Ispitivanje antikoagulantnog efekta antagonista vitamina K kod bolesnika sa nevalvularnom atrijalnom fibrilacijom

  • Zoran Stanojković Blood Transfusion Institute Niš, Medical Faculty, University of Niš
  • Ana Antić Blood Transfusion Institute of Niš
  • Bela Balint Department of Medical Sciences, Serbian Academy of Sciences and Arts; Department of Transfusion Medicine, Institute of Cardiovascular Diseases "Dedinje"; Institute of Medical Research, University of Belgrade
  • Milena Todorović Clinic for Hematology, Clinical Center of Serbia, Belgrade; Medical Faculty, University of Belgrade
  • Miodrag Vučić Clinic for Hematology, Clinical Center Niš; Medical Faculty, University of Niš
  • Nebojša Vacić Clinic for Hematology, Clinical Center Niš;
  • Milan Lazarević Clinic for Cardiovascular and Transplant Surgery, Clinical center Niš
DOI: https://doi.org/10.2298/VSP181214008S
Ključne reči: antikoagulansi;, fibrilacija pretkomora;, krv, testovi koagulacije;, lekovi, odnos doza-reakcija;, vitamin k

Sažetak


Uvod/Cilj. I pored uvođenja novih oralnih antikoagulantnih lekova (dabigatran, rivoroksaban, apiksaban), antagonisti vitamina K (AVK), kao što su varfarin i acenokumarol, još uvek su najčešće primenjivani oralni antikoagulantni lekovi u terapiji nevalvularne atrijalne fibrilacije (NVAF). Vreme u terapijskom opsegu (Time in Therapeutic Range – TTR) predstavlja meru kvaliteta antikoagulantnog efekta tih lekova, te se smatra da su niže vrednosti TTR udružene sa neželjenim efektima terapije. Cilj rada bio je da se utvrde efikasnost terapije AVK kod bolesnika sa NVAF i faktori koji utiču na kvalitet antikoagulantnog efekta tih lekova. Metode. Retrospektivnom analizom obuhvaćeno je 725 bolesnika sa NVAF koji su ambulantno praćeni u Zavodu za transfuziju krvi u Nišu, u periodu januar-decembar 2017. godine. Laboratorijsko određevanje međunarodnog normalizovanog


odnosa (International Normalized Ratio – INR) vršeno je iz kapilarne krvi bolesnika na aparatima Trombotrack Solo (Axis Shield, Norveška) i Thrombostat (Behnk Elektronik, Nemačka). Ciljni terapijski INR bio je između 2,0 i 3,0. Na osnovu svih dostupnih vrednosti INR za svakog bolesnika pojedinačno, određen je individulani TTR metodom po Rosendaal-u. Rezultati. Ispitivanjem su bila obuhvaćena ukupno 725 bolesnika sa NVAF kojima je u toku 2017. godine urađeno 6,105 kontrola INR (8,13 ± 2,47 INR kontrola po bolesniku). Srednja vrednost TTR bila je 60,15 ± 17,52%, ali je 49,72% bolesnika imalo TTR < 60%. Bolesnici su imali visok rizik od tromboze u 6,15% vremena (INR < 1,5), a u 2,2% vremena visok rizik od krvarenja (INR > 4,5). Najznačajniji nezavisni faktori koji su uticali na kvalitet AVK terapije bili su: pol i arterijska hipertenzija, dijabetes melitus, upotreba amiodarona i antitrombocitnih lekova (aspirin, klopidogrel). Zaključak. Parametar TTR je nedvosmisleno koristan pokazatelj efikasnosti antikoagulantnog efekta AVK. Najznačajniji prediktori lošije efikasnosti AVK su: pol, arterijska hipertenzija, dijabetes melitus, upotreba amiodarona i antitrombocitnih lekova (aspirin, klopidogrel). U cilju unapređenja kvaliteta primene i monitoringa antikoagulantnog efekta AVK neophodna je pravilna edukacija i bolja saradnja sa bolesnicima, ali i bolji timski rad kliničara.

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2021/01/15
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Vol. 77 Br. 12 (2020): Vojnosanitetski Pregled
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Originalni članak