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Àëêîãîëü è è ïðîäîëæèòåëüíîñòü æèçíè â íåäàâíåé ïóáëèêàöèè - ïî ñðàâíåíèþ ñî 100 ã àáñ. àëêîãîëÿ â íåäåëþ ïðèåì áîëåå 350 ã (èëè áîëåå 125 ã 40% âîäêè â äåíü) ñîêðàùàåò æèçíü íà 4-5 ëåò:
Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Ñåãîäíÿ íàòêíóëñÿ íà òàêóþ çàìåòêó â íîâîñòÿõ:
"Ðîññèéñêèå ó÷åíûå óäèâèëè Çàïàä ñïîñîáîì ïðèìåíåíèÿ Áîòîêñà Óíèâåðñèòåò Äüþêà îöåíèë ýôôåêòèâíîñòü è áåçîïàñíîñòü îòå÷åñòâåííîãî ñðåäñòâà, ñïàñàþùåãî îò ôèáðèëëÿöèè ïðåäñåðäèé... ðàíåå áîòóëîòîêñèí â êàðäèîëîãèè íå ïðèìåíÿëñÿ. Íàöèîíàëüíûé ìåäèöèíñêèé èññëåäîâàòåëüñêèé öåíòð èìåíè Å.Ì. Ìåøàëêèíà ñòàë ïåðâûì. Ñåé÷àñ æå êàê ñðåäñòâî îò àðèòìèè áîòóëîòîêñèí óæå òåñòèðóåò Allergan, ïðîèçâîäèòåëü ýòîãî òîêñèíà. Ìåæäó òåì, â îò÷åòå ðîññèéñêèõ ó÷åíûõ ãîâîðèòñÿ: "Ñïóñòÿ òðè ãîäà ïîñëå ââåäåíèÿ òîêñèíà âûÿñíèëîñü, ÷òî îí ïðîäîëæàåò ñâîå äåéñòâèå è ýôôåêòèâíî óñòðàíÿåò ðàçâèòèå ôèáðèëëÿöèé ïðåäñåðäèÿ ïî ñðàâíåíèþ ñ ãðóïïîé ïëàöåáî, ñíèæàÿ ðèñê ðàçâèòèÿ àðèòìèé íà 64%". ïîëèñòàë òûðíåò: Researchers in Duke’s Department of Anesthesiology and the Duke Clinical Research Institute launched their inquiry after a study from Russian scientists reported a 70-percent drop in atrial fibrillation episodes among a small cohort of heart surgery patients who were treated with strategic injections of botulinum toxin (commonly marketed as Botox). Waldron and colleagues enrolled 130 patients who were slated to undergo a coronary artery bypass grafting procedure, valve surgery, or both. During their surgeries, roughly half the patients were randomly assigned to receive shots of botulinum toxin in the fat pads around their heart -- where the fibrillation is known to arise; the other half received harmless saline. The medical teams did not know which injection the patients received. Researchers reported an absolute 11% reduction in post-operative atrial fibrillation in these patients compared with patients who had had saline injected into their cardiac heart pads during the operation, but that difference -- 36.5% compared with 47.8% -- did not reach statistical significance (P = .18). â îðèãèíàëå ÷àñòîòà ÔÏ áûëà èíàÿ è àáñ. ñíèæåíèå áûëî â äâà ðàçà âûøå - 23%: The incidence of early postoperative atrial fibrillation within 30 days after coronary artery bypass graft was 2 of 30 patients (7%) in the botulinum toxin group and 9 of 30 patients (30%) in the placebo group (P=0.024). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ñêîðåå âñåãî èç-çà íåáîëüøîãî êîëè÷åñòâà ïàöèåíòîâ âûïàë ñëó÷àéíûé ðåçóëüòàò, îêàçàâøèéñÿ è ñòàòèñòè÷åñêè çíà÷èìûì...
