Необходимость определения остаточных концентраций прямых оральных антикоагулянтов у больных фибрилляцией предсердий, подвергнутых транскатетерной имплантации аортального клапана

Introduction. Lengthening the period of direct oral anticoagulant (DOAC) withdrawal before intervention is not allowed. Chronic kidney disease (CKD), impaired liver function, extremely low or high body mass, chronic heart failure (CHF), and age > 90 years can increase blood DOAC levels. DOAC therapy does not require routine laboratory monitoring. However, there are coagulation tests that can be used to detect the presence of a drug in blood. Duration of DOAC discontinuation and the appropriateness of assessing residual anticoagulant concentrations before intervention with a high bleeding risk in a special category of patients is to be defined.Aim. To measure residual concentrations of anticoagulants and their association with perioperative bleeding risk in patients with AF using DOACs in blood samples collected immediately before TAVI.Materials and methods. The 94 patients with atrial fibrillation (AF) included in the study were characterized by senile age, a high risk of thromboembolic complication (ТС), many comorbidities, and a high prevalence of senile asthenia. The apixaban and rivaroxaban concentrations were measured according to the value of anti-Xa activity and control plasmas with normal levels of coagulation factors (Diagnostica Stago, France).Results. The median time of DOAC withdrawal before TAVI was 60 hours [47.5; 72]. However, the DOAC concentration exceeded 30 ng/ml in 1/5 patients (19.2%), and stage 3 or more CKD was more common in these patients. Our study showed the relationship between DOAC concentration and the duration of DOAC withdrawal period. However, the relationship between DOAC concentration and bleeding that occurred in the perioperative period could not be found. Patients with signs of CKD were older and had a lower BMI as compared to patients without CKD.Conclusion. Our data showed the relationship between the DOAC concentration and the duration of DOAC withdrawal period. No relationship was found between DOAC concentrations and bleeding.Введение. Удлинение периода отмены прямых оральных антикоагулянтов (ПОАК) перед вмешательством является недопустимым.Хроническая болезнь почек (ХБП), нарушение функции печени, экстремально низкая или высокая масса тела, хроническая сердечная недостаточность (ХСН), а также возраст > 90 лет способны увеличить содержание ПОАК. Рутинный лабораторный контроль при терапии ПОАК не требуется, однако существуют коагуляционные тесты, позволяющие судить о присутствии препарата в крови. Длительность прерывания ПОАК и целесообразность оценки остаточных концентраций антикоагулянта перед вмешательством с высоким риском кровотечения у особой категории пациентов требует уточнения.Цель. Определить остаточные концентрации антикоагулянтов и их связь с риском периоперационных кровотечений у пациентов с ФП, принимающих ПОАК, в образцах крови, взятых непосредственно перед ТИАК.Материалы и методы. 94 пациента с ФП, включенных в исследование, отличались старческим возрастом, высоким риском ТО, множеством сопутствующих заболеваний и широкой распространенностью старческой астении. Концентрации апиксабана и ривароксабана определяли по величине анти-Хаактивности и контрольных плазм с нормальным уровнем факторов свертывания (производства Diagnostica Stago, Франция).Результаты. Медиана времени отмены ПОАК перед операцией ТИАК составила 60 ч (47,5; 72), однако у 1/5 больных (19,2%) концентрация ПОАК превышала 30 нг/мл и у этих больных чаще встречалась ХБП 3-й и более стадии. Наше исследование показало взаимосвязь концентрации ПОАК с длительностью периода их отмены. Тем не менее связи концентрации ПОАК с кровотечениями, случившимися в периоперационный период, обнаружить не удалось. Пациенты с признаками ХБП были старше и имели более низкий ИМТ по сравнению с пациентами, у которых ХБП не было.Выводы. Наши данные показали взаимосвязь концентрации ПОАК с длительностью периода их отмены. Связи концентрации ПОАК с кровотечениями не обнаружено

STATE POLICY OF THE RUSSIAN FEDERATION AIMED AT THE DEVELOPMENT OF EDUCATION IN THE DIGITAL ECONOMY

This article examines state measures, in particular the state program of the Russian Federation "Development of Education", approved by the Government of the Russian Federation No. 1642 of December 26, 2017. Prospects for the development of state projects are described, such as the "Modern Digital Educational Environment in Russia" ("DSS in Russia") and the "National Platform for Open Education" (NPOU), in which universities such as MSU, SPbPU, St. Petersburg State University and others. The project launched an information resource that provides access to a huge number of online courses and allows increasing the number of students in educational organizations. A comparative analysis of the level of participation of students in the process of obtaining new or additional education at distance courses in the world and in the Russian Federation is conducted. The main advantages and negative aspects of online courses are reflected. Personal contribution to the development of the competitiveness of Russian education at the international level of such higher educational institutions as the Russian Economic University. G.V. Plekhanov and the National University "Higher School of Economics." The trends in the development of platforms and formats for online learning are reflected. Negative features of exclusively traditional education and e-learning are considered. The result is considered in a combination of these two paradigms of education, that is, the introduction of mixed education

EFFICACY AND SAFETY OF ALBAREL IN PATIENTS WITH MILD, MODERATE AND SEVERE HYPERTENSION

The aim of the study was to evaluate the efficacy and safety (influence on carbohydrate, lipid and mineral metabolism, as well as nitrogen-excreting function of kidneys) of monotherapy with rilmenidine in patients with mild to moderate AH, as well as treatment of patients with severe AH as multiple combined treatment. 43 patients with essential AH I-HI degree, aged 22 to 79, were enrolled in this open label study after signing an informed consent form. Enrolled patients were divided into 2 groups. Group 1 included 20 outpatients. They received monotherapy with rilmenidine 1 mg daily. Duration of treatment was 12 weeks. Group 2 was comprised of 23 subjects admitted to an in-patient clinic. Those subjects received Albarel 1 mg or 2 mg daily as a component of multiple antihypertensive therapy. Albarel was administered 7-10 days following the admission to clinic as a second to fifth hypotensive drug. Albarel's combinations with diuretics, ACE inhibitors, calcium antagonists, beta-blockers. The result is - monotherapy with Albarel 1-2 mg daily allows to achieve target BP in 77, 8 % patients with mild to moderate AH. With Albarel as a component of multiple therapy target BP is achieved in 65, 2 % patients with severe AH. Effectively decreasing BP Albarel does not change its daily profile. It has no influence on renal function, carbohydrate metabolism, and electrolyte content of blood. Albarel is well tolerated. Adverse effects included mouth dryness and drowsiness, was noted in 2, 33 % cases and did not require drug withdrawal