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НЕКЛАПАННАЯ ФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙ И ДИАБЕТИЧЕСКАЯ НЕФРОПАТИЯ: ЭПИДЕМИОЛОГИЯ, ПРОГНОЗ И ВЫБОР АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ

https://doi.org/10.18087/cardio.2018.4.10114

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Аннотация

В обзоре представлена распространенность фибрилляции предсердий (ФП) у больных сахарным диабетом (СД) 2-го типа, диабетической нефропатией и хронической болезнью почек (ХБП). Показано, что у пациентов с неклапанной ФП и СД 2-го типа в сочетании с ХБП значительно повышены риск развития как кровотечений, так и тромбоэмболических осложнений, общая смертность. Эффективность и безопасность невитамин-К-зависимых пероральных антикоагулянтов при ФП зависит от коморбидной патологии и может определяться наличием СД 2-го типа и диабетической нефропатии. Применение варфарина при ХБП в ряде случаев не обеспечивает профилактического эффекта в отношении риска развития инсультов и характеризуется увеличением риска кровотечений за счет плохого контроля международного нормализованного отношения и, возможно, развития кальцификации артерий. Наличие диабетической нефропатии требует мониторинга фильтрационной функции почек с целью коррекции дозы или выбора другого антикоагулянта. Отсутствие данных рандомизированных клинических исследований (РКИ) затрудняет выбор антикоагулянтной терапии у больных терминальной ХБП, находящихся на гемодиализе, перенесших трансплантацию почки.

Об авторах

Н. А. Козиолова
ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава России
Россия


Е. А. Полянская
ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава России
Россия


М. В. Суровцева
ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава России
Россия


П. Г. Караваев
ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е. А. Вагнера» Минздрава России
Россия


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Для цитирования:


Козиолова Н.А., Полянская Е.А., Суровцева М.В., Караваев П.Г. НЕКЛАПАННАЯ ФИБРИЛЛЯЦИЯ ПРЕДСЕРДИЙ И ДИАБЕТИЧЕСКАЯ НЕФРОПАТИЯ: ЭПИДЕМИОЛОГИЯ, ПРОГНОЗ И ВЫБОР АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ. Кардиология. 2018;58(4):81-95. https://doi.org/10.18087/cardio.2018.4.10114

For citation:


Koziolova N.A., Polyanskaya E.A., Surovtseva M.V., Karavaev P.G. NONVALVULAR ATRIAL FIBRILLATION AND DIABETIC NEPHROPATHY: EPIDEMIOLOGY, PROGNOSIS, AND CHOICE OF ANTICOAGULANT THERAPY. Kardiologiia. 2018;58(4):81-95. (In Russ.) https://doi.org/10.18087/cardio.2018.4.10114

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