35 research outputs found
Moral values and professional development of identity of the teacher
The article consider the results of an empirical research of moral values of preschool teachers with various experience of pedagogical activityΠ Π°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠΌΠΏΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π½ΡΠ°Π²ΡΡΠ²Π΅Π½Π½ΡΡ
ΡΠ΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΏΠ΅Π΄Π°Π³ΠΎΠ³ΠΎΠ² Π΄ΠΎΡΠΊΠΎΠ»ΡΠ½ΡΡ
ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΉ Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠΌ ΡΡΠ°ΠΆΠ΅ΠΌ ΠΏΠ΅Π΄Π°Π³ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡ
The project method in the preparation of the students-masters of the psycologo-pedagogical education
The article analyzes the features of realization of project method in preparation of students-mastersΠ ΡΡΠ°ΡΡΠ΅ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΏΡΠΎΠ΅ΠΊΡΠΎΠ² ΠΏΡΠΈ ΠΏΠΎΠ΄Π³ΠΎΡΠΎΠ²ΠΊΠ΅ ΠΌΠ°Π³ΠΈΡΡΡΠΎΠ² ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΎ-ΠΏΠ΅Π΄Π°Π³ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈ
Flipped learning as interactive learning environment
The use of the flipped classroom as an alternative to the traditional learning environments has been increasingly attracting the attention of researchers and educators. The advancement in technological tools such as interactive videos, interactive in-class activities, and video conference systems paves the way for the widespread use of flipped classrooms. It is even asserted that the flipped classroom, which is used to create effective teaching environments at schools, is the best model for using technology in education. Studies about the flipped classroom appear in different disciplines including information systems, engineering, sociology, and humanities, mathematics education, and English composition. The purpose of this paper is to fulfil the needs regarding the review of recent literature on the use of the flipped classroom approach in education
Flipped classroom model
Flipped classroom is an active, student-centered approach that was formed to increase the quality of period within class. Generally, this approach whose applications are done mostly in Physical Sciences, also attracts the attention of educators and researchers in different disciplines recently. Flipped classroom learning which wide-spreads rapidly in the world, is not well recognized in our country. That is why the aim of study is to attract attention to its potential in education field and provide to make it recognize more by educators and researchers. With this aim, in the study what flipped classroom approach is, flipped classroom technology models, its advantages and limitations were explained
Features of the perception kind of the educational environment by students and teachers of college
The article discusse the perception of the educational environment by students and teachers of college. Also are analyzed different types of perception and their manifestation in educational and professional activityΠ ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π²ΠΎΡΠΏΡΠΈΡΡΠΈΡ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΡΠ΅Π΄Ρ ΡΡΡΠ΄Π΅Π½ΡΠ°ΠΌΠΈ ΠΈ ΠΏΠ΅Π΄Π°Π³ΠΎΠ³Π°ΠΌΠΈ ΠΊΠΎΠ»Π»Π΅Π΄ΠΆΠ°, Π°Π½Π°Π»ΠΈΠ·ΠΈΡΡΡΡΡΡ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΡΠ΅ ΡΠ°Π·Π»ΠΈΡΠΈΡ ΡΠΈΠΏΠΎΠ² Π²ΠΎΡΠΏΡΠΈΡΡΠΈΡ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΡΠ΅Π΄Ρ ΠΈ ΠΈΡ
ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ Π² ΡΡΠ΅Π±Π½ΠΎ-ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ ΠΈ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ ΡΡΠ°ΡΡΠ½ΠΈΠΊΠΎΠ² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈ
