THE BALANCE BETWEEN THROMBOTIC RISK AND BLEEDING. WHAT DOES THE PRACTITIONER NEED TO KNOW?

Abstract

It is clear that disease of the circulatory system is a global problem of public health and one of the leading causes of mortality in the world. An analysis of Ukrainian investigators shows that one of the largest causes of death of cardiovascular origin is ischemic heart disease (IHD). Pathogenetic mechanisms that accompany them, such as sympathetic dysregulation, endothelial dysfunction, increased vascular stiffness, hypercoagulation, atheromatosis, increased radical processes provoke advancement of even more dangerous cardiovascular complications and the greatest consequences from them are acute coronary syndromes, and itself – myocardial infarction (MI). The first successes in reducing mortality were achieved by scientific developments in thrombolytic therapy (TLT), which found its place in practical research. Almost simultaneously with the research and already quite wide developments in the practice of thrombolysis, other methods of reducing mortality from IM are also being studied, which are quite effective and apparently restore normal blood flow in the coronary arteries, and percutaneous coronary artery delivery/primary stenting (PСT). At this time, both methods are used in treating patients with acute myocardial infarction and are not mutually exclusive and can be used to complement one of their advantages and disadvantages. Regardless of the fact that the strategy of antiplatelet therapy allowed to change the risk of formation of stent thrombosis, recurrent infarctions and post-infarction angina, and it also showed a non-destructive ligament with movement severe bleeding of various localizations. The current paradigm for the management of such patients is reduced to the need to promote an individual compromise between the prevention of thrombosis and hemorrhage. The need to identify such patients and closely monitor them during the ongoing period of ongoing antiplatelet therapy dictated the need to develop clear criteria for the risk of possible bleeding for practical medicine. The ARC-HBR scale was developed by an academic research consortium based on the results of recent studies of patients with a high risk of bleeding who were previously excluded from participation in the study. clinical studies of antiplatelet therapy. We have improved recommendations for practical doctors regarding the risk of stratification of not only ischemic events, but also bleeding, especially large ones, which are dangerous even to the point of death. For this purpose, it is recommended in the current medical practice of a cardiologist and family physician to use the ARC-HBR scale, as a simple and reliable tool for stratification of hemorrhagic areas, based on the criteria These scales were more sensitive to identifying patients with bleeding in the future, while other daily indicators of the risk of bleeding were less specific.