fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2023-8-3-131-142fcmedicine-762Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESАнтикоагулянтная терапии у пациентов, перенесших протезирование клапанов сердца механическими протезамиOptimization of anticoagulant therapy in patients undergoing mechanical heart valve replacementhttps://orcid.org/0000-0002-9388-9309ТкаченкоС. А.TkachenkoS. A.

Ткаченко Софья Александровна - аспирант, врач-кардиолог.

630055, Новосибирск, ул. Речкуновская, д. 15

Sofya A. Tkachenko - MD, PhD Student, Cardiologist, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055

tkachenko_s@meshalkin.ruhttps://orcid.org/0000-0003-1130-7772АстаповД. А.AstapovD. A.

Астапов Дмитрий Александрович - доктор медицинских наук, заместитель генерального директора по организационно-методической работе, врач сердечно-сосудистый хирург.

630055, Новосибирск, ул. Речкуновская, д. 15

Dmitry A. Astapov - MD, DSc, Deputy Chief Executive Officer, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055, Novosibirsk

https://orcid.org/0000-0003-4625-4631Богачев-ПрокофьевА. В.Bogachev-ProkofievA. V.

Богачев-Прокофьев Александр Владимирович - доктор медицинских наук, директор института патологии кровообращения, врач сердечно-сосудистый хирург.

630055, Новосибирск, ул. Речкуновская, д. 15

Alexander V. Bogachev-Prokofiev - MD, DSc, Chief Executive Officer, Institute for Circulatory System Diseases, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055, Novosibirsk

https://orcid.org/0000-0002-3928-7374ЗалесовА. С.ZalesovA. S.

Залесов Антон Сергеевич - младший научный сотрудник научно-исследовательского отдела новых хирургических технологий института патологии кровообращения, врач сердечно-сосудистый хирург.

630055, Новосибирск, ул. Речкуновская, д. 15

Anton S. Zalesov - MD, Junior Researcher, Department of Novel Surgical Technologies, Institute for Circulatory System Diseases, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055, Novosibirsk

https://orcid.org/0000-0002-5752-7474ПивкинА. Н.PivkinA. N.

Пивкин Алексей Николаевич - кандидат медицинских наук, врач сердечно-сосудистый хирург.

630055, Новосибирск, ул. Речкуновская, д. 15

Alexey N. Pivkin - MD, PhD, Cardiovascular Surgeon, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055, Novosibirsk

https://orcid.org/0000-0002-0678-1026МакаевА. Г.MakaevA. G.

Макаев Александр Геннадьевич - клинический ординатор направления сердечно-сосудистая хирургия.

630055, Новосибирск, ул. Речкуновская, д. 15

Alexander G. Makaev - MD, Clinical Resident, Major Cardiovascular Surgery, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055, Novosibirsk

https://orcid.org/0000-0002-1648-1529АгаеваХ. А.AgaevaKh. A.

Агаева Хава Абдуллаевна - аспирант, младший научный сотрудник научно-исследовательского отдела хирургии аорты, коронарных и периферических артерий института патологии кровообращения, врач сердечно-сосудистый хирург.

630055, Новосибирск, ул. Речкуновская, д. 15

Khava A. Agaeva - MD, PhD Student, Junior Researcher, Department of Arterial Surgery, Institute for Circulatory System Diseases, Meshalkin National Medical Research Centre.

15, Rechkunovskaya Street, Novosibirsk, 630055

https://orcid.org/0000-0002-8832-2447ШарифулинР. М.SharifulinR. M.

Шарифулин Равиль Махарамович - кандидат медицинских наук, старший научный сотрудник научно-исследовательского отдела новых хирургических технологий института патологии кровообращения, врач сердечно-сосудистый хирург.

630055, Новосибирск, ул. Речкуновская, д. 15

Ravil M. Sharifulin - MD, DSc, Senior Researcher, Department of Novel Surgical Technologies, Institute for Circulatory System Diseases, Meshalkin National Medical Research Center.

15, Rechkunovskaya Street, 630055, Novosibirsk,

ФГБУ «Национальный медицинский исследовательский центр имени академика Е.Н. Мешалкина» Министерства здравоохранения Российской ФедерацииРоссияMeshalkin National Medical Research CenterRussian Federation20232909202383131142Copyright © Ткаченко С.А., Астапов Д.А., Богачев-Прокофьев А.В., Залесов А.С., Пивкин А.Н., Макаев А.Г., Агаева Х.А., Шарифулин Р.М., 20232023Ткаченко С.А., Астапов Д.А., Богачев-Прокофьев А.В., Залесов А.С., Пивкин А.Н., Макаев А.Г., Агаева Х.А., Шарифулин Р.М.Tkachenko S.A., Astapov D.A., Bogachev-Prokofiev A.V., Zalesov A.S., Pivkin A.N., Makaev A.G., Agaeva K.A., Sharifulin R.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/762

Приобретенные пороки сердца имеют высокую распространенность среди пациентов разных возрастных групп и являются значимой социальной проблемой. Наиболее эффективным методом лечения данной патологии является хирургическая коррекция, включающая протезирование механическими клапанами сердца с последующей постоянной антикоагулянтной терапией с применением антагонистов витамина К и постоянным контролем международного нормализованного отношения (МНО). Вопрос оптимизации подходов к терапии антикоагулянтами для указанной категории пациентов становится всё более актуальным. В настоящей работе освещены основные проблемы и возможные пути их решения для пациентов, перенесших имплантацию механического протеза и нуждающихся в постоянном приеме антагонистов витамина К.

Acquired heart defects have a high prevalence among patients of different age groups and represent a significant social problem. To date, surgery remains the only effective option to treat acquired heart disease, and replacement of the dysfunctional heart valves frequently relies on mechanical prosthetic heart valves which implantation requires lifelong anticoagulant therapy with vitamin K antagonists and constant monitoring of international normalised ratio. However, the optimal target range for international normalised ratio values remains poorly defined. Optimisation of the approaches to anticoagulant therapy for this category of patients is becoming increasingly important. This paper highlights the main problems and possible solutions for patients who have undergone implantation of mechanical heart valves and need constant intake of vitamin K antagonists.

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The authors declare that there are no conflicts of interest present.