Viability and coping strategy of teachers of preschool education
In the article are considered psychological characteristics of resilience of teachers with the higher and secondary professional education in aspect of their choice of the strategy coping behaviorΠ ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ ΠΆΠΈΠ·Π½Π΅ΡΡΠΎΠΉΠΊΠΎΡΡΠΈ ΠΏΠ΅Π΄Π°Π³ΠΎΠ³ΠΎΠ² Ρ Π²ΡΡΡΠΈΠΌ ΠΈ ΡΡΠ΅Π΄Π½ΠΈΠΌ ΠΏΡΠΎΡΠ΅ΡΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π² Π°ΡΠΏΠ΅ΠΊΡΠ΅ Π²ΡΠ±ΠΎΡΠ° ΠΈΠΌΠΈ ΠΊΠΎΠΏΠΈΠ½Π³-ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΉ ΠΏΠΎΠ²Π΅Π΄Π΅Π½ΠΈ
Π ΠΎΠ»Ρ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° Π² ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠ΅ΠΉ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ
Edoxaban is a selective direct factor Xa inhibitor. Edoxaban in a dose of 60 mg per day is an effective and safe option in the prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation, including in combination therapy in patients after percutaneous coronary interventions. ENGAGE AF-TIMI 48 is currently the most extensive study comparing direct oral anticoagulants and warfarin in patients with atrial fibrillation, both in terms of number of participants and duration of observation. For edoxaban, an adequate approach to dose reduction has been developed in patients with alikely increase in plasma concentration due to renal impairment, low body weight or inter-drug interactions. Such dose reduction does notlead to an increase in the frequency of ischemic complications.Edoxaban is characterized by an optimal safety profile in patients with chronic moderate kidney disease, a small number of drug interactions and a convenient mode of administration. In patients with atrial fibrillation and concomitant ischemic heart disease, the use of Edoxaban is associated with a decrease in the frequency of myocardial infarctions, as well as strokes and episodes of systemic thromboembolism in comparison with warfarin. The drug can be successfully used as anticoagulant support for cardioversion and catheter ablation for atrial fibrillation.Edoxaban intake does not require routinelaboratory control. In case of unexpected situations (life-threatening bleeding, urgent surgical intervention) in patients receiving edoxaban, to assess the degree of anticoagulation should use the determination of anti-Xa activity. Clinical studies of a specific antidote of edoxaban - andexanet alfa are ongoing. Before approval of the specific antidote in severe andlife-threatening bleedings against the background of edoxaban administration, the use of prothrombin complex concentrate should be considered. Data on the effective and safe use of edoxaban in routine clinical practice have been accumulated.ΠΠ΄ΠΎΠΊΡΠ°Π±Π°Π½ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΡΠ΅Π»Π΅ΠΊΡΠΈΠ²Π½ΡΠΉ ΠΏΡΡΠΌΠΎΠΉ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡ Xa-ΡΠ°ΠΊΡΠΎΡΠ° ΡΠ²Π΅ΡΡΡΠ²Π°Π½ΠΈΡ. ΠΡΠΈΠ΅ΠΌ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° Π² Π΄ΠΎΠ·Π΅ 60 ΠΌΠ³/ΡΡΡ -ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½Π°Ρ ΠΈ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½Π°Ρ ΠΎΠΏΡΠΈΡ Π² ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½Π΅ΠΊΠ»Π°ΠΏΠ°Π½Π½ΠΎΠΉ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠ΅ΠΉ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ, Π² Ρ. Ρ. Π² ΡΠΎΡΡΠ°Π²Π΅ ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΡΡ
ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΡΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ². ENGAGE AF-TIMI 48 Π½Π° ΡΠ΅Π³ΠΎΠ΄Π½ΡΡΠ½ΠΈΠΉ Π΄Π΅Π½Ρ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°ΠΌΡΠΌ ΠΌΠ°ΡΡΡΠ°Π±Π½ΡΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ, ΡΡΠ°Π²Π½ΠΈΠ²Π°ΡΡΠΈΠΌ ΠΏΡΡΠΌΡΠ΅ ΠΏΠ΅ΡΠΎΡΠ°Π»ΡΠ½ΡΠ΅ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΡ ΠΈ Π²Π°ΡΡΠ°ΡΠΈΠ½ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠ΅ΠΉ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ, ΠΊΠ°ΠΊ ΠΏΠΎ ΡΠΈΡΠ»Ρ ΡΡΠ°ΡΡΠ½ΠΈΠΊΠΎΠ², ΡΠ°ΠΊ ΠΈ ΠΏΠΎ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ. ΠΠ»Ρ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½ Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ Π΄ΠΎΠ·Ρ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²Π΅ΡΠΎΡΡΠ½ΡΠΌ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π² ΠΏΠ»Π°Π·ΠΌΠ΅, ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½Π½ΡΠΌ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΈ, ΠΌΠ°Π»Π΅Π½ΡΠΊΠΎΠΉ ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π° ΠΈΠ»ΠΈ ΠΌΠ΅ΠΆΠ»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΠΌΠΈ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΡΠΌΠΈ. ΠΠΎΠ΄ΠΎΠ±Π½ΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π΄ΠΎΠ·Ρ Π½Π΅ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΡ ΡΠ°ΡΡΠΎΡΡ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ.ΠΠ΄ΠΎΠΊΡΠ°Π±Π°Π½ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΡΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΌ ΠΏΡΠΎΡΠΈΠ»Π΅ΠΌ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΠΏΠΎΡΠ΅ΠΊ ΡΠΌΠ΅ΡΠ΅Π½Π½ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ, ΠΌΠ°Π»ΡΠΌ ΡΠΈΡΠ»ΠΎΠΌ ΠΌΠ΅ΠΆΠ»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΠΉ ΠΈ ΡΠ΄ΠΎΠ±Π½ΡΠΌ ΡΠ΅ΠΆΠΈΠΌΠΎΠΌ ΠΏΡΠΈΠ΅ΠΌΠ°. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠ΅ΠΉ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ ΠΈ ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠ΅ΠΉ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ° ΠΏΡΠΈΠ΅ΠΌ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΡΠ°ΡΡΠΎΡΡ ΠΈΠ½ΡΠ°ΡΠΊΡΠΎΠ² ΠΌΠΈΠΎΠΊΠ°ΡΠ΄Π°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΈΠ½ΡΡΠ»ΡΡΠΎΠ² ΠΈ ΡΠΏΠΈΠ·ΠΎΠ΄ΠΎΠ² ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ ΡΡΠΎΠΌΠ±ΠΎΡΠΌΠ±ΠΎΠ»ΠΈΠΈ Π² ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ Π²Π°ΡΡΠ°ΡΠΈΠ½ΠΎΠΌ. ΠΡΠ΅ΠΏΠ°ΡΠ°Ρ Ρ ΡΡΠΏΠ΅Ρ
ΠΎΠΌ ΠΌΠΎΠΆΠ΅Ρ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΡΡ Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠ³ΠΎ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π΅Π½ΠΈΡ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π΅ΡΡΠΈΠΈ ΠΈ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠ½ΠΎΠΉ Π°Π±Π»ΡΡΠΈΠΈ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΈΠΈ ΠΏΡΠ΅Π΄ΡΠ΅ΡΠ΄ΠΈΠΉ.ΠΡΠΈΠ΅ΠΌ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° Π½Π΅ ΡΡΠ΅Π±ΡΠ΅Ρ ΡΡΡΠΈΠ½Π½ΠΎΠ³ΠΎ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ. Π ΡΠ»ΡΡΠ°Π΅ Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΡ Π²Π½Π΅ΠΏΠ»Π°Π½ΠΎΠ²ΡΡ
ΡΠΈΡΡΠ°ΡΠΈΠΉ (ΠΆΠΈΠ·Π½Π΅ΡΠ³ΡΠΎΠΆΠ°ΡΡΠ΅Π΅ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠ΅, ΡΠΊΡΡΡΠ΅Π½Π½ΠΎΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎ) Ρ ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡΠΈΡ
ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΠΈ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ Π°Π½ΡΠΈ-Π₯Π° Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ. ΠΡΠΎΠ΄ΠΎΠ»ΠΆΠ°ΡΡΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ΄ΠΎΡΠ° ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° - Π°Π½Π΄Π΅ΠΊΡΠ°Π½Π΅ΡΠ° Π°Π»ΡΡΠ°. ΠΠΎ ΠΎΠ΄ΠΎΠ±ΡΠ΅Π½ΠΈΡ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½ΡΠΈΠ΄ΠΎΡΠ° ΠΏΡΠΈ ΡΡΠΆΠ΅Π»ΡΡ
