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Acta Biomedica Scientifica

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Антикоагулянтная терапия у больных с циррозом печени (обзор литературы)

https://doi.org/10.29413/ABS.2019-4.2.3

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Аннотация

Цирроз печени сопровождается сложными нарушениями гемостаза с увеличением риска как геморрагических, так и тромботических осложнений. Снижение синтеза коагуляционных белков, таких как факторы II, VII, IX, X и тромбоцитопения ассоциируются с повышенным риском кровотечений. Нарушение синтеза антикоагулянтов: протеина С, протеина S, антитромбина III сопровождается усилением генерации тромбина, что ведёт к прокоагулянтному статусу, увеличению риска венозных тромбозов, тромбоэмболии лёгочной артерии, а также тромбоза воротной вены. Активация коагуляционного каскада не только повышает риск тромбозов, но и играет большую роль в повреждении печени, способствуя прогрессированию фиброза. Цирроз печени увеличивает риск тромбоэмболических осложнений фибрилляции предсердий.

Для профилактики тромбозов и тромбоэмболических осложнений необходимы антикоагулянты. Однако большие проспективные исследования эффективности антикоагулянтной терапии у больных с циррозом отсутствуют. Недостаточно данных о безопасности антикоагулянтной терапии при циррозе. Имеются трудности мониторирования антикоагуляции при применении антагонистов витамина К и низкомолекулярных гепаринов.

В обзоре представлены имеющиеся данные по применению варфарина, нефракционированного гепарина, низкомолекулярных гепаринов и прямых оральных антикоагулянтов у больных с циррозом печени, свидетельствующие о необходимости профилактики венозных тромбозов у больных с факторами риска, возможности предупреждения декомпенсации цирроза, снижении частоты кардиоэмболических инсультов при фибрилляции предсердий у больных циррозом печени.

Об авторе

Е. С. Енисеева
Иркутская государственная медицинская академия последипломного образования – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГБОУ ВО «Иркутский государственный медицинский университет» Минздрава России
Россия

Енисеева Елена Сергеевна – кандидат медицинских наук, доцент кафедры кардиологии и функциональной диагностики; доцент кафедры госпитальной терапии

664049, г. Иркутск, Юбилейный, 100; 664003, г. Иркутск, ул. Красного Восстания, 1



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Для цитирования:


Енисеева Е.С. Антикоагулянтная терапия у больных с циррозом печени (обзор литературы). Acta Biomedica Scientifica. 2019;4(2):23-28. https://doi.org/10.29413/ABS.2019-4.2.3

For citation:


Eniseeva E.S. Anticoagulation in Patients with Liver Cirrhosis (Literature Review). Acta Biomedica Scientifica. 2019;4(2):23-28. (In Russ.) https://doi.org/10.29413/ABS.2019-4.2.3

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