Профилактика и лечение кровотечений, ассоциированных с приемом прямых оральных антикоагулянтов

Прямые оральные антикоагулянты (ПОАК), которые включают в себя ингибитор тромбина (дабигатран) и ингибиторы активированного фактора Х свертывания крови (ривароксабан, апиксабан, эдоксабан, бетриксабан), получили широкое распространение во всем мире для профилактики и лечения венозных тромбозов. Популярность ПОАК объясняется удобной и предсказуемой фармакодинамикой, отсутствием необходимости в регулярном мониторинге терапевтического эффекта, а также менее выраженным влиянием пищи и препаратов на их биодоступность. Однако, как и для любых других антикоагулянтов, для ПОАК характерен повышенный риск кровотечений, в особенности желудочно-кишечных. Корректный подход к назначению ПОАК и профилактике кровотечений на фоне лечения антикоагулянтами способен существенно снизить вероятность развития жизнеугрожающих осложнений. В случае развития кровотечения показано применение специфических и неспецифических антидотов ПОАК. Значимое кровотечение требует знания лечащим врачом четкого порядка действий в соответствии с опубликованными алгоритмами для спасения жизни пациента.

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