Vol. 23 No2/2017. Результаты применения пероральных антикоагулянтов при лечении больных. С венозными тромбоэмболическими осложнениями.


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ƒ‡ ˆ\t‡  (ƒ\n) ‹  „ \b   ‡”‡\t\b \t™ˆ „ \b’ \b ‡š‚ ‡’ \b ‚ ‡”‡\t  \t‹„ (\nƒŽ†), \t  ‚ \b 100 000   ” ‡”‡\t  \t‹\b ‘ ‰   [2].  \b \t \t ’\b \t \b 20–30% ‡\t‰‚   15% \t  ‹\b \t™ˆ „ ”‡\t„ [3]. \t‰‚ ‚   \t \b ˆ‘\b 30% ‡\t‰‚,    „  ˆ\t\b  [4].  \t ˆ ƒ\n  \b \b  45–95% ‡\t‰‚, ‚  3 ˆ ‡\t \t‚ \b\b \t \b \nƒŽ† (”\t\b\b ‡- ”\b  ‚„ ‡\t, \t \b -\r\t‰  \b \b ˆ   \b ‚„  \t‰‚ ˆ\t\b. ˆ  \t\b \t\t‰„ ˆ\t\b„ XXI   \r \r  \r    ‰ ‹ ƒ   \r ˆ \r›ƒ ‚ (\b„¤). ˆ ˆ\r\r ‚  ƒ‚ 95   \b„¤, ˆ 3 ”‹‹. \b  ”‹‹ \r\r‚ \r”‚\r‚ \r‹‚ ‹ ‰\n  ”‹  \rƒ 5 \r  \t ‹  6-‚ƒ\t  ƒ‚ ‹ ‹\t ”‹‹  ‹ƒ ‰,  \r\t  \r\r\t œ . Ž\n ˆ‚ ”\r  2 (5,7%)  ‹\t ”‹‹. Š”ƒ ‚ ‹\t ”‹‹ ˆ  8 (22,9%) ,  \r\t ”‹‹ 3 (10%),  \r\r\t ”‹‹ 13 (37,1%) ‹\t ”‹‹,  15 (50%) \r\t   14 (46,7%) ‹\n\r \r\r\t ”‹‹. †ˆ 8 (23,3%) ‹\t ”‹‹,  12 (40%) ‹\n\r  \r\t ”‹‹   11 (36,6%) ‹\n\r  \r\r\t \r\r\t ”‹‹ ‹ •   , ƒ\r ”\r   ‹‚\r ‹ ›‰‰\r\r  ˆ‹\r   . ˆ \r›ƒ ‚, ƒ, ‰, ”\r  \r\f \r\n\r\t\b  ­€ ­‚­  X \r \t‰ ‚ ‹‚ \t„  ‚  ‘  –†‚-‚ ‘\b  : \b \t ‚ ”\r\r  ‡ \r  „   (‡ˆ \t ‡  \nƒŽ†? †‚  ” ‚ ¤\t‰ \t\b:  ‡ ”\r\r ‡  ‡ˆ \r  \t  ‡\t‰‚  \t    \t \t‰ ‡\t\b \t \b 95 ‡\t‰‚  ‚ ƒ\n, \b \t\b „ ˆ ‡\t„ \t „ ‡\t‰‚ ˆ. †\t  ‡\t‰‚ „  „ ’ ˆ.   2013–2015 ˆˆ. ‹  ‡‚\t 56 (58,9%), ‹’ 39 (41,1%),  18  75 \t („  57,4±1,2 ˆ). \f\b\b \t\t‰‰ ‡\t\b  \t\b \t 8,7±1,4 . \b \t‘ \b  ‡‚\t: \t  \t‰‚  ‡/\t    \t‰‚  \t;  ‡\t‰‚ ‡\t 2 \t‰;  \r ˆ\t    \t.  \t‘ \b: ƒŽ  ‡\t‰„ \b ‡\t; \t  „ ˆ\t\b„ ; \b‹\t‚  ‘’ ‡\t\b ,        ‡  \t‚   , ˆ\tˆ,  ‹ \t‰ ˆ „ ‚ ‹  „   «Philips» (\t\t\b), «GE» (\f­). \n \t\t‘  \b‹‰ ‡,  ˆ ‚ ‡„. ‰ ‡ ˆ  \t \t‘’ ‡: ‡ - ‚„; \t„  „ ‡„  ‡   – \t‰‚„. \t\b \t‘ \b „  „ ƒŽ    \t ‚\t\b \t \t‰\t‰‘ ‰‘‘ ˆ\r‘ \t™ˆ,   ‹ ˆ ƒŽ  \t \t‰ \t . \t\b \t‘ \b     ‡\t\b ‡\t‰‚  ‚\t\b\t \r‡ˆ- ‘, \t‰ \t ˆ \t‰‚  \t‰ \b \b: \tˆ ˆ  1     10 „, \b \t 1% 2,0 