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Ìàéñêàÿ ïóáëèêàöèÿ â JAMA 2018 - 13-ëåòíåå íàáëþäåíèå â Äàíèè çà 30 òûñ. ïàöèåíòîâ ñ ÔÏ è èíñóëüòîì â ñðåäíåì âîçðàñòå 79-82 ëåò - òðåòü ïîëó÷àëà àíòèêîàãóëÿíòû, îêîëî 40% àíòèàãðåãàíòû è ÷åòâåðòü íå ïîëó÷àëà íèêàêîãî àíòèòðîìáîòè÷åñêîãî ëå÷åíèÿ, çà ïîñëåäóþùèå 10 ëåò ïîâòîðíûé òðîìáîýìáîëè÷åñêèé ýïèçîä ðàçâèëñÿ â 17.5%, 21.2%, è 21.5% ñëó÷àÿõ â êàæäîé ãðóïïå ñîîòâåòñòâåííî è ñìåðòíîñòü áûëà 72.7%, 86.4%, and 86.2%, â ãðóïïå àíòèêîàãóëÿíòîâ íå áûëî ïîâûøåííîãî ðèñêà îñëîæíåíèé, ñâÿçàííîãî ñ êðîâîòå÷åíèÿìè.
Âïå÷àòëÿåò ïîëíîå îòñóòñòâèå ýôôåêòà îò àíòèàãðåãàíòîâ è ïëþñ ~13.5% øàíñû íå óìåðåòü ê 90-òà ãîäàì, åñëè ïðèíèìàòü àíòèêîàãóëÿíòû ïîäðîáíåå Prestroke and Poststroke Antithrombotic Therapy in Patients With Atrial Fibrillation Results From a Nationwide Cohort [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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âïîëíå îæèäàåìûé ðåçóëüòàò
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Ñ óâàæåíèåì |
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Î èíôàðêòå ìèîêàðäà 2-ãî òèïà â íåäàâíåé ïóáëèêàöèè
Viewpoint June 11, 2018 Type 2 Myocardial Infarction—Diagnosis, Prognosis, and Treatment [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Èíòåðåñíîå íàáëþäåíèå îò øâåäîâ - íåò ðàçíèöû â èñõîäàõ, åñëè ïàöèåíòû ñ ÔÏ íà âàðôàðèíå â áîëåå 70% ïðåáûâàþò â òåðàïåâòè÷åñêîì äèàïàçîíå èëè æå ïîëó÷àþò íîâûå àíòèêîàãóëÿíòû, íî ÷àñòîòà êðîâîòå÷åíèé ñóùåñòâåííî íèæå íà àïèêñàáàíå è äàáèãàòðàíå, íî íå íà ðèâàðîêñàáàíå (àïèêñàáàí ïîëó÷àëè íàèáîëüøåå êîëè÷åñòâî ïàöèåíòîâ, íåñìîòðÿ íà òî, ÷òî ýòîò ïðåïàðàò ïðèøåë íà ðûíîê ñàìûì ïîñëåäíèì):
Nationwide retrospective cohort study based on Swedish quality registries. Atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban or warfarin between 2013-01-01 and 2015-12-31 were included. Main outcome measures were all-cause stroke and systemic embolism, all-cause stroke, ischemic stroke, hemorrhagic stroke; major bleeding, intracranial bleeding, gastrointestinal bleeding, other bleeding (fatal or requiring hospital care); all-cause mortality; myocardial infarction. The study included 64,382 patients corresponding to 81,176 treatment years. Of these, 37,174 patients were instituted on warfarin, 6574 on