Статья
Особенности антикоагуляции при сочетании фибрилляции предсердий и хронической болезни почек
В связи со старением населения и накоплением сопутствующих заболеваний увеличивается распространённость самой частой аритмии — фибрилляции предсердий (ФП). С другой стороны, у 14% популяции определяется хроническая болезнь почек (ХБП). Эти состояния нередко сочетаются вместе и, вызывая протромбогенный эффект, значительно увеличивают количество неблагоприятных исходов в виде роста тромбоэмболий, инсультов, инфарктов и сердечно-сосудистых смертей. Особенно это касается последних стадий ХБП, так называемой терминальной болезни почек со скоростью клубочковой фильтрации <29 мл/мин/1,73 м2. Ранее основным препаратом для антикоагулянтной терапии сочетания ФП + ХБП служил антагонист витамина К варфарин, однако в последнее десятилетие, по мере нарастания доказательной базы, широко стали применяться прямые пероральные антикоагулянты. В данной статье рассматривается доказательная база каждого из антикоагулянтов при сочетании ФП и ХБП по сравнению с варфарином, в т.ч. в зависимости от степени снижения скорости клубочковой фильтрации.
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