Dvoynaya antitrombotsitarnaya terapiya – proverennyy vremenem effektivnyy sposob lecheniya ostrogo koronarnogo sindroma


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Abstract

Несмотря на значительные усилия по увеличению доступности инвазивного лечения коронарной болезни сердца большинство больных с острым коронарным синдромом (ОКС) в нашей стране продолжают лечиться неинвазивно, особенно в случаях, когда нет показаний для срочного восстановления проходимости окклюзированной коронарной артерии. Так, по данным регистра РЕКОРД, включавшего данные о 796 больных, лечившихся в 18 стационарах, 10 из которых располагали возможностями выполнения чрескожных коронарных вмешательств (ЧКВ), процедура была выполнена у 25,6% больных с ОКС со стойкими подъемами сегмента ST на электрокардиограмме (ЭКГ) – ОКСпST. При ОКС без стойких подъемов сегмента ST на ЭКГ (ОКСбпST) во время госпитализации инвазивные вмешательства на коронарных артериях выполнялись в 20,4% случаев. Похожий результат получен и в Регистре ОКС на значительно большем клиническом материале – доля больных с ОКС, подвергнутых ЧКВ, составила 12,8%: при ОКСпST 22,3%, а при ОКСбпST всего лишь 7,6%. Соответственно, для большинства больных с ОКС возможность уменьшения частоты неблагоприятных исходов за счет своевременно выполненной реваскуляризация миокарда оказывается упущенной. Очевидно, что в этих условиях особую важность приобретает необходимость строго следовать принципам надлежащего медикаментозного лечения заболевания, чтобы не упустить оставшиеся возможности положительно воздействовать на прогноз.В данном сообщении на примере наиболее хорошо изученного и имеющего широкие показания сочетания ацетилсалициловой кислоты (АСК) и клопидогрела будут представлены сведения о клинических эффектах, которые ожидаются при применении двойной антитромбоцитарной терапии при неинвазивном лечении ОКС.

About the authors

I. S Yavelov

ГБОУ ВПО РНИМУ им. Н.И.Пирогова Минздрава РФ, Москва

Кафедра клинической фармакологии

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