dabigatran, 8323 on rivaroxaban and 12,311 on apixaban. In warfarin treated patients, the time in therapeutic range was 71.4%. After propensity score matching, there was no significant difference in risk of stroke or systemic embolism between NOAC and warfarin treated patients. Hazard ratios for major bleeding events were 0.63(95%CI 0.52-0.75) for apixaban, 0.74(0.62-0.87) for dabigatran and 1.06(0.92-1.23) for rivaroxaban, compared with warfarin. --- Thromb Res. 2018 May 17;167:113-118. Dabigatran, rivaroxaban and apixaban vs. high TTR warfarin in atrial fibrillation.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
First look at the new 2018 European Guidelines for the treatment of high blood pressure 1) Êëàññèôèêàöèÿ ÀÄ è îïðåäåëåíèå Àà íå èçìåíèëèñü è îïðåäåëÿþòñÿ êàê îôèñíûå èçìåðåíèÿ ÑÀÄ ≥ 140 ìì ðò ñò è/èëè ÄÀÄ ≥ 90 ìì ðò ñò, ÷òî ÿâëÿåòñÿ ýêâèâàëåíòîì 24-÷àñîâîãî ñðåäíåãî ÀÄ ≥130/80 èëè äîìàøíèõ ñàìîèçìåðåíèé ≥ 135/85. 2) Ñêðèíèíã â âèäå èçìåðåíèÿ ÀÄ íåîáõîäèì êàê ìèíèìóì êàæäûå 5 ëåò è ÷àùå ó ïàöèåíòîâ ñ âûñîêèì íîðìàëüíûì ÀÄ. Àêöåíò íà àêêóðàòíîñòü èçìåðåíèé ÀÄ ñ èñïîëüçîâàíèåì ñðåäíåãî îò èçìåðåíèé, ñäåëàííûõ âî âðåìÿ íåñêîëüêèõ âèçèòîâ çà èñêëþ÷åíèåì òÿæåëîé Àà (íàïðèìåð, ïðè 3 ñòåïåíè è ïàöèåíòîâ âûñîêîãî ðèñêà) è íà âíåîôèñíûõ èçìåðåíèÿõ (åñëè ëîãèñòè÷åñêè è ýêîíîìè÷åñêè äîïóñòèìî). Õîòÿ Àà îïðåäåëÿåòñÿ íà îñíîâàíèè îôèñíûõ èçìåðåíèé, áîëåå øèðîêîå èñïîëüçîâàíèÿ âíåîôèñíûõ èçìåðåíèé ÀÄ ñ ïîìîùüþ ÑÌÀÄ è äîìàøíèõ èçìåðåíèé, îñîáåííî äîìàøíèå èçìåðåíèÿ äëÿ âûÿâëåíèÿ ãèïåðòîíèè áåëîãî õàëàòà, ìàñêèðîâàííîé ãèïåðòîíèè è ìîíèòîðèðîâàíèÿ êîíòðîëÿ ÀÄ. 3) Äëÿ ïàöèåíòîâ áåç ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé ðåêîìåíäîâàíà îöåíêà ïîðàæåíèÿ îðãàíîâ ìèøåíåé, òàê êàê îíî ïîâûøàåò ñåðäå÷íî-ñîñóäèñòûé ðèñê äî áîëåå âûñîêîãî óðîâíÿ.  ñïèñîê ôàêòîðîâ, âëèÿþùèõ íà ÑÑ ðèñê ó ïàöèåíòîâ ñ ÀÃ, äîáàâëåíà ×ÑÑ ïîêîÿ áîëåå 80 óäàðîâ â ìèíóòó. 4) Áîëåå íèçêèå öåëåâûå óðîâíè ÀÄ ðåêîìåíäîâàíû ñ àêöåíòîì ïðè ïðèíÿòèè ðåøåíèÿ íà áèîëîãè÷åñêèé, à íå õðîíîëîãè÷åñêèé âîçðàñò (õðóïêîñòü, îòñóòñòâèå íåîáõîäèìîñòè â ïîñòîðîííåé ïîìîùè, ïåðåíîñèìîñòü òåðàïèè). Ïîä÷åðêèâàåòñÿ, ÷òî òåðàïèÿ íå äîëæíà îòìåíÿòüñÿ íà îñíîâàíèè âîçðàñòà, åñëè îíà íîðìàëüíî ïåðåíîñèòñÿ. 