Статья
Применение пероральных антикоагулянтов у пожилых пациентов с гериатрическими синдромами: что нового?
В обзорной статье обсуждаются вопросы применения пероральных антикоагулянтов у пожилых пациентов с гериатрическими синдромами, такими как синдром старческой астении, падения и высокий риск падений, деменция, полиморбидность, полипрагмазия. Рассмотрена доказательная база по использованию антикоагулянтов у пациентов с фибрилляцией предсердий в возрасте ≥75, ≥80, ≥85 и ≥90 лет, у пациентов с фибрилляцией предсердий и различными гериатрическими синдромами, а также у пожилых пациентов с венозными тромбоэмболическими осложнениями и синдромом «хрупкости». Результаты подавляющего большинства исследований указывают на значительные преимущества прямых пероральных антикоагулянтов (дабигатрана, ривароксабана, апиксабана и эдоксабана) над антагонистом витамина К варфарином у пожилых пациентов с гериатрическими синдромами. Также представлена обновленная версия консенсусного документа FORTA, целью которого является оптимизация назначения лекарственных средств пожилым людям. По мнению экспертов FORTA, апиксабан имеет класс безопасности FORTA-A и является наиболее безопасным пероральным антикоагулянтом для пожилых пациентов.
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