Гастропротективная терапия у пациентов с фибрилляцией предсердий, получающих антикоагулянтную терапию
- Авторы: Остроумова О.Д.1,2, Кочетков А.И.1, Батюкина С.В.1, Черемушкин С.В.3,4,5
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Учреждения:
- ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России
- ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
- ЧУЗ «Центральная клиническая больница „РЖД-Медицина“»
- ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России
- Центральная дирекция здравоохранения – филиала ОАО «РЖД»
- Выпуск: Том 25, № 5 (2023): Гастроэнтерология
- Страницы: 368-374
- Раздел: Статьи
- URL: https://journals.rcsi.science/2075-1753/article/view/131684
- DOI: https://doi.org/10.26442/20751753.2023.5.202294
- ID: 131684
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Аннотация
Профилактика тромбоэмболических осложнений является главной целью у пациентов с фибрилляцией предсердий. Для этого используют антикоагулянтную терапию, и здесь предпочтение отдается прямым оральным антикоагулянтам. Однако данная терапия сопряжена с риском кровотечений, среди которых желудочно-кишечные кровотечения (ЖКК) занимают лидирующее место. В настоящее время для профилактики ЖКК из верхних отделов желудочно-кишечного тракта (ЖКТ) широко применяются ингибиторы протонной помпы (ИПП), которые, однако, при долгосрочном применении могут ассоциироваться с рядом нежелательных лекарственных реакций, включая повышение риска неблагоприятных сердечно-сосудистых событий. Согласно имеющимся данным длительный прием ИПП может влиять на эффекты антитромбоцитарных препаратов, нарушать функцию эндотелия сосудов, индуцировать гипомагниемию, дефицит железа, витаминов D и К. Одновременно с этим терапия ИПП не защищает от риска кровотечений из нижних отделов ЖКТ. Таким образом, в качестве эффективной гастро- и энтеропротекции необходимо назначать препараты, обеспечивающие защиту ЖКТ на всем его протяжении. Таким препаратом является ребамипид, оказывающий комплексное протективное действие на ЖКТ, защищая слизистую оболочку на всех ее уровнях организации (пре-, постэпителиальном и непосредственно эпителиальном) и обеспечивая восстановление плотных контактов в эпителии пищеварительной трубки на всем ее протяжении. Следует отметить, что в актуальных согласительных документах ведущих экспертов по проблеме снижения риска ЖКК на фоне терапии прямыми оральными антикоагулянтами именно ребамипид рекомендуется к применению на всем ее протяжении.
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Ольга Дмитриевна Остроумова
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)
Автор, ответственный за переписку.
Email: ostroumova.olga@mail.ru
ORCID iD: 0000-0002-0795-8225
SPIN-код: 3910-6585
д-р мед. наук, проф., зав. каф. терапии и полиморбидной патологии им. акад. М.С. Вовси, проф. каф. клинической фармакологии и пропедевтики внутренних болезней
Россия, Москва; МоскваАлексей Иванович Кочетков
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России
Email: ak_info@list.ru
ORCID iD: 0000-0001-5801-3742
SPIN-код: 9212-6010
канд. мед. наук, доц., доц. каф. терапии и полиморбидной патологии им. акад. М.С. Вовси
Россия, МоскваСветлана Владимировна Батюкина
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России
Email: batyukina.svetlana@yandex.ru
ORCID iD: 0000-0003-1316-7654
аспирант 3-го года каф. терапии и полиморбидной патологии им. акад. М.С. Вовси
Россия, МоскваСергей Викторович Черемушкин
ЧУЗ «Центральная клиническая больница „РЖД-Медицина“»; ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России; Центральная дирекция здравоохранения – филиала ОАО «РЖД»
Email: svch555362@yandex.ru
ORCID iD: 0000-0002-0982-2006
SPIN-код: 5861-9287
канд. мед. наук, зам. глав. врача по терапевтической помощи, доц. каф. пропедевтики внутренних болезней и гастроэнтерологии, гл. терапевт
Россия, Москва; Москва; МоскваСписок литературы
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