5) Ïîæèëûå ïàöèåíòû: Ðåêîìåíäàöèè, êàñàþùèåñÿ íà÷àëà àíòèãèïåðòåíçèâíîé òåðàïèè èçìåíèëèñü: ïðè õîðîøåé ïåðåíîñèìîñòè íå ðåêîìåíäîâàíà îòìåíà òåðàïèè íà îñíîâàíèè âîçðàñòà, äàæå â âîçðàñòå ñòàðøå ≥ 80 ëåò. Àíòèãèïåðòåíçèâíàÿ òåðàïèÿ è ìîäèôèêàöèÿ îáðàçà æèçíè ðåêîìåíäîâàíà ïîæèëûì ïàöèåíòàì ñ ÀÃ: > 80 ËÅÒ, ïðè ÑÀÄ ≥ 160 ìì ðò ñò. > 65 ëåò, íî íå ñòàðøå > 80 ëåò, êîãäà ÑÀÄ 1 ñòåïåíè ïîâûøåíèÿ ÀÄ (140–159 ìì ðò ñò), ïðè óñëîâèè õîðîøåé ïåðåíîñèìîñòè. 6) Ïàöèåíòàì ñ âûñîêèì íîðìàëüíûì ÀÄ (130–139/85–89 ìì ðò ñò) è Àà 1 ñòåïåíè ðåêîìåíäîâàíà ìîäèôèêàöèÿ îáðàçà æèçíè. Ïðè Àà 1 ñòåïåíè â ñëó÷àå íèçêîãî è ñðåäíåãî ðèñêà è áåç ïîäòâåðæäåíèÿ ïîðàæåíèÿ îðãàíîâ-ìèøåíåé àíòèãèïåðòåíçèâíàÿ òåðàïèÿ ðåêîìåíäîâàíà, åñëè ìîäèôèêàöèÿ îáðàçà æèçíè íå äàëà ýôôåêòà. Ïðè Àà 1 ñòåïåíè â ñëó÷àå âûñîêîãî ðèñêà èëè ïîðàæåíèè îðãàíîâ ìèøåíåé ðåêîìåíäîâàíî íåçàìåäëèòåëüíîå íàçíà÷åíèå àíòèãèïåðòåíçèâíîé òåðàïèè ñ ìîäèôèêàöèåé îáðàçà æèçíè, ñ ðåêîìåíäàöèåé íèêîãäà íå îòêëàäûâàòü íà÷àëî àíòèãèïåðòåíçèâíîé òåðàïèè ó ïàöèåíòîâ ñ ïîðàæåíèåì îðãàíîâ ìèøåíåé èëè âûñîêèì ÑÑ ðèñêîì. Íåçàìåäëèòåëüíîå íàçíà÷åíèå àíòèãèïåðòåíçèâíîé òåðàïèè ñ ìîäèôèêàöèåé îáðàçà æèçíè ðåêîìåíäîâàíî ó ïàöèåíòîâ ñ Àà 2 è 3 ñòåïåíè ïðè ëþáîì ðèñêå. Ïåðâîé öåëüþ òåðàïèè äîëæíî áûòü ñíèæåíèå ÀÄ <140/90 ìì ðò ñò ó âñåõ ïàöèåíòîâ. Ïðè õîðîøåé ïåðåíîñèìîñòè òåðàïèè ÀÄ äîëæíî ñíèæàòüñÿ äî 130/80 ìì ðò ñò è íèæå. Öåëåâîé óðîâåíü ÄÀÄ <80 ìì ðò ñò äîëæåí èñïîëüçîâàòüñÿ ó âñåõ ïàöèåíòîâ ñ ÀÃ, íåçàâèñèìî îò ÑÑ ðèñêà è ñîïóòñòâóþùèõ çàáîëåâàíèé. Ïîæèëûå è î÷åíü ïîæèëûå ïàöèåíòû: íîâà êîíöåïöèÿ ñ ìåíåå êîíñåðâàòèâíûì ïîäõîäîì ê öåëåâûì çíà÷åíèÿì ÀÄ. Âîçðàñò < 65 ëåò: ÑÀÄ 120 - <130 ìì ðò ñò Âîçðàñò > 65: ÑÀÄ 130 - <140 ìì ðò ñò - Íåîáõîäèìî èçáåãàòü çíà÷åíèé ÑÀÄ < 130 ìì ðò ñò -  êà÷åñòâå öåëè íå äîëæíî ðàññìàòðèâàòüñÿ ÑÀÄ < 120 ìì ðò ñò. Ñàõàðíûé äèàáåò: ÑÀÄ 130 è íèæå ÈÁÑ: ÑÀÄ 130 è íèæå ÕÁÏ: ÑÀÄ 130 - <140 ìì ðò ñò Ïîñëå èíñóëüòà: ÑÀÄ 120 - <130 ìì ðò ñò (äëÿ ðåøåíèÿ) 7) Îñíîâíîé àêöåíò ðåêîìåíäàöèé íà óïðîùåíèè òåðàïåâòè÷åñêîé ñòðàòåãèè äëÿ óëó÷øåíèÿ ïðèâåðæåííîñòè ëå÷åíèÿ è êîíòðîëÿ ÀÄ ïîñðåäñòâîì íàçíà÷åíèÿ îäíîé òàáëåòêè (ôèêñèðîâàííûå êîìáèíàöèè) áîëüøèíñòâó ïàöèåíòîâ. ÎÑÍÎÂÓ ÀÍÒÈÃÈÏÅÐÒÅÍÇÈÂÍÎÉ ÒÅÐÀÏÈÈ ÄÎËÆÍÛ ÑÎÑÒÀÂËßÒÜ ÒÅÆÅ 5 ÎÑÍÎÂÍÛÕ ÊËÀÑÑΠÀÍÒÈÃÈÏÅÐÒÅÍÇÈÂÍÛÕ ÏÐÅÏÀÐÀÒÎÂ Ñ ÏÐÅÈÌÓÙÅÑÒÂÅÍÍÛÌ ÈÑÏÎËÜÇÎÂÀÍÈÅÌ ÍÅÊÎÒÎÐÛÕ ÏÐÅÏÀÐÀÒΠÏÐÈ ÍÅÊÎÒÎÐÛÕ ÑÎÑÒÎßÍÈßÕ. Íà÷àëî òåðàïèè ñ 2 ïðåïàðàòîâ ó