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Архивъ внутренней медицины

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СОВРЕМЕННЫЕ ВЗГЛЯДЫ НА АНТИКОАГУЛЯНТНУЮ И ТРОМБОЛИТИЧЕСКУЮ ТЕРАПИЮ ОСТРОЙ ЛЕГОЧНОЙ ЭМБОЛИИ

https://doi.org/10.20514/2226-6704-2019-9-5-348-366

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Аннотация

Представленный обзор посвящен современным представлениям об особенностях антикоагулянтной и тромболитической терапии венозной тромбоэмболии и, в большей степени, острой легочной эмболии. Приводится современная классификация больных с острой легочной эмболией на основе расчёта риска ранней смертности и массивности тромбоэмбологенного события. Подчеркивается важность мультидисциплинарного подхода ведения больных легочной эмболией с привлечением кардиолога, реаниматолога, пульмонолога, торакального и кардиохирурга, нацеленных на лечение легочной эмболии на всех её этапах: от клинического подозрения до выбора и осуществления любого медицинского вмешательства. Подробно освещена антикоагулянтная терапия с демонстрацией результатов крупных исследований, посвященных оценке эффективности и безопасности антикоагулянтных препаратов. Приведена характеристика, основные дозировки и схемы применения прямых (новых) антикоагулянтов, включая апиксабан, ривароксабан, дабигатран, эдоксабан и бетриксабан. Отдельно затронуты вопросы ведения больных с геморрагическими осложнениями при проведении антикоагулянтной терапии и её применения у онкологических больных, часто страдающих венозными тромбоэмболиями. Кроме того, в обзоре подробно изложены современные подходы к проведению системного тромболизиса с использованием внутривенно вводимых препаратов: стрептокиназы, урокиназы и тканевых активаторов плазминогена. Описываются показания, противопоказания, результаты клинических исследований, посвященных различным режимам тромболитической терапии, включая лечение легочной эмболии пониженными дозировками фибринолитиков.

Об авторах

Г. А. Игнатенко
ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»
Украина

Донецк



Г. Г. Тарадин
ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»; ГУ «Институт неотложной и восстановительной хирургии им. В.К. Гусака»
Украина

Геннадий Геннадьевич Тарадин

Донецк



Н. Т. Ватутин
ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»; ГУ «Институт неотложной и восстановительной хирургии им. В.К. Гусака»
Украина
Донецк


И. В. Канишева
ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»
Украина
Донецк


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Для цитирования:


Игнатенко Г.А., Тарадин Г.Г., Ватутин Н.Т., Канишева И.В. СОВРЕМЕННЫЕ ВЗГЛЯДЫ НА АНТИКОАГУЛЯНТНУЮ И ТРОМБОЛИТИЧЕСКУЮ ТЕРАПИЮ ОСТРОЙ ЛЕГОЧНОЙ ЭМБОЛИИ. Архивъ внутренней медицины. 2019;9(5):348-366. https://doi.org/10.20514/2226-6704-2019-9-5-348-366

For citation:


Ignatenko G.A., Taradin G.G., Vatutin N.T., Kanisheva I.V. CURRENT VIEW ON ANTICOAGULANT AND THROMBOLYTIC TREATMENT OF ACUTE PULMONARY EMBOLISM. The Russian Archives of Internal Medicine. 2019;9(5):348-366. https://doi.org/10.20514/2226-6704-2019-9-5-348-366

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