Научно-практический журнал
«Клиническая физиология кровообращения»

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


Антитромбоцитарная терапия у больных ишемической болезнью сердца при плановом аортокоронарном шунтировании: реальная клиническая практика против стандартов

Авторы: Гвалия С.Л., Бузиашвили Ю.И., Гришенок А.В.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2022-19-4-291-301

УДК: 615.273.55+616.12-005.4-089.843

Библиографическая ссылка: Клиническая физиология кровообращения. 2022; 4 (19): 291-301

Цитировать как: Гвалия С.Л., Бузиашвили Ю.И., Гришенок А.В. . Антитромбоцитарная терапия у больных ишемической болезнью сердца при плановом аортокоронарном шунтировании: реальная клиническая практика против стандартов. Клиническая физиология кровообращения. 2022; 4 (19): 291-301. DOI: 10.24022/1814-6910-2022-19-4-291-301

Ключевые слова: аортокоронарное шунтирование, недостаточность шунтов, кровотечения, антитромбоцитарные препараты, тромбоциты

Поступила / Принята к печати:  08.11.2022 / 21.12.2022

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Аннотация

В данном обзоре литературы освещены фундаментальные проблемы ближайшего и отдаленного послеоперационного периода аортокоронарного шунтирования (АКШ) и изложены предложения новых путей оптимизации вторичной профилактики и прогноза. Как известно, наиболее частые основные негативные исходы АКШ включают, с одной стороны, тромботические события, лежащие в основе дисфункции шунтов, и с другой – геморрагические осложнения. Главным образом они связаны с отклонениями гемореологических свойств крови, и ключевую роль в этом играют тромбоциты. В соответствии с этим основной фокус обсуждений направлен на периоперационное использование антиагрегантных средств. Если для больных в условиях острой патологии прочно заложена консенсусная рекомендация по обязательному назначению двойной антитромбоцитарной терапии в самые ранние сроки после АКШ, то для больных со стабильными формами ишемической болезни сердца ввиду ограниченности клинических данных дела обстоят иначе. Сегодня уже нельзя не замечать целого ряда проблем, связанных с тривиальностью лечебного подхода к данным больным. Сложившаяся ситуация заставляет признать перспективность развития новых подходов к принятию клинического решения в отношении антитромбоцитарной терапии. В частности, весьма разумной концепцией представляется персонализированный подход, основанный на мониторинге эффективности и безопасности антитромбоцитарной терапии.

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  6. Kamel H., Johnston S.C., Kirkham J.C., Turner C.G., Kizer J.R., Devereux R.B. et al. Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction. Circulation. 2012; 126 (2): 207–12. DOI: 10.1161/CIRCULATIONAHA.112.094326
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Об авторах

  • Гвалия Софья Лериевна, аспирант; ORCID
  • Бузиашвили Юрий Иосифович, д-р мед. наук, профессор, академик РАН, заведующий клинико-диагностическим отделением; ORCID
  • Гришенок Алена Викторовна, аспирант; ORCID

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