ΠΈ ΠΆΠΈΠ·Π½Π΅ΡΠ³ΡΠΎΠΆΠ°ΡΡΠΈΡ
ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡΡ
Π½Π° ΡΠΎΠ½Π΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° ΡΠ»Π΅Π΄ΡΠ΅Ρ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅ΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠ° ΠΏΡΠΎΡΡΠΎΠΌΠ±ΠΈΠ½ΠΎΠ²ΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ°. ΠΠ°ΠΊΠΎΠΏΠ»Π΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΎΠ± ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΌ ΠΈ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΠΌ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π° Π² ΡΡΡΠΈΠ½Π½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅
Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΉ Π²Π·Π³Π»ΡΠ΄ Π½Π° Π°Π½ΡΠΈΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ°ΡΠ½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΡΡΠΌ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΡΠΌ ΡΠΈΠ½Π΄ΡΠΎΠΌΠΎΠΌ: ΠΌΠ΅ΡΡΠΎ ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π»Π°
Clopidogrel is the most studied P2Y12 receptor blocker and still has no alternative in a number of categories of ACS patients in whom ticagrelor or prasugrel have not been studied or their use is associated with an unacceptably high risk of bleeding. The review is devoted to a detailed consideration of these clinical situations, both in the light of the evidence base for the benefits of clopidogrel andthe practical aspects of its use. Clopidogrel remains the drug of choice in ST-segment elevation ACS patients undergoing thrombolysis, pharmacoinvasive strategy is implemented, and reperfusion therapy is not used at all. In patients with ACS without ST-segment elevation, clopidogrel is preferable in high risk of bleeding. The article discusses in more detail some particular cases of high bleeding risk in ACS patients, in which it is advisable to use clopidogrel: concomitant use of oral anticoagulants, active cancer, chronic kidney disease stages IV-V. Relatively new data on the peculiarities of ACS antiplatelet therapy in the mongoloid race are discussed, which is relevantto the Russian Federation. In real clinical practice, clopidogrel is often used because of intolerance, contraindications or unavailability of more powerful P2Y12 receptor blockers. Affordability, good tolerability, greater safety (including in relation to the development of recurrent minor βannoyingβ bleedings), single dose clopidogrel and availability of fixed combinations with acetylsalicylic acid result in better adherence to treatment with this drug than with more powerful P2Y12 receptor blockers, which in real-world settings may provide a more optimal treatment outcome. The article discusses approaches to forced de-escalation of antiplatelet therapy β switching from a more potent P2Y12 receptor blocker to clopidogrel. Data is also presented on the study of routine de-escalation at the end of the acute ACS period, both empirical and controlled by functional or genetic tests characterizing the efficacy of clopidogrel. Although routine de-escalation is not currently recommended, randomized trials suggest that this treatment strategy is promising for preventing hemorrhagic complications and reducing the cost of managing patients with ACS.ΠΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π» ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΈΠ·ΡΡΠ΅Π½Π½ΡΠΌ Π±Π»ΠΎΠΊΠ°ΡΠΎΡΠΎΠΌ ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠΎΠ² P2Y12 ΠΈ ΠΏΠΎ-ΠΏΡΠ΅ΠΆΠ½Π΅ΠΌΡ Π½Π΅ ΠΈΠΌΠ΅Π΅Ρ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Ρ Ρ ΡΠ΅Π»ΠΎΠ³ΠΎ ΡΡΠ΄Π° ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘, Ρ ΠΊΠΎΡΠΎΡΡΡ
