#1
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Àíòèòðîìáîöèòàðíîå äåéñòâèå äèïèðèäàìîëà
Öèòàòà:
Ñóäÿ ïî îáðûâî÷íûì ñâåäåíèÿì î ïðîòåêàíèè ïåðâîé áåðåìåííîñòè ìîæíî ïðåäïîëîæèòü, ÷òî ïåðâàÿ áåðåìåííîñòü áûëà îñëîæíåíà ãåñòîçîì. Ãåñòîç âî âðåìÿ ïðåäøåñòâóþùåé áåðåìåííîñòè ÿâëÿåòñÿ ôàêòîðîì ðèñêà ðàçâèòèÿ ãåñòîçà â íàñòîÿùóþ áåðåìåííîñòü. Ïîýòîìó, ìîæåò áûòü, àñïèðèí íàçíà÷åí èìåííî ñ öåëüþ ïðîôèëàêòèêè ãåñòîçà. Ðåêîìåíäóþ Âàì óòî÷íèòü ñ êàêîé èìåííî öåëüþ áûë íàçíà÷åí àñïèðèí. Ïîêàçàíèé ê àíòèêîàãóëÿíòîé òåðàïèè äåéñòâèòåëüíî íå óñìàòðèâàåòñÿ. |
#2
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Ìîæíî ïîïðîáîâàòü êóðàíòèë è íå ìîðî÷èòñÿ ñ ÿçâàìè.
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#3
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Òîò êóðàíòèë, êîòîðûé ïðîäàåòñÿ â ÑÍà àáñîëþòíî íå îáëàäàåò àñïèðèíîïîäîáíûì äåéñòâèåì (ÿ ãîâîðþ î êàðäèîëîãèè, íå çíàþ ïðè ãåñòîçå - êîëëåãè ïîïðàâÿò). Ïðîëîíãèðîâàííûé êóðàíòèë (ïðîëîíãèðîâàííûé äèïèðèäàìîë) ïîêà íå ïîñòóïàåò â ÑÍÃ. Ïîýòîìó, íà ìîé âçãëÿä, àñïèðèí çàìåíèòü íå÷åì.
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#4
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ß áû íåìíîæêî ïîïðàâèë - îìåç ýòî êàòåãîðèÿ Ñ ïðè áåðåìåííîñòè, åãî íåëüçÿ.
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#5
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Õì, óâàæàåìûé Ñåðãåé Ñåðãååâè÷, äèïèðèäàìîë îí è â Àôðèêå äèïèðèäàìîë. È íå ïðîëîíãèðîâàííûé, íè îáû÷íûé, äåéñòâèòåëüíî íå îáëàäàþò àñïèðèíîïîäîáíûì äåéñòâèåì. Ó äèïèðèäàìîëà, âèäèòå ëè äðóãîé ìåõàíèçì äåéñòâèÿ.
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#6
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Öèòàòà:
Ìîíîòåðàïèÿ àñïèðèíîì (50-325 ìã/äåíü) èëè àñïèðèí â ñî÷åòàíèè ñ äèïèðèäàìîëîì çàìåäëåííîãî âûñâîáîæäåíèÿ èëè ìîíîòåðàïèÿ êëîïèäîãðåëåì ÿâëÿþòñÿ äîïóñòèìûìè âàðèàíòàìè â êà÷åñòâå ñòàðòîâîé àíòèòðîìáîöèòàðíîé òåðàïèè*. (Êëàññ I, Óðîâåíü äîêàçàííîñòè À.) Ñî÷åòàíèå àñïèðèíà è äèïèðèäàìîëà çàìåäëåííîãî âûñâîáîæäåíèÿ ðåêîìåíäóåòñÿ êàê ïðåäïî÷òèòåëüíîå ê ìîíîòåðàïèè àñïèðèíîì. (Êëàññ I, Óðîâåíü äîêàçàííîñòè B). Íà îñíîâàíèè ðåçóëüòàòà èññëåäîâàíèÿ SPARKL, íàçíà÷åíèå ñòàòèíà ñ âûðàæåííûì ãèïîëèïèäåìè÷åñêèì äåéñòâèåì ðåêîìåíäîâàíî ó ïàöèåíòîâ ñ àòåðîñêëåðîòè÷åñêèì èíñóëüòîì èëè ÏÍÌÊ â àíàìíåçå íåçàâèñèìî îò íàëè÷èÿ èëè îòñóòñòâèÿ ÊÁÑ äëÿ ñíèæåíèÿ ðèñêà èíñóëüòà èëè ñåðäå÷íî-ñîñóäèñòûõ ñîáûòèé. Êîíåö öèòàòû. Âîò ýòî ÿ èìåë â âèäó (ìîæåò ÿ íåïðàâèëüíî âûðàçèëñÿ). Âïðî÷åì åñëè ãåñòîç ëå÷àò êóðàíòèëîì, òî îíî êîíå÷íî. |
#7
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Íó òàê ýòî ïîòîìó, ÷òî "áûñòðûé" äèïèðèäàìîë - ýòî ñòðåññ-ÝÕÎ ñ äèïèðèäàìîëîì äëÿ ÈÁÑíèêà, íî áåç ÝÕÎ-ÊÃ
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#9
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Íàñêîëüêî ÿ çíàþ, êóðàíòèë â ïðîôèëàêòèêå ãåñòîçà èìååò êàêîé-òî âåñüìà ñëàáûé ýâèäåíñ. Êñòàòè íàïîìíþ, ÷òî äàííîé æåíùèíå íå òî ÷òîáû ãåñòîç ïðîôèëàêòèðóþò, à ñêîðåå äàæå ïðîñòî "ëå÷àò êîàãóëîãðàììó" Äà âîò ÷òî ÿ òóò íàøåë:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Maternal outcomes There was no overall difference in the risk of pregnancy induced hypertension in the 27 trials (18 147 women) reporting this outcome (relative risk 0.97, 95% confidence interval 0.89 to 1.05). The 15% reduction in risk of pre-eclampsia associated with antiplatelet drugs (32 trials, 29 331 women; relative risk 0.85 95% confidence interval 0.78 to 0.92; risk difference 0.01, 95% confidence interval 0.017 to 0.006; number needed to treat 100, 95% confidence interval 59 to 167) was