2   ‰   10 „, \t\r \b 3,0 ‚  1    3 „, ”\t \b \b ‹„  , \r‚ (ˆ\b  10 „). \n  \b  ˆ\t\b„  ‡\t‰‚ ‡‚\t \t‚   ‘ ˆ  \t 35 ‡\t‰‚,  ‘   ‰‘ 30. \n ˆ‚ ‡‚\t ‚   ‡\t‰‚, ‚ \t   - „. \n \t‰ \r‚ ‚\t\t\b‚   450–500 €  1 ˆ ‚ \t. \f\b\b  \b  ˆ \t\b \t  \t‰ ‹   12,5 ‚. €     6.00,  14.00   22.00. \t‰ ‚ ˆ ’\t\b\t 1   ˆ  ˆ ‡\tˆ  (…ƒ\n).    ˆ …ƒ\n 2–2,5   80–90 . \n „ ˆ   48  \t  \t  5 ˆ.  3 ‰   \b \r \t\b\t  ‹ \t  (†) \t ‘ ‚. \n \t‘’ „ ‚ \r  ‹\b \t‰‚  2,0–3,0, \t ˆ ˆ  ‚ ‡„     \t † 1   10 „  \t \t   ‹\t‰. \n „ ˆ \b \b ˆ   5 .  6  ˆ ‡\t‰  \t ‡ˆ ” \t  150 ˆ 2   ‰    6 \b. ‡ \b ˆ ‘ ‚   \t. \n ‰„ ˆ \t   \t‰ \tˆ  „ ˆ, ‡\t‰‚  ‡ˆ \t \t 15 ˆ 2       3 \t‰,   20 ˆ 1    \t‰ \t‰ \t ˆ\t‡  ‹‚  „. †\t\b\t \t\t‘ „ ‚. … 1 ˆ \t  \b \t \b \t \t‰ \t  ‡\t ‡\t‰‚ \t\b \t\b  \b‹ Š\n   ‹ ‡\t‰‚. \t\b    ‹ ‡‚\t \t‰  «SF-36 Health Status Survey». \t\b   „   \t „ \t‰\t „ ˆ\t t-„ \f‰‘. \t \b  \t    ‚    \t‰ \t „ ‚ ‹„ ‹„   \t ˆ\t‡   „ ˆ \t‡\t‰ 18  96 , \t\b\b   59,4±19,7 ,  2 14  89  (  59,7±20,3 ),  3 –  15  87  ( \t‰‚ ‡ (‡„ ‚   ‹ \t„ ‚   ˆ\t):  1 17 (48,6%) ‡\t‰‚,  2 ˆ 16 3 ˆ 15 (50%).    ‡‚\t ‡‚ „ ‚   ‡ ‡„, \t„ ‚   7 (20%) ‡\t‰‚  5 (16,7%)   ‹„  2  3  ‚ \t \b ˆ‚    ˆ.  \t ‡\t‰‚  \b‹ ‹\b ‡\t. 1.  ‡\t‚ ‡\t‰‚ \t  ‚„,   ‡\t‰‚„ ‡ ˆ\t‡ . Ž \t  . \t‰‚„ ‡ \t \t ‘ \t  \b\t\b\t\b \tˆ„  ‰‘ „  ,  ‡\t‰‚„ ‡ ‡ – \b‹\t„ ‰‘.   ‚ \t‰ˆ \t\b „ ˆ  33 (94,3%) ‡\t‰‚ ‡ ‡‚\t  ‚,   2 (5,7%)    \r\t\b  ‡, ‡\b 2 ˆ  28 (93,3%) ‡\t‰‚ ‡ \t \t‘‚„,    \r\t\b \t‰„  ‡, \b‹ ‡\t 4,5–5 ;  ‡‚\t 3 ˆ 3 (10%) ˆ . \t‘’„ ‡ \t\b ‡„ ,   \t \b \t ‡„ ‚\t 4 . \n   ‚   \t  \t ˆ\t\b„   ‚,   \t \b ˆ   ˆ .   \t‰„ ‰‘„ ˆ\r 4 (4,3%) ‡\t‰‚:    \t ‘  1  3 ˆ    \t \b  2 ‹ ˆ‚ „ \t  \b\t\b\t‰ \r-„. \f\t  ‰,   \t  ƒŽ  \t‰    \t\b  , \t  ˆ \t \b  ” ƒŽ  ‡\t\b (‡‹ ‡ ˆ,   \t ‚  ‡ „  ƒŽ)   \b  ˆ  2   ‚ \t \t\t‰‚„ ‡ \t„ ‹„  ‡„ .    \t‰‚ \t‰‚ \t„ ‡‚ „  „ .  ‚    ‡.   ’\t‰ \t\t‰ ‡\t  ‚\b\t ‰  ˆ\t\b„  \t ‹„ ‡\r\t; ˆ\t\b\b \b   ” ‡\t‰‚ ‹\t\t‰‚ \b\t\b    ‡\t. 2. \t ‚ ‹\t\t‰‚ \b\t\b  \t‹\b  ­\b \t\t \r“¦§”\r“¦§”\r“¦§” “©”“©”“©” „ˆ“©”“©”“©” “ ©”“©” “©” °„ˆ “©”“©”“©” 13 ‹\t -     \b 2 (5,7%) ‡\t‰‚ „ ˆ‚,  \r. ˆ\t\b\b \b  ” ‡\t‰‚ ‡‚\t ’. ‡\t  ‹\t\t‰‚ ”\r\r‚ \b\t\b\t‰  «\t‚»  „, ‚ 4 (11,4%) ‡\t‰‚ 1 ˆ‚,  3  2 (6,7%) ‡\t‰ ‚ 3 ˆ‚. \n  \t \b   ‡‚\t ‡\t ‘’ˆ \t \b, \t\b  \b\t‰    1 ˆ‚ \t  \r  1 (3,3%) ‡\t‰ˆ, \t ˆ ‡ˆ, \t \b ‚\b\t ‚  ‡\t,     ˆ‚ ‚,  \b   ‚  ˆ\t\b\b \b \t‚ \b \t „ ‚ ‹   \b \t \b  \t \b ˆ  \t \b 71 (74,7%) ‡\t‰ˆ \t \t\b  „ ”\r\r ˆ\t\b„ . Ž\r \t\b‘  \t \t ˆ\t‡  ‚\t \r 12,9%,  ‡ 9,6%.  ‹\t‘,  \t   \t  \r ‹‚„ ˆ ‚ \t\b \t‘‚. Ž \t‰ ‡‚\t ‹, 17,6%  ˆ ‡\t‰‚, \t \b ‡ˆ  11%  ˆ, \t     ‚ \t „  \t\b \t ‡ \t ‡\t‰‚  Š\n  1 ˆ \t  \b \t \b \t  ‡\t. 4. \f\t  \b Š\n   „  ‰„ ˆ ‡‚\t   „,  16,7  . … \tˆ \r Š\n ‡‚\t   ˆ,  \b  \b\b  \b ‚ „ \t\b  \f\b„–ˆ\r“¦§”\r“¦§”\r“¦§” º……Ž“©” »\r\bŽ‡‰Ž  \rˆ “©”“©”“©” žŽ…Ž‡ Œ\r²‹…  “©”“©”  “©”“©”¡“©”¡  ª€…  …ˆ\rˆ‚ Œ …\t \r\t ŒŠ\r“¦§”\r“¦§”\r“¦§” “©”“©”¡“©”¡ “ ©”“©”“©” ˜‹† “©”“©”¡“©”¡  ª€…  …ˆ\rˆ‚ ˆ ˆ \r \f\b\t  \r“¦§”\r“¦§”\r“¦§” ÂŽ\rŠ… œœ ¡œ ¡  œœ¡œ¡  œœ¡œ ¡ œ œ¡ œ ¡ œœ¡œ œœ¡œ —Ž\b…  œœœ œœ¡œ ÂŽˆƒ\b…† œœ ¡œ ¡ —Žˆƒ\b…† œœ ¡œ ¡  ª€…  …ˆ\rˆ‚ › \t \r\r\r\f“¦§” ˜\r…\r  “©”“©”¡“©”¡“©” “©”“©”“©”“©” “‚©”“©”¡“©”¡“©” °†–† “©”“©”¡“©”¡“©”  ª€…  …ˆ\rˆ‚ , ’  „ ˆ,   „ \f   ‚ \t „ ‹ ‡  ” \t‰‚    ‹ \t  ˆ\t‰‚ \t   ‹ \t ‡\t‰‚ „ ‰„ ˆ  ‘  „. \f    ‚ \t „  \t\b‘    ‹  ‡\t‰‚ „  ‰„ ˆ   ‚ \t\b \t,   ‡ˆ,   \b  \r  \r  \t  „ ˆ ‡\t‰‚.    ‡ˆ   ‡ ‹ ‡„    ‚ \t „  ‡‹. ‡ˆ ‡ ˆ ‰\b \f .. \t‰ ‚ \t‰‚ …‰ 1. Šˆ\b. „ \t    ˆ , \t ‘  \r\t ‚  ‡”‡\t  \t‹„. \t‡\tˆ\b. 2010; 4: 2: 2–37. 3.  . ‡‰ ‡     ˆ    \t\t‰„  ˆ ‡. \t‡\t ˆ\b. 2016; 10: 1: 7–25. 4. .ƒ.   \t ‚  ˆ\t\b„ \b ˆ\b. 2016; 22: 2: 15–20. 5.   ‡ ˆ\t‡   \t‰ \t‰ˆ ˆ‡ ‡. \t‡\tˆ\b. 201; 9: 1: 26–29. 6. . \tˆ„  \r. ˆ\t \b ˆ\b. 2016; 22: 33–40. 7. iksson B.I., Dahl O.E., Huo M.H., et al. gatran versus enoxaparin for thromboprophylaxis af ter primary total hip arthroplasty (RE-NOVATE II*). randomised, double-blind, non-inferiority trial. J. Thromb. Haemost. 