áîëüøèíñòâà ïàöèåíòîâ (èíãèáèòîð ÐÀÀÑ+ àíòàãîíèñò êàëüöèÿ èëè äèóðåòèê). Ñòðàòåãèÿ 1 òàáëåòêè êàê íà÷àëüíîé òåðàïèè ó áîëüøèíñòâà ïàöèåíòîâ. - Êîìáèíèðîâàííàÿ òåðàïèÿ äëÿ íà÷àëüíàÿ òåðàïèè ñ ïðåèìóùåñòâåííûì èñïîëüçîâàíèåì ôèêñèðîâàííûõ êîìáèíàöèé â îäíîé òàáëåòêå ó áîëüøèíñòâà ïàöèåíòîâ. Èñêëþ÷åíèå õðóïêèå ïîæèëûå ïàöèåíòû è ïàöèåíòû ñ íèçêèì ðèñêîì è ïðè âûñîêîì íîðìàëüíîì ÀÄ. - Èñïîëüçîâàíèå ìîíîòåðàïèè ó ïàöèåíòîâ íèçêîãî ðèñêà ñ Àà 1 ñòåïåíè èëè ïîæèëûõ õðóïêèõ ïàöèåíòîâ. -Èñïîëüçîâàíèå ôèêñèðîâàííîé òðîéíîé êîìáèíàöèè â îäíîé òàáëåòêå, âêëþ÷àþùåé èíãèáèòîð ÐÀÀÑ, Àíòàãîíèñò êàëüöèÿ è äèóðåòèêà ïðè îòñóòñòâèè êîíòðîëÿ ÀÄ íà äâîéíîé êîìáèíàöèè. Åñëè ÀÄ íå êîíòðîëèðóåòñÿ êîìáèíàöèåé 3 ïðåïàðàòîâ, íåîáõîäèìî èíòåíñèôèöèðîâàòü òåðàïèþ ïóòåì äîáàâëåíèÿ ñïèðîíîëàêòîíà (25-50 ìã) ïðè îòñóòñòâèè ïðîòèâîïîêàçàíèé èëè äðóãèõ äèóðåòèêîâ êàê àìèëîðèä èëè áîëåå âûñîêèìè äîçàìè äðóãèõ äèóðåòèêîâ, áåòà-áëîêàòîðîâ èëè àëüôà-áëîêàòîðîâ. Íàçíà÷àéòå áåòà-áëîêàòîðû ïðè íàëè÷èè ñîîòâåòñòâóþùèõ ïîêàçàíèé ê èõ èñïîëüçîâàíèþ, íàïðèìåð, ÕÑÍ, ñòåíîêàðäèè, ïîñëå èíôàðêòà ìèîêàðäà, ïðè ôèáðèëëÿöèè ïðåäñåðäèé èëè ó ìîëîäûõ æåíùèí ñ íàñòîÿùåé èëè ïëàíèðóþùåéñÿ áåðåìåííîñòüþ. Îñíîâíîé àëãîðèòì ïðèìåíèì òàêæå ïîðàæåíèåì îðãàíîâ ìèøåíåé, öåðåáîâàñêóëÿðíûìè çàáîëåâàíèÿìè, ñàõàðíûì äèàáåòîì èëè çàáîëåâàíèåì ïåðèôåðè÷åñêèõ àðòåðèé. • Óïðîùåííûé àëãîðèòì àíòèãèïåðòåíçèâíîé òåðàïèè ñ ïðåäïî÷òèòåëüíûì èñïîëüçîâàíèåì èíãèáèòîðîâ ÀÏÔ èëè ñàðòàíîâ â êîìáèíàöèè ñ àíòàãîíèñòàìè êàëüöèÿ è/èëè òèàçèäíûìè/òèàçèäîïîäîáíûìè äèóðåòèêàìè êàê îñíîâíàÿ ñòðàòåãèÿ äëÿ áîëüøèíñòâà ïàöèåíòîâ. Áåòà-áëîêàòîðû â êîìáèíàöèè ñ äèóðåòèêîì èëè äðóãèì ïðåïàðàòîì èç îñíîâíûõ êëàññîâ êàê àëüòåðíàòèâà, ïðè íàëè÷èè ñîîòâåòñòâóþùèõ ïîêàçàíèé ê èõ èñïîëüçîâàíèþ, íàïðèìåð, ÕÑÍ, ñòåíîêàðäèè, ïîñëå èíôàðêòà ìèîêàðäà, íåîáõîäèìîñòü êîíòðîëÿ ×ÑÑ. Òèàçèäû, õëîðòîëèäîí èëè èíäàïàìèä ìîãóò ñ÷èòàòüñÿ ïîäõîäÿùèìè ïðåïàðàòàìè. Íà 1 ìã õëîðòàëèäîí è èíäàïàìèä áîëåå ýôôåêòèâíû â ñíèæåíèè ÀÄ, ÷åì ãèäðîõëîðòèàçèä, ñ áîëüøåé ïðîäîëæèòåëüíîñòüþ äåéñòâèÿ è áåç äîêàçàíî áîëüøèõ ïîáî÷íûõ ýôôåêòîâ.
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íàèáîëåå èíòåðåñíîå íà ìîé âçãëÿä â ýòîì ïåðåñìîòðå, ýòî êîðèäîð öåëåâûõ çíà÷åíèé ÑÀÄ äî 65 ëåò - 120-130, 130-140 ïîñëå 65 ëåò è äëÿ ÕÏÍ, è ÄÀÄ 70-80 ìì ðò ñò.
