Статья
Профилактика желудочно-кишечных кровотечений у пациентов, получающих пероральные антикоагулянты: фокус на ингибиторы протонной помпы
В обзоре рассматривается проблема развития желудочно-кишечных кровотечений (ЖКК) у пациентов, получающих пероральные антикоагулянты, и возможности ингибиторов протонной помпы (ИПП) в снижении частоты таких осложнений. Представлены эпидемиологические данные о распространенности ЖКК на фоне приема новых оральных антикоагулянтов (НОАК) и варфарина. Обсуждаются факторы, повышающие риск кровотечений, ассоциированных с применением антикоагулянтов, в т.ч. потенциально возможные межлекарственные взаимодействия и особенности рациона питания больных. Дано описание шкал, оценивающих вероятность развития кровотечений на фоне антикоагулянтной терапии. Во второй части обзора рассматриваются принципы профилактики и минимизации риска ЖКК при назначении НОАК. С точки зрения доказательной медицины подробно обсуждается роль ИПП в снижении риска ЖКК. Детально описаны результаты масштабных рандомизированных, клинических исследований и мета-анализов последних лет, свидетельствующие о способности ИПП благоприятно влиять на риск кровотечений из верхних отделов желудочно-кишечного тракта при приеме НОАК и варфа-рина, особенно при сопутствующей терапии ацетилсалициловой кислотой, благодаря чему ИПП могут рассматриваться в качестве одного из эффективных “инструментов” медикаментозной профилактики указанных осложнений.
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