CC BY
2
УДК 616.125-008
Niyozaliev A.G. master's degree Usmanova U.I., candidate of medical sciences
associate professor department of GP №1 Dzhumabayeva S.E., candidate of medical sciences
associate professor department of GP №1 Andijan State Medical Institute
EVALUATION OF THE EFFECTIVENESS OF ORAL ANTICOAGULANTS IN TREATMENT AND PREVENTION ATRIAL FIBRILLATION IN THE BACKGROUND OF ISCHEMIC
HEART DISEASE
Summary: Fibrillation remains one of the most important problems in modern cardiology. Over the last 20 years, the incidence of hospitalization with fibrillation has increased by 66% as a result of population aging and an increase in the prevalence of chronic heart disease. Fibrillation has a negative impact on hemodynamics, quality of life, and long-term prognosis. The prevalence of compartmental fibrillation in the general population is 0.4-1%, with up to 8% observed in people over 80 years of age. Approximately 60% of patients over 75 years of age with compartmental fibrillation are women.Fibrillation of the compartments is associated with an increased risk of stroke, heart failure (HF), and all-cause mortality, especially in women.
Key words: Fibrillation of the compartments,oralanticoagulants, chronic heart failure.
The urgency of the problem. Treatment and prevention of thromboembolic complications remains a topical issue for modern medicine. Oral anticoagulants (OAC) are prescribed to reduce blood clots in the blood vessels and prevent them from forming. An important point in OAC therapy is the assessment of the risk of thromboembolism and primarily ischemic stroke. The prevalence of fibrillation has been steadily increasing in the last decade as a common heart rhythm disorder.In 2010, fibrillation was recorded in 33.5 million people worldwide. fibrillation is the cause of the development of ischemic stroke in 25% of cases. In patients with fibrillation, the incidence of cardioembolic stroke and systemic thromboembolism is increased by 5 times. The use of anticoagulants in patients with fibrillation significantly improves the risk of thromboembolism. There are 3 levels of risk of fibrillation thromboembolic complications: low risk ischemic stroke less than 2% per year, moderate risk is 2-5% per year, high risk is 6% per year and more.
The purpose of scientific work. To study the efficacy and safety of oral anticoagulants (OAC) in the prevention of thromboembolic complications (TE) in patients with fibrillationon the background of ischemic heart disease.
Materials and research methods. Selection of patients for the study was carried out on the basis of the clinic of Andijan State Medical Institute. Patient complaints, anamnesis and clinical and laboratory diagnostic methods were used for examination and treatment: general blood analysis, blood biochemical analysis, echocardiography, ECG examination, international normative relations (INR /MHO) examination, abdominal ultrasound, coagulogram, PTI ( index), if necessary, analysis of fecal occult blood. Patients' quality of life was assessed. Bleeding risk factors were considered.
Research results. The longest-acting OAC in clinical practice have been studied by comparing the safety and efficacy of warfarin and rivoraxaban to prevent vascular and arterial thromboembolism in patients with fibrillation. During the study, 2.5 mg of warfarin and 20 mg of rivoraxaban (xarleto) were selected. During the study, 40 patients with BF were divided into 2 groups and received warfarin and rivoraksaban for 1 year, and on the basis of traditional treatment principles received beta-blockers, iAPF, nitrate, diuretics, antiarrhythmic, hypolipidemic drugs. The mean age of the patients was around 66.6 ± 3.9. During the study, patients receiving warfarin were monitored in the International Normative Relationship (INR/MNO) monitoring system. The dose of warfarin is 2.5 mg, which is standard in all cases. During titration of the warfarin dose, patients underwent INR examination once every 4 days and then at least twice a month. Determining the effectiveness of prophylaxis is the administration of indirect anticoagulants in the therapeutic range of INR 2 to 3.Lack of anticoagulant effect (less than INR 2) increases the risk of thrombotic. Being above INR 3 increases the risk of bleeding, including the risk of intracranial hemorrhage. Thus, according to the literature, the annual frequency of major bleeding during treatment with indirect anticoagulants ranges from 0.2% to 5.2%; among them, the frequency of fatal bleeding ranged from 0.07% to 0.7%. Rivoraxaban was prescribed taking into account the frequency of recurrence of fibrillation and factors predisposing to embolism. Treatment was started with 20 mg, depending on the patient's condition.Patients over 60 years of age should be treated with low-dose rivoraxaban (15 mg / day), taking into account the effects of drugs that enhance the anticoagulant effect of rivoraxaban, chronic heart failure (CHF), chronic renal disease (ball filtration rate less than 50 ml / min).
Conclusion.
1. Patients with fibrillation are treated with long-term anticoagulants, often for decades. This analysis showed not only the high efficacy of rivoraxaban, but also the safety of this therapy.
2. The efficacy and safety of rivoraxaban from warfarin have now been proven in patients with ischemic heart disease, diabetes mellitus, and chronic kidney disease.
3. The efficacy and safety of rivoraxaban have now been proven not only in randomized clinical trials but also in actual clinical practice.
References:
1. Баркаган З.С., Момот А.П., Тараненко И.А., Шойхет Я.Н. /Основы пролонгированнойпрофилактики и терапии тромбоэмболий антикоагулянтами непрямого действия.М.:«Ньюдиамед»,2003,с.5-38.
2. Аркадьева Г.В. Длительная терапия варфарином у больных с мерцательной аритмией без поражения клапанов сердца с целью профилактики тромбоэмболических осложнений. //Российский кардиологический журнал. -2005. - № 6. - С. 50-56
3. Бокарев И.Н., Козлова Т.В. Принципы рациональной терапии оральными антикоагулянтами.//Тромбоз, гемостаз и реология. 2000, №4(4),с. 16-22.
4. Гордеев Н.А., Седов В.М., Вавилова Т.В., КадинскаяМ.И., Ткаченко О.Б. //Тромбозы, кровоточивость и болезни сосудов.2004, №4,с.41 -44.
5. Долгов В.В., Щетникович К.А., Добровольский А.Б. Лабораторный контроль терапии непрямыми антикоагулянтами с использованием МНО.Методические указания. М., 2003.
6. 3убаиров Д.М./Молекулярные основы свертывания крови и тромбообразования. Казань: «ФЭН», 2000, 364с.
7. Кабеева Е.В., Бокарев И.Н. Оральные антикоагулянтыантивитамины К. Более полувека в медицине.//М., ММА им. И.М.Сеченова,2000.
8. Козлова Т.В. Оценка риска геморрагических осложнений при длительном применении варфарина для профилактики рецидива венозноготромбоза.//Тромбы, кровоточивость и болезни сосудов. 2005, №3, с.60-61.
9. Кропачева Е.С., Панченко Е.П., Добровольский А.Б., Аттауллаханова Д.М., Быкова Е.С., Титаева Е.В., Атьков О.Ю. Длительная терапиянепрямыми антикоагулянтами у больных с мерцательной аритмией безпоражения клапанов сердца (проспективное наблюдение). Часть I.
10. Internet data
