[MKMED]

Сообщение от Gilarov

До внедрения ксабанов/гатранов всерьез предлагалось использовать аспири+клопи в случае невозможности назначения варфарина. Эта комбинация лучше, чем просто аспирин.

Cовершенно верно, но надо оговориться: "До внедрения ксабанов/гатранов кардиологами всерьез предлагалось использовать аспири+клопи в случае невозможности назначения варфарина "

Так как в рекомендациях AHA говорится:

An additional arm of this study (ACTIVE A) compared
aspirin versus clopidogrel plus aspirin in AF patients who
were considered “unsuitable for vitamin K antagonist therapy”
and reported a reduction in the rate of stroke with
clopidogrel plus aspirin. Stroke occurred in 296 patients
receiving clopidogrel plus aspirin (2.4% per year) and 408
patients receiving aspirin monotherapy (3.3% per year; RR,
0.72; 95% CI, 0.62 to 0.83; P0.001). Major bleeding
occurred in 251 patients receiving clopidogrel plus aspirin
(2.0% per year) and in 162 patients receiving aspirin alone
(1.3% per year; RR, 1.57; 95% CI, 1.29 to 1.92; P0.001).232
An analysis of major vascular events combined with major
hemorrhage showed no difference between the 2 treatment
options (RR, 0.97; 95% CI, 0.89 to 1.06; P
0.54). The
majority of patients enrolled in this study were deemed to be
unsuitable for warfarin based on physician judgment or
patient preference; only 23% had increased bleeding risk or
inability to comply with monitoring as the reason for enrollment.
Therefore, on the basis of uncertainty of how to
identify patients who are “unsuitable” for anticoagulation, as
well as the lack of benefit in the analysis of vascular events
plus major hemorrhage, aspirin remains the treatment of
choice for AF patients who have a clear contraindication to
vitamin K antagonist therapy but are able to tolerate antiplatelet
therapy.

В наиболее свежем Кохрановском обзоре:

The available evidence demonstrates that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular
events and an increased risk of bleeding compared with aspirin alone. Only in patients with acute non-ST coronary syndrome benefits
outweigh harms.

ESO упомянать не будем, так как им давно пора обновлять свои рекомендации

Таким образом, неврологи, будучи людьми осторожными, к этой комбинации прибегают крайне редко и обычно не при ФП.

А про МНО - так ведь инсульты не только ночью случаются.