ΡΠΈΠΊΠ°Π³ΡΠ΅Π»ΠΎΡ ΠΈΠ»ΠΈ ΠΏΡΠ°ΡΡΠ³ΡΠ΅Π» Π½Π΅ ΠΈΠ·ΡΡΠ°Π»ΠΈΡΡ, Π»ΠΈΠ±ΠΎ ΠΈΡ
ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΡΠΎΠΏΡΡΠΆΠ΅Π½ΠΎ Ρ Π½Π΅ΠΏΡΠΈΠ΅ΠΌΠ»Π΅ΠΌΠΎ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ. ΠΠ±Π·ΠΎΡ ΠΏΠΎΡΠ²ΡΡΠ΅Π½ ΠΏΠΎΠ΄ΡΠΎΠ±Π½ΠΎΠΌΡ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½ΠΈΡ ΡΡΠΈΡ
ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΈΡΡΠ°ΡΠΈΠΉ ΠΊΠ°ΠΊ Π² ΡΠ²Π΅ΡΠ΅ Π΄ΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π±Π°Π·Ρ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ² ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π»Π°, ΡΠ°ΠΊ ΠΈ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π°ΡΠΏΠ΅ΠΊΡΠΎΠ² Π΅Π³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ. ΠΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π» ΠΎΡΡΠ°Π΅ΡΡΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ Π²ΡΠ±ΠΎΡΠ° Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘ Ρ ΠΏΠΎΠ΄ΡΠ΅ΠΌΠΎΠΌ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ° ST, ΠΊΠΎΡΠΎΡΡΠΌ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡΡ ΡΡΠΎΠΌΠ±ΠΎΠ»ΠΈΠ·ΠΈΡ, ΡΠ΅Π°Π»ΠΈΠ·ΡΠ΅ΡΡΡ ΡΠ°ΡΠΌΠ°ΠΊΠΎΠΈΠ½Π²Π°Π·ΠΈΠ²Π½Π°Ρ ΡΡΡΠ°ΡΠ΅Π³ΠΈΡ, ΡΠ΅ΠΏΠ΅ΡΡΡΠ·ΠΈΠΎΠ½Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ Π½Π΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΡΡΡ ΡΠΎΠ²ΡΠ΅ΠΌ. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘ Π±Π΅Π· ΠΏΠΎΠ΄ΡΠ΅ΠΌΠ° ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ° ST ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π» ΠΏΡΠ΅Π΄ΠΏΠΎΡΡΠΈΡΠ΅Π»Π΅Π½ ΠΏΡΠΈ Π²ΡΡΠΎΠΊΠΎΠΌ ΡΠΈΡΠΊΠ΅ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ. Π ΡΡΠ°ΡΡΠ΅ Π±ΠΎΠ»Π΅Π΅ ΠΏΠΎΠ΄ΡΠΎΠ±Π½ΠΎ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ Π½Π΅ΠΊΠΎΡΠΎΡΡΠ΅ ΡΠ°ΡΡΠ½ΡΠ΅ ΡΠ»ΡΡΠ°ΠΈ Π²ΡΡΠΎΠΊΠΎΠ³ΠΎ ΡΠΈΡΠΊΠ° ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘, Π² ΠΊΠΎΡΠΎΡΡΡ
ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°ΡΡ ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π»: ΡΠΎΠΏΡΡΡΡΠ²ΡΡΡΠΈΠΉ ΠΏΡΠΈΠ΅ΠΌ ΠΏΠ΅ΡΠΎΡΠ°Π»ΡΠ½ΡΡ
Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠΎΠ², Π°ΠΊΡΠΈΠ²Π½ΡΠΉ ΡΠ°ΠΊ, Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ Π±ΠΎΠ»Π΅Π·Π½Ρ ΠΏΠΎΡΠ΅ΠΊ IVβV ΡΡΠ°Π΄ΠΈΠΉ. ΠΠ±ΡΡΠΆΠ΄Π΅Π½Ρ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎ Π½ΠΎΠ²ΡΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΎΠ± ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΡ
Π°Π½ΡΠΈΠ°Π³ΡΠ΅Π³Π°Π½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠΠ‘ Ρ ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈΡΠ΅Π»Π΅ΠΉ ΠΌΠΎΠ½Π³ΠΎΠ»ΠΎΠΈΠ΄Π½ΠΎΠΉ ΡΠ°ΡΡ, ΡΡΠΎ Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎ Π΄Π»Ρ Π ΠΎΡΡΠΈΠΉΡΠΊΠΎΠΉ Π€Π΅Π΄Π΅ΡΠ°ΡΠΈΠΈ. Π ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π» Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΡΠ°ΡΡΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΡΡΡ ΠΏΠΎ ΠΏΡΠΈΡΠΈΠ½Π΅ Π½Π΅ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠΈΠΌΠΎΡΡΠΈ, Π½Π°Π»ΠΈΡΠΈΡ ΠΏΡΠΎΡΠΈΠ²ΠΎΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΠΉ ΠΈΠ»ΠΈ Π½Π΅Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΠΈ Π±ΠΎΠ»Π΅Π΅ ΠΌΠΎΡΠ½ΡΡ
Π±Π»ΠΎΠΊΠ°ΡΠΎΡΠΎΠ² ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠΎΠ² P2Y12. ΠΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠ°Ρ Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΡ, Ρ
ΠΎΡΠΎΡΠ°Ρ ΠΏΠ΅ΡΠ΅Π½ΠΎΡΠΈΠΌΠΎΡΡΡ, Π±ΠΎΠ»ΡΡΠ°Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΡ (Π² Ρ. Ρ. Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΡΠ΅ΡΠΈΠ΄ΠΈΠ²ΠΈΡΡΡΡΠΈΡ
ΠΌΠ°Π»ΡΡ
Β«Π½Π°Π΄ΠΎΠ΅Π΄Π»ΠΈΠ²ΡΡ
