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Ингибиторы IIв/IIIa рецепторов в РекомендацияхИнгибиторы IIв/IIIa рецепторов тромбоцитов наилучшим образом изучены у пациентов с ОКС, подвергавшихся чрескожной коронарной ангиопластике (E.Antman et al., 2004; J.Anderson et al., 2007). Однако они приносят пользу и получавшим консервативную терапию ОКС больным сахарным диабетом (M.Roffi et al., 2001). Абциксимаб является предпочтительным средством этого класса для начальной терапии перед коронарной ангиопластикой и в течение 12 часов после вмешательства (E.Topol et al., 2001). Эптифибатид и тирофибан, другие препараты этого класса, вводят на протяжении 18-24 часов после ангиопластики, причем первый обеспечивает лучшие исходы по данным проведенных исследований (E.Antman et al., 2004; J.Anderson et al., 2007). Введение абциксимаба, тирофибана или эптифибатида следует начинать как можно раньше во время первичной ангиопластики у больных ИМ с подъемами сегмента ST (F.Kushner et al., 2009). При реваскуляризации миокарда у больных с ОКС без подъемов сегмента ST при тромбообразовании в коронарной артерии рекомендован абциксимаб, в такой же ситуации у пациентов с ОКС с подъемами сегмента ST следует применять абциксимаб или эптифибатид (W.Wijns et al., 2010). Ингибиторы IIв/IIIa рецепторов увеличивают риск тяжелых кровотечений, что может приводить к повышению летальности (S.Manoukian et al., 2007). Способы снижения частоты больших кровотечений: 1) индивидуальный подбор дозы, особенно для пожилых и пациентов с нарушением функции почек (E.Antman et al., 2004; J.Anderson et al., 2007). 2) прекращение введения гепаринов после реваскуляризации (E.Karvouni et al., 2003); 3) введение ингибиторов IIв/IIIa рецепторов тромбоцитов непосредственно в лаборатории для катетеризации (и предпочтительно интракоронарно) после оценки состояния пораженных артерий (J.Wohrle et al., 2003).
Литература
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