Статья
Антитромбоцитарная терапия и риск желудочно-кишечных кровотечений
Назначение аспирина для предупреждения сердечно-сосудистых катастроф требует сопоставления риска атеротромбоза с риском геморрагических осложнений. Вероятно, не существует такой минимальной дозы аспирина, которая, с одной стороны, обладала бы антитромбоцитарной активностью, а с другой, была бы безопасна в плане желудочно-кишечных кровотечений. Результаты крупных, рандомизированных исследований позволяют констатировать хорошую переносимость и меньшее число побочных эффектов клопидогреля. Пациентам группы высокого риска атеротромбоза с непереносимостью аспирина следует назначать клопидогрель как более безопасный препарат. В комбинации с клопидогрелем аспирин рекомендуется использовать в минимальной дозе. Защита желудочно-кишечного тракта ингибиторами протонной помпы и/или эрадикация Helicobacter pylori у пациентов, получающих аспирин, активно обсуждаются в литературе, но пока не получили серьезной доказательной базы, что чрезвычайно важно, когда речь идет о пожизненной защите пациента от повторных неблагоприятных атеротромботических событий.
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