Список литературы

2687-0940

Актуальные проблемы медицины

2687-0940

10.52575/2687-0940-2021-44-3-286-295

ВНУТРЕННИЕ БОЛЕЗНИ

Антикоагулянтная терапия при хронической болезни почек и фибрилляции предсердий у пациентов пожилого возраста (обзор литературы)

Anticoagulant therapy for chronic kidney disease and atrial fibrillation in elderly patients (review)

Панина

Юлия Николаевна

Panina

Yulia N.

doc.panina@yandex.ru

Вишневский

Валерий Иванович

Vishnevskij

Valery I.

vishnevsky.orel@mail.ru

2021

44300

Распространенность фибрилляции предсердий (ФП) среди населения очень высока и продолжает расти. По имеющейся статистике, её распространенность достигает около 2 %, что в два раза больше, чем считалось в последнее десятилетие. Распространенность ФП среди пациентов с хронической болезнью почек (ХБП) колеблется от 11 до 22 % (по другим данным – от 15 до 20 %) и увеличивается с возрастом, значительно превышая таковой в общей популяции среди всех возрастных групп. Подавляющее большинство пациентов с ФП нуждается в лечении антикоагулянтами для предотвращения ишемического инсульта и системных тромбоэмболий. Однако в случае сочетания ФП и ХБП, помимо увеличения частоты инсультов и тромбоэмболических осложнений, также значительно увеличивается частота крупных кровотечений, что значительно затрудняет выбор адекватной антикоагулянтной терапии в такой ситуации. Многие годы антагонисты витамина К были единственными представителями класса антикоагулянтов для длительной терапии пациентов с ФП. Их общеизвестные недостатки (узкое терапевтическое окно, необходимость частого лабораторного контроля, многочисленные лекарственные и диетические взаимодействия, непредсказуемость фармакодинамики и фармакокинетики у отдельных пациентов) способствовали поиску новых, более удобных в использовании лекарственных средств. Прямые пероральные антикоагулянты были проще в использовании, и по результатам основных исследований не уступали или не превосходили варфарин в отношении баланса эффективности и безопасности. Однако они не изучались специально у пациентов со сниженной функцией почек. В обзоре рассмотрены особенности современной антикоагулянтной терапии у пожилых пациентов с ФП и ХБП.

Prevalence of atrial fibrillation (AF) in population is very high and continues to grow. According to the existing statistics its prevalence reaches about 2 % so it is twice more, than it was considered in the last decade. Prevalence of AF among patients with chronic kidney disease (CKD) varies from 11 to 22 % (according to other data – from 15 to 20 %) and increases with age, considerably surpassing that in the general population among all age groups. Vast majority of patients with AF need in treatment with anticoagulants to prevent an ischemic stroke and systemic thromboembolisms. However, in case of combination AF and CKD, in addition to increase in frequency of strokes and the thromboembolic events, also the frequency of major bleedings significantly increases that considerably complicates the choice of adequate anticoagulant therapy in such situation. Many years the vitamin K antagonists were the only representatives of a class of anticoagulants for long-term therapy in patients with AF. Their well-known deficiencies (a narrow therapeutic window, need of frequent laboratory control, numerous drug-drug and dietary interactions, unpredictability of a pharmacodynamics and pharmacokinetics at certain patients) promoted search of new medicines, more convenient in use. Direct oral anticoagulants were easier to use, and by results of the main studies didn't yield or exceeded warfarin concerning balance of efficiency and safety. However, they were not specially studied in patients with the reduced kidney function. Features of modern anticoagulant therapy in elder patients with the AF and CKD are considered in the review.

антикоагулянтная терапияпожилой возрастфибрилляция предсердийхроническая болезнь почек

anticoagulant therapyadvanced ageatrial fibrillationchronic kidney disease

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