Cпорные и нерешенные аспекты лекарственно-индуцированного геморрагического инсульта: фокус на селективные ингибиторы обратного захвата серотонина, нестероидные противовоспалительные средства и статины
Геморрагический инсульт (ГИ) – полиэтиологическое заболевание, включающее все формы нетравматического внутричерепного кровоизлияния. ГИ является важным заболеванием для клинической практики, т.к. характеризуется высокими уровнями заболеваемости и смертности. Одним из важных этиологических факторов данного заболевания считаются лекарственные средства. Помимо препаратов, влияющих на гемостаз, в литературе также описано увеличение риска ГИ на фоне применения антидепрессантов группы селективных ингибиторов обратного захвата серотонина (СИОЗС), нестероидных противовоспалительных средств (НПВС) и статинов. При проведении крупных систематических обзоров выявлено увеличение риска всех подвидов ГИ на фоне применения СИОЗС; увеличение риска может коррелировать с силой ингибирования захвата серотонина. Возможной мерой профилактики ГИ в данном случае может быть применение СИОЗС со слабой силой ингибирования. Вопрос ГИ, индуцированного приемом НПВС, сложен и до конца не изучен. Данный побочный эффект не был выявлен в рандомизированных контролируемых исследованиях, а результаты мета-анализов и систематических обзоров противоречивы. Тем не менее лечащие врачи должны принимать во внимание потенциальный риск развития ГИ на фоне применения НПВС. Статины, в отношении которых были опубликованы некоторые данные о риске внутримозгового кровоизлияния (ВМК), после проведения многочисленных мета-анализов не могут считаться препаратами – индукторами ГИ. Более того, имеются данные о снижении риска ВМК на фоне статинотерапии.Листратов А.И., Остроумова Т.М., Кочетков А.И., Остроумова О.Д., Сычев Д.А.
Ключевые слова
геморрагический инсульт
внутричерепное кровоизлияние
внутримозговое кровоизлияние
лекарственно-индуцированное внутримозговое кровоизлияние
лекарственно-индуцированное внутричерепное кровоизлияние
нестероидные противовоспалительные средства
селективные ингибиторы обратного захвата серотонина
статины
Список литературы
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Об авторах / Для корреспонденции
Автор для связи: Ольга Дмитриевна Остроумова, д.м.н., профессор, заведующая кафедрой терапии и полиморбидной патологии им. академика М.С. Вовси, Российская медицинская академия непрерывного профессионального образования; профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет), Москва, Россия; ostroumova.olga@mail.ru">href="mailto:ostroumova.olga@mail.ru">ostroumova.olga@mail.ru
ORCID / eLibrary SPIN:
А.И. Листратов (A.I. Listratov), https://orcid.org/0000-0002-0401-1132, eLibrary SPIN: 1357-7122
Т.М. Остроумова (T.M. Ostroumova), https://orcid.org/0000-0003-1499-247x, eLibrary SPIN: 5043-4713
А.И. Кочетков (A.I. Kochetkov), https://orcid.ois/0000-0001-5801-3742; eLibrary SPIN: 9212-6010
О.Д. Остроумова (O.D. Ostroumova), https://orcid.org/0000-0002-0795-8225, eLibrary SPIN: 3910-6585
Д.А. Сычев (D.A. Sychev), https://orcid.org/0000-0002-4496-3680, eLibrary SPIN: 4525-7556
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