Β» ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ), ΠΎΠ΄Π½ΠΎΠΊΡΠ°ΡΠ½ΡΠΉ ΠΏΡΠΈΠ΅ΠΌ ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π»Π° ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΉ Ρ Π°ΡΠ΅ΡΠΈΠ»ΡΠ°Π»ΠΈΡΠΈΠ»ΠΎΠ²ΠΎΠΉ ΠΊΠΈΡΠ»ΠΎΡΠΎΠΉ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»ΠΈΠ²Π°ΡΡ Π»ΡΡΡΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΠΏΡΠΈΠ²Π΅ΡΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΠΊ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡΠΈΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ, ΡΠ΅ΠΌ Ρ Π±ΠΎΠ»Π΅Π΅ ΠΌΠΎΡΠ½ΡΡ
Π±Π»ΠΎΠΊΠ°ΡΠΎΡΠΎΠ² ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠΎΠ² P2Y12, ΡΡΠΎ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΡΠ΅Π°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ ΠΌΠΎΠΆΠ΅Ρ Π΄Π°Π²Π°ΡΡ Π±ΠΎΠ»Π΅Π΅ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΉ ΠΈΡΠΎΠ³ΠΎΠ²ΡΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ. Π ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡΡΡ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ Π²ΡΠ½ΡΠΆΠ΄Π΅Π½Π½ΠΎΠΉ Π΄Π΅ΡΡΠΊΠ°Π»Π°ΡΠΈΠΈ Π°Π½ΡΠΈΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠ°ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ β ΠΏΠ΅ΡΠ΅Ρ
ΠΎΠ΄Ρ Ρ Π±ΠΎΠ»Π΅Π΅ ΠΌΠΎΡΠ½ΠΎΠ³ΠΎ Π±Π»ΠΎΠΊΠ°ΡΠΎΡΠ° ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠΎΠ² P2Y12 Π½Π° ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π». Π’Π°ΠΊΠΆΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΏΠΎ ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ ΡΡΡΠΈΠ½Π½ΠΎΠΉ Π΄Π΅ΡΡΠΊΠ°Π»Π°ΡΠΈΠΈ ΠΏΠΎ Π·Π°Π²Π΅ΡΡΠ΅Π½ΠΈΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° ΠΠΠ‘, ΠΊΠ°ΠΊ ΡΠΌΠΏΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ, ΡΠ°ΠΊ ΠΈ ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌΠΈ ΠΈΠ»ΠΈ Π³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠ΅ΡΡΠ°ΠΌΠΈ, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΠΈΠΌΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠ»ΠΎΠΏΠΈΠ΄ΠΎΠ³ΡΠ΅Π»Π°. Π₯ΠΎΡΡ Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΡΡΡΠΈΠ½Π½Π°Ρ Π΄Π΅ΡΡΠΊΠ°Π»Π°ΡΠΈΡ Π½Π΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½Π°, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΠ΅ ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π³ΠΎΠ²ΠΎΡΡΡ ΠΎ ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΡΠ°ΠΊΠΎΠΉ ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ, Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ Π½Π° ΠΏΡΠ΅Π΄ΠΎΡΠ²ΡΠ°ΡΠ΅Π½ΠΈΠ΅ Π³Π΅ΠΌΠΎΡΡΠ°Π³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π·Π°ΡΡΠ°Ρ Π½Π° Π²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘
Π‘ΠΠΠ¦ΠΠ€ΠΠ§ΠΠ‘ΠΠΠ ΠΠΠ’ΠΠΠΠ’Π« Π ΠΠΠΠ«Π ΠΠΠ ΠΠ ΠΠΠ¬ΠΠ«Π ΠΠΠ’ΠΠΠΠΠΠ£ΠΠ―ΠΠ’ΠΠ
Safety profiles of the novel oral anticoagulants (NOAC) (rivaroxaban, apixaban, edoxaban, Β dabigatran) are better than that of warfarin. However, the risk (including lifethreatening) of bleeding Β is no less than 2.3β3.1% per year. Three specific antidotes Β to NOAC are currently Β in different phases of clinical Β trial and implementation. Idarucizumab Β is a monoclonal Β antibody which immediately and completely Β reverses the anticoagulation effect of dabigatran. Andexanet Β alfa is a recombinant, modified factor Xa molecule Β that binds and inhibits the effects of oral and parenteral factor Xa inhibitors Β (rivaroxaban, apixaban, Β edoxaban, fondaparinux, heparins). Β Andexanet Β is already in 3b Phase, and at the end of 2016 Β β beginning Β of 2017 it is expected Β to be approved Β for clinical Β use. Ciraparantag Β is a small molecule, Β non-covalently binding to factor Xa inhibitors, and dabigatran Β (i.e., a universal Β antidote). Β Recently, promising results of phase 1 trials involving aripazin were published. The article Β tells about the practical Β aspects of the use of antidotes, treatment Β approaches for life-threatening bleeding Β during treatment Β with NOAC.ΠΡΠΎΡΠΈΠ»Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ Ρ Π½ΠΎΠ²ΡΡ
