#16
|
||||
|
||||
|
#17
|
||||
|
||||
Öèòàòà:
íèçêèå äîçû àñïèðèíà íàçíà÷àþòñÿ ïðîôèëàêòè÷åñêè æåíùèíàì, êîòîðûå â àíàìíåçå èìåþò ðàííþþ (ðàíüøå 28 íåäåëü) ïðåýêëàìïñèþ. |
#18
|
|||
|
|||
Âîîáùå-òî âîïðîñ íå òàê óæ ïðîñò, êàê ýòî ìîãëî áû ïîêàçàòüñÿ íà ïåðâûé âçãëÿä.
Åñëè åãî ïåðåôîðìóëèðîâàòü â ñòðóêòóðèðîâàííûé êëèíè÷åñêèé çàïðîñ, òî îí áóäåò âûãëÿäåòü ïðèìåðíî òàê: Ó áåðåìåííûõ ïàöèåíòîê ñ ðèñêîì ðàçâèòèÿ ãåñòîçà (àíàìíåç ãåñòîçà â ïðåäøåñòâóþùóþ áåðåìåííîñòü) è ÿçâîé æåëóäêà/12 ïåðñòíîé êèøêè â àíàìíåçå íàñêîëüêî áåçîïàñíî è ýôôåêòèâíî íàçíà÷åíèå àñïèðèíà â íèçêèõ äîçàõ ñ öåëüþ ïðîôèëàêòèêè ãåñòîçà. Åñëè ïî âîïðîñó ýôôåêòèâíîñòè ñîìíåíèé â ïîëüçå àñïèðèíà íåò, ïîñêîëüêó â íåñêîëüêèõ ìåòà-àíàëèçàõ ïðîäåìîíñòðèðîâàí ïðîòåêòèâíûé ýôôåêò, òî âîïðîñ áåçîïàñíîñòè â òàêîé óçêîé ãðóïïå áåðåìåííûõ ïàöèåíòîê ïðàêòè÷åñêè íå èçó÷åí.  öåëîì, â îáùåé ïîïóëÿöèè áåðåìåííûõ ðèñê íåæåëàòåëüíûõ ÿâëåíèé ñî ñòîðîíû ÆÊÒ ïðè ïðèåìå àñïèðèíà íåâûñîê. Ìíå íå óäàëîñü íàéòè íè îäíîãî êëèíè÷åñêîãî èñïûòàíèÿ, â êîòîðîì áû îöåíèâàëàñü áåçîïàñíîñòü íèçêîäîçîâîãî àñïèðèíà ó áåðåìåííûõ ñ ÿçâåííûì àíàìíåçîì. Ìîæíî ïîïûòàòüñÿ ýêñòðàïîëèðîâàòü ðåçóëüòàòû ëå÷åíèÿ íèçêîäîçîâûì àñïèðèíîì â äðóãèõ ïîïóëÿöèÿõ. Ïî ïàðàìåòðàì ïîëà, âîçðàñòà, ñîïóòñòâóþùèõ çàáîëåâàíèé ïàöèåíòêó ìîæíî îòíåñòè ê ãðóïïå íèçêîãî ðèñêà, ðèñê ÆÊÒ-îñëîæíåíèé íà íèçêîäîçîâîì àñïèðèíå íà óðîâíå 1,5 - 2%.  òî æå âðåìÿ ñíèæåíèå ðèñêà ãåñòîçà íà óðîâíå 10-15%. Ïîëó÷àåòñÿ, ÷òî áàëàíñ â ïîëüçó èñïîëüçîâàíèÿ àñïèðèíà. Öèòàòà:
Ïëàöåáî-êîíòðîëèðóåìûõ ÐÊÈ äèïèðèäàìîëà äëÿ ïðîôèëàêòèêè ãåñòîçà íå îïóáëèêîâàíî. Åñòü áîëüøèå ñîìíåíèÿ, ÷òî êóðàíòèë áåç àñïèðèíà ñïîñîáåí ñíèæàòü ðèñê ãåñòîçà. Ïîýòîìó àñïèðèí, äåéñòâèòåëüíî, çàìåíèòü íå÷åì. Íàñ÷åò ïðîôèëàêòèêè ãàñòðîïàòèè ÈÏÏ (îìåïðàçîë è èæå ñ íèì) íå ìîãó íå ñîãëàñèòüñÿ ñ óâàæàåìûì Dr., ÷òî ýòî êàòåãîðèÿ Ñ. Íå òî ÷òîáû ñîâñåì íåëüçÿ, íî íåèçó÷åíî. À äàâàòü àñïèðèí íàäî íà âåñü ñðîê áåðåìåííîñòè. Ïðîòåêöèÿ îìåïðàçîëîì íà òàêîé ñðîê ÿâíî íå îïðàâäàíà. |
#20
|
||||
|
||||
À ïîáî÷íûå ýôôåêòû â áîëüøåé ñòåïåíè ñâÿçàíû ñ åãî ñèñòåìíûì, à íå ëîêàëüíûì äåéñòâèåì
|
#21
|
||||
|
||||
Ïàöèåíòû ó íàñ ãðàìîòíûå. Êîãäà èì íàçíà÷àåøü îáû÷íûé àñïèðèí ïðè ßÁ âíå îáîñòðåíèÿ, îíè áîÿòñÿ åãî ïðèíèìàòü äàæå êîãäà ïîêàæåøü èì ñòàòèñòèêó ïðåîáëàäàíèÿ ïîëüçû. Íî êîãäà îáúÿñíèøü èì, ÷òî àñïèðèí êèøå÷íûé è íà æåëóäîê è 12 ï. êèøêó íå äåéñòâóåò, îíè ïðèíèìàþò åãî îõîòíî.
