Rizik od krvarenja i interakcije lekova kod pacijenata sa atrijalnom fibrilacijom koji su na oralnoj antikoagulantnoj terapiji
Sažetak
Pacijenti sa atrijalnom fibrilacijom (AF) imaju povećan rizik od tromboembolijskog moždanog udara i mortaliteta od svih uzroka. Pored antiaritmika, lečenje AF podrazumeva upotrebu antikoagulanasa, koji značajno smanjuju rizik od ishemijskog moždanog udara, ali nose rizik od krvarenja. Ova studija je imala za cilj da proceni rizik od krvarenja kod pacijenata sa AF na oralnoj antikoagulantnoj terapiji i da odredi učestalost potencijalno klinički značajnih interakcija lekova (pLLI) koje mogu dodatno povećati rizik od krvarenja. Urađena je retrospektivna opservaciona studija na Odeljenju za kardiologiju Kliničko-bolničkog centra „Bežanijska kosa”. Kvantifikacija rizika od krvarenja je izvršena korišćenjem HAS-BLED skora. Lexi-Interact je korišćen za identifikaciju pLLI. Studija je obuhvatila 124 pacijenta (srednja starost 72 godine, žene 50,8%). Kod 10,5% pacijenata procenjen je visok rizik od krvarenja usled primene oralne antikoagulantne terapije. Prevalenca pLLI koje mogu dodatno povećati rizik od krvarenja iznosila je 18,5%. Interakcije su obuhvatile kombinacije antagonista vitamina K sa selektivnim inhibitorima ponovnog preuzimanja serotonina, inhibitorima protonske pumpe, levotiroksinom, derivatima sulfonilureje, statinima i propafenonom. Prilikom vođenja i praćenja pacijenata sa AF na oralnoj antikoagulantnoj terapiji, korišćenje skorova za procenu rizika od krvarenja treba da bude dopunjeno informacijama o interakcijama lekova, kako bi se optimizovao odnos koristi i rizika antikoagulantne terapije.
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