#16
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Êñòàòè, èíòåðåñíî, ÷òî 30% ÈÌ ñëó÷èëèñü óæå ïîñëå îòìåíû èññëåäóåìûõïðåïàðàòîâ. À â Ðîññèè áûëî, âðîäå áû, 18 èëè 20 öåíòðîâ.
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#17
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#18
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Öèòàòà:
Ê ñîæàëåíèþ íå ïðèõîäèëîñü âñòðå÷àòüñÿ ñ ñåðüåçíûìè èññëåäîâàíèÿìè ïî ýôôåêòèâíîñòè äàííîé êîìáèíàöèè â ïðîôèëàêòèêå èíñóëüòà ïðè ÔÏ. |
#19
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À êàê æå óïîìÿíóòîå Gilarov èññëåäîâàíèå ACTIVE (W, A)?
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#20
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 èññëåäîâàíèè ACTIVE äîáàâëåíèå êëîïèäîãðåëÿ ê àñïèðèíó ñíèæàëî ðèñê èíñóëüòà, íî ïîâûøàëî ðèñê áîëüøèõ êðîâîòå÷åíèé... â íåäàâíåé ïóáëèêàöèè íåò-áåíåôèòû îò äîáàâëåíèÿ êëîïèäîãðåëÿ ñòàò. íåäîñòîâåðíû:
Adding clopidogrel to aspirin therapy prevented 0.57 ischemic stroke equivalent (95% CI, -0.12 to 1.24) per 100 patient-years of treatment when weighted by hazard for death after ischemia or hemorrhage and 0.67 ischemic stroke equivalent (CI, -0.03 to 1.18) when weighted by death or disability after ischemia or hemorrhage. --- Ann Intern Med. 2011 Nov 1;155(9):579-86. Net clinical benefit of adding clopidogrel to aspirin therapy in patients with atrial fibrillation for whom vitamin K antagonists are unsuitable. è ïîõîæå äàííàÿ êîìáèíàöèÿ öåíîâî-ýôôåêòèâíà òîëüêî äëÿ îïðåäåëåííîé ãðóïïû ïàöèåíòîâ: clopidogrel plus aspirin appears cost-effective compared to aspirin alone for stroke prevention in patients with AF with a CHADS(2) of ≥2 and a lower risk of bleeding. --- Am J Cardiol. 2012 Jan 3. Cost-Effectiveness of Clopidogrel Plus Aspirin for Stroke Prevention in Patients With Atrial Fibrillation in Whom Warfarin Is Unsuitable.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#21
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Öèòàòà:
PS êàê áûñòðî â Âàøåì ëå÷åáíîì ó÷ðåæäåíèè îïðåäåëÿþò ÌÍÎ, åñëè ïàöèåíò ïîñòóïàåò â âå÷åðíåå èëè íî÷íîå âðåìÿ? |
#22
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Äàæå åñëè ïîòîðîïèòü ìåäñåñò¸ð, çàáèðàþùèõ êðîâü, ñàíèòàðîê, îòíîñÿùèõ êðîâü, è ëàáîðàòîðèþ (÷åãî íè òå, íè äðóãèå, íè òðåòüè ñèëüíî íå ëþáÿò) - ìèíèìóì 20 ìèíóò.
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#23
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Âàì êðóïíî ïîâåçëî.  íàøåé áîëüíèöå âå÷åðîì, íî÷üþ è ïî âûõîäíûì ÌÍÎ íå îïðåäåëÿþò âîâñå.
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#24
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Ðå÷ü øëà î ðåãèîíàëüíîì ñîñóäèñòîì öåíòðå - òàê ÷òî, âîçìîæíî, ýòî äàæå äîëãî. Ïðî òðîìáîëèçèñ íà ôîíå âàðôàðèíà ïðè ÌÍÎ ìåíåå 1,4 - âàæíîå äîïîëíåíèå (óòî÷íèì - âðîäå íå áîëåå 1,3).
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#25
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Öèòàòà:
Òàê êàê â ðåêîìåíäàöèÿõ AHA ãîâîðèòñÿ: Öèòàòà:
Öèòàòà:
Òàêèì îáðàçîì, íåâðîëîãè, áóäó÷è ëþäüìè îñòîðîæíûìè, ê ýòîé êîìáèíàöèè ïðèáåãàþò êðàéíå ðåäêî è îáû÷íî íå ïðè ÔÏ. À ïðî ÌÍÎ - òàê âåäü èíñóëüòû íå òîëüêî íî÷üþ ñëó÷àþòñÿ. |
#26
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#27
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Ñëîæíî ñêàçàòü, ÷òî âàæíåå - èíñòðóêöèÿ ê ïðåïàðàòó (ãäå ÌÍÎ 1,3, à òåðàïåâòè÷åñêîå îêíî äëÿ ÎÍÌÊ - 3 ÷àñà) èëè ðåêîìåíäàöèè íåâðîëîãè÷åñêèõ ñîîáùåñòâ (ãäå ÌÍÎ 1.7, à òàêæå ýêñïåðèìåíòû â îêíå 3-4,5 ÷àñà). Ïî ìíå - ïåðâîå.
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#28
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À êàêèìè ðåêîìåíäàöèÿìè ðóêîâîäñòâóþòñÿ îñòîðîæíûå íåâðîëîãè â âûáîðå ñðåäñòâà ïðåäóïðåæäåíèÿ èíñóëüòà ïðè ÔÏ? Ðåêîìåíäàöèè ïî ÔÏ è òðîìáîïðîôèëàêòèêó ïðè íåé íàïèñàíû â ìàññå ñâîåé êàðäèîëîãàìè. Åñòü ëè ÷òî-òî íà ýòó òåìó, íàïèñàííîå íåâðîëîãàìè?
P S òàê âñå æå ÌÍÎ â Âàøåé áîëüíèöå íî÷üþ îïðåäåëÿþò? |
#29
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ÌÍÎ: ÿ ñîâìåùàþ â ÐÑÖ è ãîðîäñêîé áîëüíèöå - â ïåðâîé îïðåäåëÿþò îäíîçíà÷íî, à ïðî âòîðóþ - åñëè äåæóðèò âðà÷-ëàáîðàíò (ïðàêòè÷åñêè âñå áóäíè è íå âñå âûõîäíûå) è î÷åíü ïîïðîñèòü, òî âûïîëíÿò è íî÷üþ.
Èíòåðåñíî: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
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#30
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] è ïðî÷. È òàì ýòà ñàìàÿ êîìáèíàöèÿ íèãäå íå ðåêîìåíäóåòñÿ, â îòëè÷èè îò ãàéäîâ, îïóáëèêîâàííûõ â Chest ÷èñòî êàðäèîëîãè÷åñêîé ãðóïïîé. PS  Ñåé÷àñ ÿ ðàáîòàþ â áîëüíèöå, êîòîðàÿ íå ÿâëÿåòñÿ ñêîðîïîìîùíîé è íå ÿâëÿåòñÿ ñîñóäèñòûì öåíòðîì, ïîýòîìó ìíå íè ðàçó íå ïîíàäîáèëîñü ÌÍÎ íî÷üþ. Íî äóìàþ ýòî âîçìîæíî - ïîñòîÿííî äåæóðèò âðà÷-ëàáîðàíò. PPS Ïîâòîðþñü - ÒËÒ ïðîâîäèòñÿ è äíåì. |