ЭФФЕКТИВНОСТЬ ДЛИТЕЛЬНОЙ ТЕРАПИИ ВАРФАРИНОМ: ВЛИЯНИЕ НА ЧАСТОТУ ИШЕМИЧЕСКИХ НАРУШЕНИЙ МОЗГОВОГО КРОВООБРАЩЕНИЯ И КЛИНИЧЕСКИЕ ПРЕДИКТОРЫ ИХ РАЗВИТИЯ (результаты проспективного 10-летнего наблюдения)

Большинство пациентов с фибрилляцией предсердий имеют показания для длительной терапии пероральными антикоагулянтами. Антагонисты витамина К продолжают оставаться основными препаратами для рутинной клинической практики. По данным проспективного 10-летнего наблюдения за больными с фибрилляцией предсердий, получающими терапию варфарином, выявлено, что частота всех нарушений мозгового кровообращения составила 2,59 на 100/пациенто-лет. Терапия варфарином способствовала тому, что среди нарушений мозгового кровообращения, произошедших на протяжении терапии, преобладали нефатальные события. Частота фатальных ишемических инсультов за 10 лет наблюдения составила 0,91 на 100/пациентолет. Значение времени нахождения в пределах целевого диапазона (TTR) < 70% повышало относительный риск развития ишемических нарушений мозгового кровообращения в 2,77 раза (95% ДИ 1,367—5,633) по сравнению с больными со средним значением TTR ≥ 70%. Результаты исследования демонстрируют, что среди пациентов, имевших средние значения TTR ≥ 70%, без ишемических нарушений мозгового кровообращения в течение 10 лет прожили 86,5% больных. Отдельный анализ пациентов высокого тромбоэмболического риска (имевших 4 и более баллов по шкале CHA2DS2-VASc) показал, что достижение TTR ≥ 70% способствовало тому, что за 10 лет наблюдения без инсульта прожили 70,7% пациентов. По результатам пошагового дискриминантного анализа было выявлено, что предикторами развития ишемических нарушений мозгового кровообращения (инсультов и транзиторных ишемических атак) у больных, получающих терапию варфарином, являются исходное снижение когнитивных функций, инсульт в анамнезе и значения TTR < 70%.

варфарин, ишемический инсульт, эффективность терапии, МНО, TTR

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