Тромбоз стента у пациента с острым коронарным синдромом без подъема сегмента ST с высокой остаточной реактивностью тромбоцитов
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Анотація
Тромбоз стента является опасным жизнеугрожающим состоянием, которое чаще наблюдается в течение первого месяца после имплантации стента. В настоящее время существует несколько возможных схем профилактики тромбоза стента с помощью клопидогреля и более сильных ингибиторов Р2Y12-рецепторов. В статье описан клинический случай тромбоза стента у больного с резистентностью к клопидогрелю на фоне носительства аллельного варианта гена CYP2C19*2, «медленного метаболизатора клопидогреля». Несмотря на рекомендуемое применение высоких доз клопидогреля для улучшения клинического исхода у больных с гомозиготой CYP2C19*2 (*2/*2), данный клинический случай показал высокую сомнительность такой тактики. В таких случаях применение более сильных ингибиторов P2Y12-рецепторов является оправданным, так как позволяет улучшить клинические исходы механической реваскуляризации.
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