Kardiologiya
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One of actual problems of modern cardiology is assessment and correction of risk of cardiac complications of noncardiac surgery. Recommendations on this issue propose reduction of preoperative examination and wide use of drug therapy, primarily statins and β-blockers. However, new data accumulated in recent years, as well as the recognition of scientific inconsistency of the DECREASE research series, force a new outlook at the problem. In this review in light of new facts the following important issues of perioperative medicine are discussed: administration of β-blockers and statins, volume of preoperative cardiac examination, value of preventive myocardial revascularization.
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Comparative Study
[Cost-effectiveness of apixaban compared to other new oral anticoagulants in patients with non-valvular atrial fibrillation].
Atrial fibrillation is associated with development of thromboembolic events. New oral anticoagulants (apixaban, rivaroxaban and dabigatran) are recommended for antithrombotic therapy in patients with non-valvular atrial fibrillation (NVAF) with moderate and high risk of stroke. ⋯ Apixaban provided increased life expectancy compared to other new anticoagulants and may be considered as a cost-effective alternative to dabigatran 110 mg and 150 mg and rivaroxaban from the Russian Federation national health care system perspective.
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The ATLANTIC trial compared effects of initiation of ticagrelor at the prehospital (ambulance) or hospital (in the catheterization laboratory) stage of treatment of patients with ST-segment elevation myocardial infarction. Initiation of therapy with ticagrelor at prehospital stage short before percutaneous coronary intervention was safe, but did not improve coronary reperfusion before this procedure. However, earlier administration of ticagrelor significantly reduced the risk of stent thrombosis after percutaneous coronary intervention.
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The article deals with renal dysfunction, methods of assessment and monitoring in patients receiving anticoagulant therapy. Due to the negative impact of renal impairment on the incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation problem identifying renal failure and its degree is an actual problem. Set forth in Article current recommendations and practical aspects of the evaluation of renal function and selecting dosing regimen can improve the safety of anticoagulants therapy.