Фибрилляция предсердий в старческом возрасте: управление рисками и особенности применения прямых пероральных антикоагулянтов

Больные с фибрилляцией предсердий (ФП) старческого возраста подвержены большему риску тромбоэмболии и кровотечения, чем более молодые пациенты. Три прямых пероральных антикоагулянта (ПОАК) – апиксабан, дабигатран и ривароксабан зарегистрированы в Российской Федерации и широко назначаются для предотвращения инсульта у пациентов с ФП. Применение ПОАК у больных с ФП старческого возраста требует учета особенностей пациентов, клинических ситуаций и свойств отдельных препаратов для достижения баланса эффективности и безопасности, комплексной защиты при проведении антикоагулянтной терапии. Согласно исследованиям реальной клинической практики ПОАК могут иметь преимущества в сравнении с варфарином (снижение риска переломов, сахарного диабета, деменции). Приверженность и постоянство лечения ПОАК важны для обеспечения его результативности, особенно у людей старческого возраста. Результаты клинических исследований и исследований реальной клинической практики подтверждают, что ривароксабан может создавать комплексную защиту пожилого пациента с ФП, которая обеспечивается благоприятными показателями эффективности и безопасности, положительным влиянием на риски коронарных событий и риски ухудшения функции почек, а дозирование ривароксабана 1 раз в сутки способствует улучшению приверженности лечению и постоянству терапии.

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