152015Козиолова Н.А., Полянская Е.А.Koziolova N.A., Polyanskaya Е.А.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/250

Как показывает клиническая практика, врач часто сталкивается с про­блемой непереносимости любых пероральных антикоагулянтов, как антагонистов витамина К, так и новых пероральных антикоагулянтов, или отказа пациентов от их применения. Поэтому перед врачом встает вопрос выбора антитромботической терапии у больных с фибрилля­цией предсердий (ФП), и, прежде всего, на фоне ишемической болез­ни сердца, сахарного диабета, перенесенного ишемического инсуль­та. В литературе остро обсуждается проблема целесообразности назначения таким больным аспирина в виде монотерапии с целью профилактики инсульта и инфаркта миокарда. В статье представлен клинический пример больной с неклапанной ФП, перенесшей ишеми- ческий инсульт, острый коронарный синдром на фоне множественной коморбидной патологии, показаны ошибки в тактике ведения больной в выборе антитромботической терапии и даны варианты решения проблемы вторичной профилактики тромбоэмболических осложне­ний, повторных ишемических событий с научно-обоснованной аргу­ментацией в соответствии с Международными и Российскими реко­мендациями. 

As does the clinical practice show, physician often deals with a problem of intolerability of oral anticoagulants, both vitamin K antagonists and new oral anticoagulants, either with a refuse taking these drugs at all. Hence there is an issue raises on the selection of antithrombotic therapy in atrial fibrillation (AF), and primarily, with ischemic heart disease, diabetes, stroke in anamnesis. There is a broad discussion in literature of the purpose for prescription of aspirin monotherapy to such patients with the aim of myocardial infarction and ischemic stroke prevention. In the article we present a case of female patient with nonvalvular AF having ischemic stroke and acute coronary syndrome at the background of serious comorbidities, the errors in the management are shown on the selection of antithrombotic therapy and directions provided for secondary prevention of thromboembolic complications, recurrent ischemic events according to International and Russian Guidelines.

 

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