References

cardiovascular

Кардиоваскулярная терапия и профилактика

Cardiovascular Therapy and Prevention

1728-88002619-0125

«SILICEA-POLIGRAF» LLC

cardiovascular-995

Research Article

ОБЗОРЫ ЛИТЕРАТУРЫ

REVIEW ARTICLES

Антитромбоцитарная терапия и риск желудочно-кишечных кровотечений

Antiplatelet treatment and gastro-intestinal hemorrhage risk

Дупляков

Д. В.

Duplyakov

D. V.

Медсанчасть ОАО «АВТОВАЗ», ТольяттиVAZ Medical Center, Togliatti

2005

20082005

44108115

2005

Дупляков Д.В.

Duplyakov D.V.

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/995

Назначение аспирина для предупреждения сердечно-сосудистых катастроф требует сопоставления риска атеротромбоза с риском геморрагических осложнений. Вероятно, не существует такой минимальной дозы аспирина, которая, с одной стороны, обладала бы антитромбоцитарной активностью, а с другой, была бы безопасна в плане желудочно-кишечных кровотечений. Результаты крупных, рандомизированных исследований позволяют констатировать хорошую переносимость и меньшее число побочных эффектов клопидогреля. Пациентам группы высокого риска атеротромбоза с непереносимостью аспирина следует назначать клопидогрель как более безопасный препарат. В комбинации с клопидогрелем аспирин рекомендуется использовать в минимальной дозе. Защита желудочно-кишечного тракта ингибиторами протонной помпы и/или эрадикация Helicobacter pylori у пациентов, получающих аспирин, активно обсуждаются в литературе, но пока не получили серьезной доказательной базы, что чрезвычайно важно, когда речь идет о пожизненной защите пациента от повторных неблагоприятных атеротромботических событий.

Ratio of atherothrombotic risk and risk of hemorrhage complications should be estimated before aspirin prescription as a component of cardiovascular event prevention. It is unlikely that there exists a daily aspirin dose, possessing antiplatelet efficacy, but without gastro-intestinal (GI) hemorrhage risk. Data of large-scale randomized trails have demonstrated the benefits of clopidogrel, with fewer adverse effects and better tolerability. According to CAPRIE trail results, clopidogrel should be prescribed to high-risk patients unable to take aspirin. It is recommended to use only minimal effective aspirin doses in combination with clopidogrel. The strategy of GI protection with proton pump inhibitors and/or H. pylori eradication for aspirin-taking patients at high risk of GI bleeding is widely discussed in literature. Up to now, there is little evidence supporting this strategy that is most important for life-long protection against atherothrombotic events.

антитромбоцитарная терапияаспиринклопидогрельжелудочно-кишечные кровотечения

antiplatelet treatmentaspirinclopidogrelgastro-intestinal hemorrhage

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