|
#22
|
|||
|
|||
Öèòàòà:
|
|
#23
|
|||
|
|||
Ãåñòîç = ïîçäíèé òîêñèêîç = ïðåýêëàìïñèÿ (ëåãêàÿ è òÿæåëàÿ), ïîñëåäíèé òåðìèí ñîâðåìåííûé.
|
#24
|
||||
|
||||
A. Antiplatelet agents versus placebo or no treatment for the primary prevention of pre-eclampsia and its complications
Proteinuric pre-eclampsia Overall there is a 17% reduction in the risk of pre-eclampsia associated with the use of antiplatelet agents ((46 trials with 32,891 women, RR 0.83, 95% CI 0.77 to 0.89), RD -1.39% (-1.94, - 0.24), NNT 72 (52, 119)). This reduction in risk is statistically significant regardless of whether the woman was at moderate or high risk, gestation at trial entry, whether or not she was in a placebo controlled trial. Although there is a trend for the relative risk reduction to be greater in women at high risk of pre-eclampsia at trial entry (RR 0.75, 95% CI 0.66 to 0.85) than those at moderate risk (RR 0.86, 95% CI 0.79 to 0.95), the confidence intervals overlap and there is no clear statistical difference. However, there is a significant increase in the absolute risk reduction and consequent reduction in number needed to treat to prevent one case of pre-eclampsia in the high-risk women (RD -5.2%(-7.5, -2.9), NNT 19 (13, 34)) compared with moderate-risk women (RD -0.84 (-1.37, -0.3), NNT 119 (73, 333)). In the nine trials (1587 women) that were not placebo controlled, the reduction in risk of pre-eclampsia was significantly greater (RR 0.52, 95% CI 0.39 to 0.71) than in the 34 placebo controlled trials (31,003women) (RR0.85, 95%CI 0.78 to 0.92). Compared with trials using 75 mg or less of aspirin, there is a significant reduction in the risk of pre-eclampsia in trials using higher doses of antiplatelet agents. In the 21 trials (26,984 women) that evaluated 75mg/day or less of aspirin the RR is 0.88 (95%CI 0.81 to 0.95), in the 17 trials (3061 women) evaluating more than 75 mg/day of aspirin the RR is 0.64 (95% CI 0.51 to 0.80) and in the five trials of 506 women evaluating more than 75 mg/day of aspirin plus dipyridamole the RR is 0.30 (95% CI 0.15 to 0.60). No trials make a direct comparison of different doses of aspirin. A few small trials have combined aspirin with dipyridamole. In view of the small numbers, the results in this subgroup should be interpreted with caution. --- Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004659
__________________
Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#25
|
||||
|
||||
Öèòàòà:
ß áû ñêîðåå ïðåäïîëîæèë, ÷òî ðàçëè÷íûå äîïîëíèòåëüíûå êîìïîíåíòû òàáëåòêè, ìåøàþùèå âûñâîáîæäåíèþ ïðåïàðàòà, ìîãóò ñíèæàò àíòèòðîìáîöèòàðíóþ ýôôåêòèâíîñòü ËÑ. Íî ýòî, áåçóñëîâíî, òðåáóåò äîêàçàòåëüñòâ. Êàê, íàïðèìåð, ïîêàçàíî â îòíîøåíèè êèøå÷íîðàñòâîðèìîãî àñïèðèíà. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Íî ýòî íå ìåøàåò åãî ðåêîìåíäîâàòü. Åñëè âû ïðî÷èòàåòå èíñòðóêöèþ ê Àããðåíîêñó [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] òî äàæå ïðîèçâîäèòåëü ðåòàðäèðîâàííîãî äèïèðèäàìîëà ïðèçíàåò: Ðàçëè÷íûå êèíåòè÷åñêèå èññëåäîâàíèÿ ïðè ðàâíîâåñíîì ñîñòîÿíèè ïîêàçàëè, ÷òî ïî ôàðìàêîêèíåòè÷åñêèì ïàðàìåòðàì, õàðàêòåðèçóþùèì ïðåïàðàòû ñ ìîäèôèöèðîâàííûì âûñâîáîæäåíèåì, êàïñóëû äèïèðèäàìîëà ñ ìîäèôèöèðîâàííûì âûñâîáîæäåíèåì, êîòîðûå ïðèíèìàþò 2 ðàçà/ñóò, ëèáî ýêâèâàëåíòíû, ëèáî ïî íåêîòîðûì ïîêàçàòåëÿì, ïðåâîñõîäÿò òàáëåòêè äèïèðèäàìîëà, êîòîðûå ïðèíèìàþò 3-4 ðàçà/ñóò. Platelet function in pregnant women receiving aspirin and dipyridamole [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] http://www.ncbi.nlm.nih.gov/pubmed/3318469?ordinalpos=1&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pu bmed_Discovery_RA&linkpos=2&log$=relatedarticles&l ogdbfrom=pubmed . Low-dose aspirin and dipyridamole direct prostacyclin/thromboxane A2 balance in pregnancy to the dominance of prostacyclin and may thus prevent idiopathic uteroplacental insufficiency and fetal growth retardation in high-risk patients. Inhibition of platelet aggregation in whole blood by dipyridamole and aspirin [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] A comparison of the effects of aspirin and dipyridamole on platelet aggregation in vivo and ex vivo [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Mechanism of action of dipyridamole [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Beaufils M, Uzan S, Donsimoni R, Colau JC. Prospective controlled study of early antiplatelet therapy in prevention of preeclampsia. Adv Nephrol 1986;15:87–94. Wallenburg HCS, Rotmans N. Prophylactic low-dose aspirin and dipyridamole in pregnancy. Lancet 1988;1:939. DIPYRIDAMOLE AND PLATELET FUNCTION [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Effect of dipyridamole of prostaglandin generation by human platelets and vessel walls [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |