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#1
28.03.2012, 18:34
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Фарм.поддрежка при ЧКВ: Брилинта + Варфарин?
Нужен совет.
Пациент 60 лет, в 2006 году перенес АКШ и сейчас ему предстоит ЧКВ (ПМЖВ -3,0*30 и ОВ - 3,5*38), но имеется аллергия на клопидогрель - доказанная, и при приеме аспирина резко обостряется подагра. Есть идея применить брилинту в комбинации с варфарином. Есть ли у кого подобный опыт и что может посоветовать уважаемое общество в данной ситуации. 
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#2
28.03.2012, 19:06
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#3
28.03.2012, 19:15
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Повторная АКШ сопровождается большим риском и никто не отменял медикаментозную терапию, но мы же интервенционисты и должны поддерживать наше направление
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#4
28.03.2012, 19:22
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можно не изобретать "велик" и воспользоваться зарубежным опытом, напр.:
Intern Med J. 2010 Aug;40(8):596-9. Rapid and sequential desensitization to both aspirin and clopidogrel. Fernando SL, Assaad NN. SourceDepartment of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia. Hypersensitivity reactions to aspirin and clopidogrel are 2.5% and 1%, respectively. Dual anti-platelet therapy with these drugs is effective in preventing thrombosis following deployment of stents for cerebrovascular and cardiovascular syndromes. Desensitization therapy with both aspirin and clopidogrel may be required for patients undergoing stent implantation that have experienced hypersensitivity to these agents. We report the case of a 58-year-old woman who developed urticaria and angioedema following aspirin therapy for ischaemic cerebrovascular disease. She developed an identical reaction after clopidogrel was subsequently administered. Investigations revealed the presence of an internal carotid artery aneurysm that required deployment of a stent. Rapid desensitization to aspirin over 5.5 h followed 3 days later by rapid desensitization to clopidogrel over 2.5 h was successfully performed prior to stenting. After 4 months she has tolerated this dual anti-platelet therapy without any adverse reaction. Rapid and sequential desensitization to both aspirin and clopidogrel can be successfully performed for patients who require stent deployment but have hypersensitivity to both these anti-platelet agents. --- Expert Rev Clin Pharmacol. 2010 Jul;3(4):553-61. Clopidogrel hypersensitivity: clinical challenges and options for management. Campbell KL, Cohn JR, Savage MP. SourceDepartment of Medicine, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine level, Philadelphia, PA 19107, USA. Over 90 million patients have been prescribed clopidogrel since its US FDA approval in 1997. Clopidogrel hypersensitivity affects up to 6% of patients, most commonly in the form of a pruritic rash. Symptoms are severe enough to result in drug discontinuation in 1.5% of patients. Premature discontinuation of clopidogrel is problematic following percutaneous coronary intervention because of the risk of stent thrombosis leading to myocardial infarction and death. Accordingly, the management of patients with clopidogrel hypersensitivity is of significant clinical importance. Conventional clopidogrel desensitization protocols, while successful in most patients, employ a washout period off medication to enable accurate detection of a reaction during the desensitization. However, interruption of therapy is potentially hazardous in patients with recent stent placement. Our clinical experience demonstrates that clopidogrel hypersensitivity can be successfully treated without drug interruption using short-course corticosteroids and antihistamines to enable the development of physiologic tolerance while the medication is continued. The role of newer agents, such as prasugrel, as surrogate therapy in patients with clopidogrel hypersensitivity is yet to be defined. --- Neth Heart J. 2008;16(1):21-3. Rapid oral desensitisation procedure in clopidogrel hypersensitivity. [Ссылки доступны только зарегистрированным пользователям ]
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#5
28.03.2012, 19:24
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#6
29.03.2012, 15:59
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#7
29.03.2012, 17:41
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#8
30.03.2012, 01:25
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А какие будут мнения по поводу монотерапии брилинтой?
Или же учитывая важность двойной терапии пренебречь обострением подагры и пробовать брилинту с аспирином? P.S. Спасибо всем за обсуждение - для меня важно мнение коллег P.P.S - прасугреля нет в наличии
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#9
30.03.2012, 15:44
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#10
30.03.2012, 15:46
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#11
30.03.2012, 23:29
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Линейный вид
