Статья
ПРИВЕРЖЕННОСТЬ К ПРИЕМУ НОВЫХ ПЕРОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ У БОЛЬНЫХ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ – ПУТЬ К РЕШЕНИЮ ПРОБЛЕМЫ ЭФФЕКТИВНОСТИ И БЕЗОПАСНОСТИ ЛЕЧЕНИЯ
Фибрилляция предсердий (ФП) увеличивает риск развития инсульта, поэтому долгосрочная антикоагулянтная терапия является стандартом лечения абсолютного большинства пациентов с этой аритмией. Варианты антикоагулянтной терапии включают антагонисты витамина К, такие как варфарин, польза которых давно установлена, но имеющие ряд недостатков, а также их альтернативу – пероральные антикоагулянты – не антагонисты витамина К, рекомендуемые для лечения пациентов с ФП при умеренном или высоком риске развития инсульта. Приверженность к фармакотерапии важна для долгосрочной эффективности любых препаратов, однако в «реальном мире» у пациентов с ФП следует ожидать относительно низкие уровни приверженности к лекарственным средствам по сравнению с клиническими исследованиями. Опыт в нескольких областях терапии, включая лечение сердечно-сосудистых заболеваний, показывает, что низкая приверженность к постоянному приему лекарств – обычное явление. Однако здесь могут оказаться выгодными простые схемы дозирования, поскольку долгосрочные исходы при ФП, вероятно, будут зависеть от приверженности к лечению. Ривароксабан можно назначать в фиксированных дозах без рутинного контроля коагуляции, а исследования III фазы и реальная клиническая практика продемонстрировали его безопасность и эффективность у больных с ФП, включая пожилых людей и пациентов с сопутствующими заболеваниями. Прием перорального антикоагулянта не антагониста витамина К, в частности ривароксабана, 1 раз в день потенциально способен улучшать приверженность к терапии и результаты профилактики инсульта у пациентов с ФП.
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