Статья
Антитромботический эффект препаратов ацетилсалициловой кислоты в разных лекарственных формах: есть ли разница?
К настоящему времени накоплен солидный объем клинических исследований, продемонстрировавших сниженный антитромбоцитарный эффект кишечнорастворимых (КР) форм низкодозовых препаратов ацетилсалициловой кислоты (АСК). Замедленное и неполное всасывание из щелочной среды кишечника, значительно снижающее биодоступность препарата, считается основной причиной лабораторной “аспиринорезистентности” (псевдорезистентности) к КР формам АСК. Особое значение данный феномен имеет для пациентов с острым коронарным синдромом, когда необходим быстрый эффект, а также для больных сахарным диабетом и ожирением из-за наличия у них дополнительных причин повышенной активности тромбоцитов, с одной стороны, и сниженной биодоступности АСК — с другой. Принимая во внимание, помимо вопроса эффективности, сомнительный гастропротективный эффект и более выраженное повреждающее действие на слизистую тонкой кишки, следует избегать применения КР форм АСК, в особенности у пациентов с многофакторным риском недостаточного ответа на терапию. Хорошую альтернативу представляет буферная АСК, которая быстро растворяется и частично всасывается непосредственно в желудке, обладая сопоставимой с простой АСК антитромбоцитарной активностью и схожим уровнем “аспиринорезистентности”, ассоциируется с меньшим риском индуцированной энтеропатии в сравнении с КР формами АСК. Помимо того, согласно данным ряда небольших исследований и ретроспективных анализов, буферная АСК реже вызывает повреждения слизистой желудка в сравнении с КР.
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