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ãåïàòîòîêñè÷íîñòü è ïðî÷èå ïîá. ýôôåêòû ðèâàðîêñàáàíà, íå ñâÿçàííûå ñ êðîâîòå÷åíèÿìè:
Non-hemorrhage-related adverse effects of rivaroxaban [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Åùå îäèí ïðèìåð, êàê ýôôåêòèâíîñòü íîâûõ àíòèêîàãóëÿíòîâ çàâèñèò îò òîãî, â êàêîé ãðóïïå îíè ïðèìåíÿþòñÿ - âàðôàðèí åùå ðàíî ñïèñûâàòü â óòèëü èñòîðèè: ðèâàðîêñàáàí îêàçàëñÿ õóæå êàê ïî ýôôåêòèâíîñòè, òàê è áåçîïàñíîñòè, ó ïàöèåíòîâ ñ âûñîêîðèñêîâûì àíòèôîñôîëèïèäíûì ñèíäðîìîì, êîòîðûå áûëè ïîëîæèòåëüíû ïî ÂÀ, ÀÔÀ, àíòè-áåòà2-ÃÏ1 àíòèòåëàì:
The trial was terminated prematurely after the enrollment of 120 patients (59 randomized to rivaroxaban and 61 to warfarin) because of an excess of events among patients in the rivaroxaban arm. Mean follow up was 569 days. There were 11 (19%) events in the rivaroxaban group and 2 (3%) in the warfarin group. Thromboembolic events occurred in 7 (12%) patients randomized to rivaroxaban (4 ischemic stroke and 3 myocardial infarction) while no event was recorded in those randomized to warfarin. Major bleeding occurred in 6 patients, 4 (7%) in the rivaroxaban and 2 (3%) in the warfarin group. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Âîò, è [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Ñ óâàæåíèåì |
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ïðåêðàñíàÿ èíôîãðàôèêà ïî ÐÝÎ îòêðûòîãî îâàëüíîãî îêíà ó ïàöèåíòîâ ñ êðèïòîãåííûì èíñóëüòîì [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
EXPERT CONSENSUS DOCUMENT Fourth Universal Definition of Myocardial Infarction (2018) European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Àâãóñò 2018
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
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Åùå íåñêîëüêî êàðòèíîê îòòóäà æå.
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
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Rivaroxaban at a dose of 2.5 mg twice daily was not associated with a significantly lower rate of death, myocardial infarction, or stroke than placebo among patients with worsening chronic heart failure, reduced left ventricular ejection fraction, coronary artery disease, and no atrial fibrillation.
--- N Engl J Med. 2018 Aug 27. Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |