Jaunās paaudzes antikoagulantu koncentrācijas izmaiņas pacientiem ar ātriju fibrilāciju polifarmācijas un nieru darbības traucējumu dēļ.
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pētījuma aktualitāte. Epidemioloģiskā pētījumā tika noskaidrots, ka pēdējo 20 gadu laikā ātriju fibrilācijas slimnieku skaits ir pieaudzis par 33 %. Tiek prognozēts, ka turpmāko 30 gadu laikā šis skaits varētu pieaugt par vairāk nekā 60 %. Ātriju fibrilācijas bīstamākā komplikācija ir trombembolija. Tās novēršanai tiek nozīmēta antikoagulatīvā terapija. Pamatojoties uz klīnisko pētījumu datiem, tiešie perorālie antikoagulanti ir drošāki un efektīvāki par varfarīnu. Latvijā rivaroksabāna patēriņš no 2014. līdz 2018. gadam ir pieaudzis 9,6 reizes, bet dabigatrāna patēriņš - 3,6 reizes. Tomēr arī jaunajiem tiešajiem antikoagulantiem tiek novērotas blakusparādības, tādas kā asiņošana, un piemērojami lietošanas ierobežojumi pacientiem ar nieru traucējumiem.
Pētījuma mērķis. Noteikt un analizēt polifarmācijas ietekmi uz tiešo perorālo antikoagulantu koncentrācijas izmaiņām asinīs ātriju fibrilācijas pacientiem ar samazinātu nieru funkciju.
Pētījuma atziņas. Pētījumā biežāk lietotais perorālais antikoagulants bija rivaroksabāns. Pacientiem ar samazinātu glomerulāro filtrācijas ātrumu (< 50 ml/min/1,73m2) tika konstatētas augstākas rivaroksabāna koncentrācijas asinīs. Pētījumā tika novērota iespējama rivaroksabāna mijiedarbība ar perindoprilu, rosuvastatīnu un omega-3 taukskābēm. Lietojot rivaroksabānu un rosuvastatīnu vienlaicīgi, antikoagulanta koncentrācija asinīs bija paaugstināta līdz pat nākamajai zāļu devai. Pacientiem ar samazinātu nieru funkciju un polifarmāciju novēroja paaugstinātu rivaroksabāna koncentrāciju asinīs, īpaši, ja šie abi faktori izpaudās vienlaicīgi.
Background. Epidemiological study showed that during last 20 years number of patients with atrial fibrillation has increased by 33 %. It is projected that in upcoming 30 years this number could increase by more than 60 %. The most dangerous complication of atrial fibrillation is thrombembolism. Anticoagulative therapy is the main treatment for this complication. Direct oral anticoagulants are safer and more effective than warfarin, based on clinical trial data. In Latvia consumption of rivaroxaban from 2014 to 2018 year has increased 9,6 times but consumption of dabigatran has increased 3,6 times. Altough, side effects like bleeding events have been observed for novel direct anticoagulants, and restrictions on use in patients with renal impairment. Aim of the study. To determine and analyze polypharmacy affect to changes of direct oral anticoagulant concentration in blood for patients with atrial fibrillation and decreased renal function. Results. In this study rivaroxaban was the most frequently used oral anticoagulant. Higher rivaroxaban concentrations in blood were observed for patients with decreased glomerular filtration rate (< 50 ml/min/1,73m2). Also there were observed possible interactions between rivaroxaban and perindopril, rosuvastatin and omega-3 fatty acids. In rosuvastatin group there were higher rivaroxaban concentrations until the next dose. Patients with decreased renal function and polypharmacy had higher rivaroxaban concentration in blood, especially, if these both factors were present simultaneously.
Background. Epidemiological study showed that during last 20 years number of patients with atrial fibrillation has increased by 33 %. It is projected that in upcoming 30 years this number could increase by more than 60 %. The most dangerous complication of atrial fibrillation is thrombembolism. Anticoagulative therapy is the main treatment for this complication. Direct oral anticoagulants are safer and more effective than warfarin, based on clinical trial data. In Latvia consumption of rivaroxaban from 2014 to 2018 year has increased 9,6 times but consumption of dabigatran has increased 3,6 times. Altough, side effects like bleeding events have been observed for novel direct anticoagulants, and restrictions on use in patients with renal impairment. Aim of the study. To determine and analyze polypharmacy affect to changes of direct oral anticoagulant concentration in blood for patients with atrial fibrillation and decreased renal function. Results. In this study rivaroxaban was the most frequently used oral anticoagulant. Higher rivaroxaban concentrations in blood were observed for patients with decreased glomerular filtration rate (< 50 ml/min/1,73m2). Also there were observed possible interactions between rivaroxaban and perindopril, rosuvastatin and omega-3 fatty acids. In rosuvastatin group there were higher rivaroxaban concentrations until the next dose. Patients with decreased renal function and polypharmacy had higher rivaroxaban concentration in blood, especially, if these both factors were present simultaneously.
Description
Farmācija
Pharmacy
Veselības aprūpe
Health Care
Pharmacy
Veselības aprūpe
Health Care
Keywords
Tiešie perorālie antikoagulanti, rivaroksabāns, ātriju fibrilācija, nieru traucējumi, Direct oral anticoagulants, rivaroxaban, atrial fibrillation, renal impairment