Статья
Необходима ли антикоагулянтная терапия после выписки из стационара с COVID-19-ассоциированной пневмонией?
Пандемия новой коронавирусной инфекции (COVID-19) связана с высокой вирулентностью, смертностью и нагрузкой на систему здравоохранения во всём мире. Одной из её особенностей является прокоагулянтная активность, которая приводит к высокой частоте тромбоэмболических осложнений в сосудах лёгких и других органов. Поэтому с самого начала заболевания при среднетяжёлом течении в качества антикоагулянтов стали использоваться низкомолекулярные гепарины, которые доказали своё благоприятное влияние на смертность и течение болезни и вошли во все рекомендации. Однако противоречивым является вопрос о необходимости антикоагулянтной терапии после выписки из стационара. Мнения различных медицинских профессиональных сообществ по данному вопросу разделились. В частности, некоторые из них, в т.ч. рекомендации Минздрава России, рекомендуют терапевтическую антикоагуляцию с помощью новых оральных антикоагулянтов (дабигатран, ривароксабан, апиксабан) на период 30-45 дней, однако в других источниках подобные рекомендации отсутствуют. В данном обзоре обсуждаются вопросы эффективности антикоагулянтной терапии после COVID-19, а также необходимости использования стратификационных шкал для оценки данной терапии.
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