consistent regardless of risk status (fig 2), dose of aspirin, gestation at trial entry, or use of a placebo. It was greater for women allocated >75 mg aspirin (relative risk 0.35, 0.24 to 0.52), but the numbers in this subgroup are small (13 trials, 1264 women). There were no significant differences between treatment and control groups in the risk of eclampsia (nine trials, 14 623 women), maternal death (two trials, 9438 women), caesarean section (17 trials, 25 827 women), induction of labour (three trials, 15 935 women), antenatal admission (one trial, 6049 women), or placental abruption (12 trials, 22 309 women). Outcomes for babies In 23 trials (28 268 women) that reported preterm birth there was a small (8%) reduction in the risk of being born too early (relative risk 0.92, 0.88 to 0.97; risk difference 0.014, 0.023 to 0.005; number needed to treat 72, 44 to 200; fig 3). The size of this reduction was consistent across all subgroups, except those receiving >75 mg aspirin (557 women; relative risk 0.58, 0.38 to 0.88). Ïî êóðàíòèëó òàì ìàëî. |
#10
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Ñåðãåé Ñåðãååâè÷, äîðîãîé. âû ìåíÿ ïðÿì óáèâàåòå. Ïî÷åìó âû ðåøèëè ÷òî îáû÷íûé äèïèðèäàìîë íå îáëàäàåò àíòèòðîìáîöèòàðíûì äåéñòâèåì? Íó íåëüçÿ æå òîëüêî ãàéäû ÷èòàòü. Âñå ðàâíî ÷òî ñêàçàòü, ÷òî ïðîëîíãèðîâàííûé ïåíèöèëëèí îáëàäàåò äåéñòâèåì íà òðåïîíåìó, à îáû÷íûé íåò.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Êóðàíòèë - äèïèðèäàìîë â ÑÍÃ. Ïåðñàíòèë - äèïèðèäàìîë â Åâðîïå. Àãðåíîêñ - Âàø ëþáèìûé ðåòàðäèðîâàííûé äèïèðèäàìîë â ñî÷åòàíèè ñ àñïèðèíîì. À â ãàéäàõ îáû÷íîãî äèïèðèäàìîëà íåò, ïîòîìó ÷òî èññëåäîâàëñÿ ïðîëîíãèðîâàííûé, ïîòîìó ÷òî ñïîíñîðîì èññëåäîâàíèÿ âûñòóïàëà êîìïàíèÿ Áåðèíãåð, ïðîèçâîäÿùàÿ èìåííî àãðåíîêñ, ïîòîìó ÷òî..., âîò äîì, êîòîðûé ïîñòðîèë Äæåê (ñ) Ïðîâîäÿòñÿ äåñÿòêè èññëåäîâàíèé ñ îáû÷íûì äèïèðèäàìîëîì. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ß íå âñòðå÷àë ñðàâíèòåëüíûõ èññëåäîâàíèé, ïîêàçûâàþùèõ ïðåèìóùåñòâà ðåòàðäèðîâàííîãî äèïèðèäàìîëà íàä îáû÷íûì. Ìîæåò âû ïîäñêàæåòå? |
#11
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Äèïèðèäàìîëà â êàðäèîëîãè÷åñêèõ ãàéäàõ íåò, çíà÷èò åãî íåò âîîáùå; ìíå õâàòàåò àñïèðèíà, êëîïè è äëèííîãî êóðàíòèëà. Âîò, êòî ìíå ñêàæåò àñïèðèí äëÿ ïðîôèëàêòèêè ãåñòîçà òîæå íå èç ãàéäîâ, à èç îïûòà ìîñêîâñêîãî ðîääîìà ¹2?
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#12
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Åñòü îïðåäåëåííîå ïîäîçðåíèå, ÷òî êîðîòêèé êóðàíòèë âî-ïåðâûõ íåäîëãî äåéñòâóåò, à âî-âòîðûõ - áîëåå àêòèâíî âûçûâàåò àðòåðèîëîäèëàòàöèþ è ôåíîìåí îáêðàäûâàíèÿ ó áîëüíûõ ñ èøåìè÷åñêîé áîëåçíü ñåðäöà. Îò îòñóòñòâèÿ àããðåíîêñà ìíîãèå ëþäè ó íàñ â ñòðàíå ñòðàäàþò - âñåì õî÷åòñÿ åáýýìíî ïðîôèëàêòèðîâàòü èíñóëüò ïðîâåðåííîé ðåòàðäíîé êîìáèíàöèåé, äà âîò íå ïîëó÷àåòñÿ (ñì. öèòàòó îò Ñåðãåÿ Ñåðãååâè÷à).
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#13
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Antiplatelet therapy, in particular, low dose (< 75 mg) aspirin, reduces the risk of pre-eclampsia by around 15% for women at both low and high risk. There appears to be a similar reduction in the risk of perinatal death. Aspirin should be considered, particularly for women at high risk. In countries with a high prevalence of pre-eclampsia, more widespread use may be worthwhile. (Grade B)
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ìîæíî è ïîíîâåå íàéòè, ëåíü |
#14
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Öèòàòà:
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