#1
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Не ДААТ, а аспирин или клопи. Мне казалось, что стентированные пациенты получают какой-либо антиагрегант пожизненно. Нет данных, что новые антикоагулянты достойно заменяют антиагреганты у стентированных больных. Впрочем, по варфарину таких данных тоже нет. Но есть консенсус. А так, наверное, и новые антикоагулянты можно. Что касается публикаций по кровотечениям на дабигатране, то пока ничего особенного я не читал, что отличалось бы от данных RE-LY. Более того, выживаемость при кровотечениях на дабигатране лучше, чем на варфарине.
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#2
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Цитата:
Among the phase 3 trials, 627 patients in the dabigatran arm had major bleeding vs 407 in the warfarin age. Patients in the dabigatran arm were older, 75.3 years vs 71.8 years in the warfarin arm (P<0.0001), and two thirds of the patients were male (64.4% vs 65.9%). “Patients with major bleeds on dabigatran were older, had lower creatinine clearance, and had more frequent use of aspirin or nonsteroidal antiinflammatory agents than those on warfarin,” Dr. Majeed said. In the RE-LY study, 439 of 741 patients (59.2%) had major bleeds transfused with red cells vs 210 of 421 patients (49.9%) on warfarin (P=0.002). However, those on warfarin required more fresh frozen plasma transfusions (30.2% vs 19.8%; P<0.001) and more vitamin K for bleeding management (27.3% vs 9.4%; P<0.001) than those on dabigatran. Mean length of stay in intensive care was 2.7 days for those on warfarin vs 1.0 days for those on dabigatran (P=0.01). A total of 15% of patients on warfarin had bleeds requiring surgery vs 12.2% with dabigatran (P=0.017). Recombinant factor VIIa was used for eight patients treated with dabigatran and three with warfarin (P=0.53). Outcomes based on event reports from the five phase 3 trials found a reduced risk for death with dabigatran vs warfarin during 30 days from bleeding (P=0.052). Mortality did not differ significantly based on age, creatinine clearance, or use of aspirin. “Despite the unavailability of a specific antidote against dabigatran, the overall resources required to manage bleeding are not greater,” Dr. Majeed concluded. “More frequent transfusion with red cells is counterbalanced by shorter stay in the intensive care unit and less frequent transfusion of plasma.” [Ссылки доступны только зарегистрированным пользователям ]
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Искренне, Вадим Валерьевич. |