2011; 105: 4: 721–729. . \b  ˆ\b. 2014; 20: 95–100. 9. for symptomatic venous thromboembolism. N. Engl. J. Med. 2010; 363: 26: 2499–2510.  ­€ \f‘\rŒ\t\b\n\t ’\t … ­€š §»…‚ ˜ ‡ „‡\f‘\rŒ\t\b\n\t ’\t … ­€š §»…‚ ˜ ‡ RESULTS OF ADMINISTERING ORAL ANTICOAGULANTS FOR TREATMENT OF PATIENTS WITH VENOUS THROMBOEMBOLIC COMPLICATIONS dabigatran with warfarin treatment of patients with acute venous thromboembolic complications (VTEC). The authors analysed the results of examining and treating a total of 95 patients presenting with VTEC randomly divided into three groups. In all groups the initial anticoagulant therapy consisted in unfractionated heparin administered for 5 days, after which the patients followed by switching were switched to course anticoagulants. Patients from Group One received warfarin, Group Two patients were Group Three patients were treated with rivaroxaban. Relapses of the disease were diagnosed in 2 (5.7%) patients from Group One. Haemorrhagic complications were noted in (22.9%) Group One patients, in (10%) Group Two patients and 2 (6.7%) Group Three end of the thrombosed veins was revealed 13 (37.1%) 15 (50%) patients from Group Two and in 14 (46.7%) patients from Group Three. end of treatment, freedom from chronic venous insu£ciency was observed in 8 (23.3%) patients Group One, in 12 (40%) patients of Group Two and in 11 (36.6%) patients of Group Three. The composite quality of indices after the course were (appeared to higher in Two and patients Hence, a conclusion was drawn that dabigatran and rivaroxaban turned out to superior by and warfarin in treatment of this patient cohort. No statistically signiŒcant dižerences were observed rivaroxaban. Key words:  \t\t\f\n \n \n\t\f\f \f  \n  \r\f \n\t\t\b \r\f\t\t\r\b\t \r\t\r\f\t\t\t\n\n\n\r\n\r\t\t\b\n  \r\f \n\t\t\b \r\f\t\t\r\b\t \r\t\r\f\t\t\t\n\n\n\r\n\r\t\t\b\n

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