ΠΏΠ΅ΡΠΎΡΠ°Π»ΡΠ½ΡΡ
Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠΎΠ² (ΠΠΠΠ) (ΡΠΈΠ²Π°ΡΠΎΠΊΡΠ°Π±Π°Π½, Π°ΠΏΠΈΠΊΡΠ°Π±Π°Π½, ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½, Π΄Π°Π±ΠΈΠ³Π°ΡΡΠ°Π½) Π»ΡΡΡΠ΅, ΡΠ΅ΠΌ Ρ Π²Π°ΡΡΠ°ΡΠΈΠ½Π°. ΠΠ΄Π½Π°ΠΊΠΎ ΡΠΈΡΠΊ Π±ΠΎΠ»ΡΡΠΈΡ
(Π² Ρ. Ρ. ΠΆΠΈΠ·Π½Π΅ΡΠ³ΡΠΎΠΆΠ°ΡΡΠΈΡ
) ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ ΡΠΎΡΡΠ°Π²Π»ΡΠ΅Ρ Π½Π΅ ΠΌΠ΅Π½Π΅Π΅ 2,3β3,1% Π² Π³ΠΎΠ΄. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ Π½Π° ΡΠ°Π·Π½ΡΡ
ΡΡΠ°ΠΏΠ°Ρ
ΠΈΠ·ΡΡΠ΅Π½ΠΈΡ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ Π½Π°Ρ
ΠΎΠ΄ΡΡΡΡ ΡΡΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π°Π½ΡΠΈΠ΄ΠΎΡΠ° ΠΊ ΠΠΠΠ. ΠΠ΄Π°ΡΡΡΠΈΠ·ΡΠΌΠ°Π± ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΠΌΠΎΠ½ΠΎΠΊΠ»ΠΎΠ½Π°Π»ΡΠ½ΠΎΠ΅ Π°Π½ΡΠΈΡΠ΅Π»ΠΎ, Π½Π΅ΠΌΠ΅Π΄Π»Π΅Π½Π½ΠΎ ΠΈ Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎ ΡΠ²ΡΠ·ΡΠ²Π°ΡΡΠ΅Π΅ Π΄Π°Π±ΠΈΠ³Π°ΡΡΠ°Π½. ΠΠ½Π΄Π΅ΠΊΡΠ°Π½Π΅Ρ Π°Π»ΡΡΠ° ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΡΠ΅ΠΊΠΎΠΌΠ±ΠΈΠ½Π°Π½ΡΠ½ΡΡ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ ΠΌΠΎΠ»Π΅ΠΊΡΠ»Ρ Π₯Π°-ΡΠ°ΠΊΡΠΎΡΠ°, ΠΊΠΎΡΠΎΡΡΠΉ ΡΠ²ΡΠ·ΡΠ²Π°Π΅Ρ ΠΈ Π±Π»ΠΎΠΊΠΈΡΡΠ΅Ρ Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ ΠΏΠ΅ΡΠΎΡΠ°Π»ΡΠ½ΡΡ
ΠΈ ΠΏΠ°ΡΠ΅Π½ΡΠ΅ΡΠ°Π»ΡΠ½ΡΡ
ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠΎΠ² Π₯Π°-ΡΠ°ΠΊΡΠΎΡΠ° (ΡΠΈΠ²Π°ΡΠΎΠΊΡΠ°Π±Π°Π½Π°, Π°ΠΏΠΈΠΊΡΠ°Π±Π°Π½Π°, ΡΠ΄ΠΎΠΊΡΠ°Π±Π°Π½Π°, ΡΠΎΠ½Π΄Π°ΠΏΠ°ΡΠΈΠ½ΡΠΊΡΠ°, Π³Π΅ΠΏΠ°ΡΠΈΠ½ΠΎΠ²). Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΡΠΆΠ΅ ΠΏΡΠΎΡ
ΠΎΠ΄ΠΈΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ 3b ΡΠ°Π·Ρ Ρ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π°Π½Π΄Π΅ΠΊΡΠ°Π½Π΅ΡΠ°, Π² ΠΊΠΎΠ½ΡΠ΅2016 Π³. β Π½Π°ΡΠ°Π»Π΅2017 Π³. ΠΎΠΆΠΈΠ΄Π°Π΅ΡΡΡ ΡΠ°Π·ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π΅Π³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅. Π¦ΠΈΡΠ°ΠΏΠ°ΡΠ°Π½ΡΠ°Π³ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ΅Ρ ΡΠΎΠ±ΠΎΠΉ ΠΌΠ°Π»ΡΡ ΠΌΠΎΠ»Π΅ΠΊΡΠ»Ρ, Π½Π΅ΠΊΠΎΠ²Π°Π»Π΅Π½ΡΠ½ΠΎ ΡΠ²ΡΠ·ΡΠ²Π°ΡΡΡΡΡΡ ΠΊΠ°ΠΊ Ρ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΠ°ΠΌΠΈ Π₯Π°-ΡΠ°ΠΊΡΠΎΡΠ°, ΡΠ°ΠΊ ΠΈ Ρ Π΄Π°Π±ΠΈΠ³Π°ΡΡΠ°Π½ΠΎΠΌ (Ρ. Π΅. ΡΠ²Π»ΡΡΡΡΡΡΡ ΡΠ½ΠΈΠ²Π΅ΡΡΠ°Π»ΡΠ½ΡΠΌ Π°Π½ΡΠΈΠ΄ΠΎΡΠΎΠΌ). ΠΠ° Π΄Π°Π½Π½ΠΎΠΌ ΡΡΠ°ΠΏΠ΅ ΠΎΠΏΡΠ±Π»ΠΈΠΊΠΎΠ²Π°Π½Ρ ΠΌΠ½ΠΎΠ³ΠΎΠΎΠ±Π΅ΡΠ°ΡΡΠΈΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ 1 ΡΠ°Π·Ρ Ρ ΡΡΠ°ΡΡΠΈΠ΅ΠΌ Π°ΡΠΈΠΏΠ°Π·ΠΈΠ½Π°. Π ΡΡΠ°ΡΡΠ΅ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π°ΡΠΏΠ΅ΠΊΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π°Π½ΡΠΈΠ΄ΠΎΡΠΎΠ², ΡΠ°ΠΊΡΠΈΠΊΠ° Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΆΠΈΠ·Π½Π΅ΡΠ³ΡΠΎΠΆΠ°ΡΡΠΈΡ
ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ Π½Π° ΡΠΎΠ½Π΅ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠΠ.
Π€ΠΠΠΠΠΠΠ ΠΠΠ£ΠΠ‘ Π ΠΠΠ§ΠΠΠΠ ΠΠ‘Π’Π ΠΠΠ ΠΠΠ ΠΠΠΠ ΠΠΠΠ Π‘ΠΠΠΠ ΠΠΠ
Β Fondaparinux is a parenteral selective factor-Xa inhibitor. The drug is successfully used in the treatment of acute coronary syndrome, and is characterized by the ideal profile of effectiveness and safety. In the case of ACS without ST-segment elevation, fondaparinux is the drug of choice regardless of the treatment strategy - early invasive or conservative. In the case of PCI, an anticoagulant with anti-IIa activity (either UFH or bivalirudin) should be administered immediately before the procedure. In patients with ACS with ST-segment elevation, fondaparinux is used as an anticoagulant accompaniment of thrombolysis (primarily, with streptokinase) or in patients not receiving reperfusion therapy. In the case of elective primary PCI in these patients, it is more appropriate to use UFH. For the treatment of ACS, fondaparinux is used at a dose of 2.5 mg/day and administered within 8 days, up until discharge (if it happens earlier) or a successful PCI. The greatest benefits from the use of fondaparin- ux should be expected in patients with a high risk for bleeding, including in patients with moderate renal failure with a decrease in creatinine clearance to 30-60 ml/min.Β Β Β Β Β Β Π€ΠΎΠ½Π΄Π°ΠΏΠ°ΡΠΈΠ½ΡΠΊΡ β ΠΏΠ°ΡΠ΅Π½ΡΠ΅ΡΠ°Π»ΡΠ½ΡΠΉ ΡΠ΅Π»Π΅ΠΊΡΠΈΠ²Π½ΡΠΉ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡ Xa-ΡΠ°ΠΊΡΠΎΡΠ°. ΠΡΠ΅ΠΏΠ°ΡΠ°Ρ Ρ ΡΡΠΏΠ΅Ρ
ΠΎΠΌ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΎΡΡΡΠΎΠ³ΠΎ ΠΊΠΎΡΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΡΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΌ ΠΏΡΠΎΡΠΈΠ»Π΅ΠΌ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ/Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ. Π ΡΠ»ΡΡΠ°Π΅ ΠΠΠ‘ Π±Π΅Π· ΠΏΠΎΠ΄ΡΠ΅ΠΌΠ° ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ° ST ΡΠΎΠ½Π΄Π°ΠΏΠ°ΡΠΈΠ½ΡΠΊΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠΌ Π²ΡΠ±ΠΎΡΠ° Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΠΎ ΠΎΡ Π²ΡΠ±ΡΠ°Π½Π½ΠΎΠΉ ΡΡΡΠ°ΡΠ΅Π³ΠΈΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ β ΡΠ°Π½Π½Π΅ΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎΠΉ ΠΈΠ»ΠΈ ΠΊΠΎΠ½ΡΠ΅ΡΠ²Π°ΡΠΈΠ²Π½ΠΎΠΉ. Π ΡΠ»ΡΡΠ°Π΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π§ΠΠ Π½Π΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎ ΠΏΠ΅ΡΠ΅Π΄ ΠΏΡΠΎΡΠ΅Π΄ΡΡΠΎΠΉ ΡΠ»Π΅Π΄ΡΠ΅Ρ Π²Π²ΠΎΠ΄ΠΈΡΡ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½Ρ, ΠΎΠ±Π»Π°Π΄Π°ΡΡΠΈΠΉ Π°Π½ΡΠΈ-IIa-Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΡ (ΠΠ€Π ΠΈΠ»ΠΈ Π±ΠΈΠ²Π°Π»ΠΈΡΡΠ΄ΠΈΠ½). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘ Ρ ΠΏΠΎΠ΄ΡΠ΅ΠΌΠΎΠΌ ΡΠ΅Π³ΠΌΠ΅Π½ΡΠ° ST ΡΠΎΠ½Π΄Π°ΠΏΠ°ΡΠΈΠ½ΡΠΊΡ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡ ΠΊΠ°ΠΊ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠ½ΠΎΠ΅ ΡΠΎΠΏΡΠΎΠ²ΠΎΠΆΠ΄Π΅Π½ΠΈΠ΅ ΡΡΠΎΠΌΠ±ΠΎΠ»ΠΈΠ·ΠΈΡΠ° (Π² ΠΏΠ΅ΡΠ²ΡΡ ΠΎΡΠ΅ΡΠ΅Π΄Ρ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΡΠ΅ΠΏΡΠΎΠΊΠΈΠ½Π°Π·Ρ) Π»ΠΈΠ±ΠΎ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π½Π΅ ΠΏΠΎΠ»ΡΡΠ°ΡΡΠΈΡ
ΡΠ΅ΠΏΠ΅ΡΡΡΠ·ΠΈΠΎΠ½Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ. Π ΡΠ»ΡΡΠ°Π΅ ΠΏΠ»Π°Π½ΠΈΡΡΠ΅ΠΌΠΎΠ³ΠΎ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ Π§ΠΠ Ρ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½Π΅Π΅ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡ ΠΠ€Π. ΠΠ»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠ‘ ΡΠΎΠ½Π΄Π°ΠΏΠ°ΡΠΈΠ½ΡΠΊΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΠ΅ΡΡΡ Π² Π΄ΠΎΠ·Π΅ 2,5 ΠΌΠ³/ΡΡΡ; Π²Π²ΠΎΠ΄ΠΈΡΡΡ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 8 ΡΡΡΠΎΠΊ, Π΄ΠΎ Π²ΡΠΏΠΈΡΠΊΠΈ (Π΅ΡΠ»ΠΈ ΠΎΠ½Π° Π½Π°ΡΡΡΠΏΠ°Π΅Ρ ΡΠ°Π½ΡΡΠ΅) ΠΈΠ»ΠΈ Π΄ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ Π§ΠΠ. ΠΠ°ΠΈΠ±ΠΎΠ»ΡΡΠΈΠ΅ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π° ΠΎΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΠΎΠ½Π΄Π°ΠΏΠ°ΡΠΈΠ½ΡΠΊΡΠ° ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΎΠΆΠΈΠ΄Π°ΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΠΉ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΡΠΌΠ΅ΡΠ΅Π½Π½ΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ ΡΠΎ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ΠΌ ΠΊΠ»ΠΈΡΠ΅Π½ΡΠ° ΠΊΡΠ΅Π°ΡΠΈΠ½ΠΈΠ½Π° Π΄ΠΎ 30β60 ΠΌΠ»/ΠΌΠΈΠ½