Волгоградский государственный медицинский университет 400131, Волгоград, площадь Павших Борцов, 1 Цель. Оценить структуру назначения, эффективность и безопасность антитромботической терапии у больных с постоянной формой фибрилляции предсердий (ФП). Материал и методы. Выполнено простое несравнительное ретроспективное описательное одномоментное фармакоэпидемиологическое исследование на основе анализа 263 историй болезни пациентов с постоянной формой ФП, госпитализированных в кардиологическое отделение многопрофильного стационара. Результаты. Все пациенты стратифицированы на три группы в зависимости от значения индекса CHA 2 DS 2-VASc. В каждой группе оценивали антитромботическую терапию. У 1% (n=3) пациентов вероятность развития инсульта минимальная, поэтому необходимость в антитромботической терапии отсутствовала. Группу пациентов со значением индекса CHA 2 DS 2-VASc, равном 1, составили 6% (n=15) больных с ФП, которым в 0,7% случаев (n=2) была назначена ацетилсалициловая кислота, в 5% (n=12)-варфарин. Высокий риск развития тромбоэмболических осложнений (CHA 2 DS 2-VASc≥2) имели 93% (n=245) пациентов, 65% (n=172) из которых получали варфарин. Заключение. Антитромботическая терапия назначалась подавляющему большинству (97,7%) пациентов с ФП. В 25,4% случаев применялись антитромбоцитарные препараты, в том числе для пациентов с высоким риском развития тромбоэмболических осложнений. Варфарин назначался в 70,3% случаев. Однако целевой уровень гипокоагуляции был достигнут лишь у 51% больных. Ключевые слова: фибрилляция предсердий, тромбоэмболические осложнения, фармакоэпидемиологическое исследование, антитромботическая терапия. Рациональная фармакотерапия в кардиологии 2014;10(2):174-178 Analysis of antithrombotic therapy in in-patients with permanent atrial fibrillation (pharmacoepidemiology study)
The purpose of this review is to examine the possibilities and prospects for the use of direct oral anticoagulants for the prevention of thromboembolic complications in patients with atrial fibrillation and chronic kidney disease. Chronic kidney disease is an independent risk factor for cardiovascular complications. Atrial fibrillation is associated with a higher risk of developing chronic kidney disease and more rapid progression of existing renal pathology. The presence of chronic kidney disease in atrial fibrillation on the one hand leads to an increased risk of thromboembolism, and on the other to an increased risk of bleeding when using anticoagulants. The standard for the prevention of thromboembolic complications in atrial fibrillation, including those with concomitant renal pathology, was considered warfarin for many years. However, modern studies have shown that the use of warfarin may enhance vascular calcification in patients with chronic kidney disease, which in turn may lead to an increased risk of ischemic strokes.Analyzing clinical recommendations, randomized studies, meta-analyzes and a systematic review on the use of anticoagulants in patients with atrial fibrillation and renal pathology, revealed the advantage of using direct oral anticoagulants over warfarin at stage 1-3 of chronic kidney disease. Data on the use of direct oral anticoagulants with a more pronounced renal dysfunction and in patients on dialysis is limited due to the lack of a sufficient number of large randomized studies. Due to the presence of renal clearance in all oral anticoagulants, their pharmacokinetics changes to some extent with a decrease in the glomerular filtration rate, which requires dose adjustment of drugs depending on creatinine clearance. Therefore, the use of anticoagulants for the prevention of thromboembolic complications during atrial fibrillation requires special attention in patients with chronic kidney disease.
Aim. To evaluate the prevalence of accomplished goal in laboratory clotting parameters for the anticoagulant therapy in deep vein thrombosis (DVT).Material and methods. The study is performed as one-stage, descriptive, analytic, pharmacoepidemiologic investigation. The material for the study were 200 case histories of DVT from Volgograd hospitals. The analyzed were: structure of anticoagulant prescription, coagulogrammes with APTT, prothrombin complex and INR.Results. Direct acting anticoagulants were prescribed in 91% cases. High-molecular heparin was used in 84,5% prescriptions, low-molecular heparins — in 6,5%. Monitoring of APTT was done only in 36% patients. The target values of APTT (1,5–2,5 times higher than upper limit) was reached only in 6% cases. Of the indirect anticoagulants warfarin was used in 75,5%. Although laboratory control of warfarin was done in 97% cases, only in 28% of patients INR at discharge was in the range 2,0–3,0.Conclusion. The data witnesses a variety of drawbacks in anticoagulant therapy of DVT patients. High dosages of HMW heparin and warfarin, not enough rigourous control and dosage titration led to the absence of the desired therapeutic diapasone of hypocoagulation.
Клинико-экономическая оценка эффективности и безопасности существующей практики проведения периоперационной антибиотикопрофилактики на оcнове фармакоэпидемиологического исследования в многопрофильных стационарах Санкт-Петербурга Применение метода многокритериального анализа принятия решений (MCDA) для разработки инструмента оценки уровня терапевтической ценности (инновационности) оригинальных лекарственных препаратов Том 10
Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) who were hospitalized in the cardiology department of a multidisciplinary hospital.Material and methods. A retrospective one-time study of medical records of 765 patients with non-valvular AF treated in the cardiology department of a multidisciplinary hospital in 2012 and 2016 was performed.Results. All patients were stratified in three groups depending on the CHA2DS2-VASc score. The frequency of prescribing antithrombotic agents was evaluated in each group. A low risk of thromboembolic complications was found in 1% (n=3) of patients in 2012 and 0.6% (n=3) in 2016. All these patients received antithrombotic agents. CHA2DS2-VASc=1 was found in 6% (n=15) of patients with AF in 2012 and in 3.4% (n=17) in 2016. A significant number of patients in this group received anticoagulant therapy with vitamin K antagonists (warfarin) or with direct oral anticoagulants. A high risk of thromboembolic complications (CHA2DS2-VASc≥2) was found in 93% of patient (n=245) in 2012 and in 96% (n=482) in 2016. Anticoagulant therapy was prescribed in 70.2% (n=172) patients with high risk in 2012 and 80% (n=387) in 2016. However, some patients with high risk of thromboembolic complications did not have the necessary therapy.Conclusion. Positive changes in the structure and frequency of prescribing anticoagulant drugs in patients with AF and a high risk of thromboembolic complications were found during the years studied.
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