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Vol 81, Supp. I (2023): Zeszyty Edukacyjne 1/2023
Artykuł poglądowy
Published online: 2023-09-27

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Dwukierunkowe hamowanie w miażdżycy układu sercowo-naczyniowego — ostatnie postępy

Stephanie Carlin1, Tim A.C. de Vries234, Andrzej Budaj5, John Eikelboom6
DOI: 10.33963/v.kp.95770

Abstract

Choroba układu sercowo-naczyniowego o podłożu miażdżycy (ASCVD, atherosclerotic cardiovascular disease), która obejmuje chorobę wieńcową (CAD, coronary artery disease), chorobę naczyń mózgowych oraz chorobę tętnic obwodowych (PAD, peripheral arterial disease), wiąże się z dużą zachorowalnością, śmiertelnością i kosztami opieki zdrowotnej. Terapia przeciwpłytkowa była od dawna podstawą leczenia przeciwzakrzepowego w profilaktyce pierwszych i ponownych incydentów ASCVD. Jednak ostatnie randomizowane badania pokazały zalety i efektywność kosztową strategii dwukierunkowego hamowania (DPI, dual pathway inhibition) w ostrej i przewlekłej ASCVD. Kwas acetylosalicylowy stosowany w skojarzeniu z małą dawką rywaroksabanu działają synergistycznie, hamując aktywację płytek krwi i generację trombiny, tym samym zapobiegając powstawaniu skrzepliny. Wśród pacjentów z niedawnym ostrym zespołem wieńcowym (ACS, acute coronary syndrome), ci z dodatnimi biomarkerami sercowymi, zawałem serca z uniesieniem odcinka ST lub historią niewydolności serca odnoszą największe bezwzględne korzyści. Wśród pacjentów z przewlekłą ASCVD, ci z zajęciem dwóch lub więcej łożysk naczyniowych, niewydolnością serca, przewlekłą chorobą nerek lub cukrzycą odnoszą największe bezwzględne korzyści. Dodatkowe badania są w trakcie realizacji, celem oceny wpływu terapii DPI w innych interesujących populacjach, w tym pacjentów z ACS z dużym ryzykiem powstania skrzepliny w lewej komorze, wewnątrzczaszkową miażdżycą tętnic po niedawno przebytym przemijającym napadzie niedokrwienia mózgu lub udarze, chorobą tętnic obwodowych z chromaniem przestankowym lub po rewaskularyzacji kończyn dolnych i zaawansowaną przewlekłą chorobą nerek z ASCVD lub czynnikami ryzyka ASCVD. Dalsze badania są potrzebne w celu oceny możliwych dodatkowych korzyści z łączenia rywaroksabanu z klopidogrelem lub tikagrelorem zamiast kwasu acetylosalicylowego.

Keywords: choroba naczyń mózgowychchoroba wieńcowachoroba tętnic obwodowychchoroba układu sercowo-naczyniowego o podłożu miażdżycyrywaroksaban

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