В какие кармашки будет залезать действующее вещество Эликвиса, как грамотно построить исследование, сравнивающее инъекции с таблетками, какую детскую игру напоминает конкурентное ингибирование и зачем организм запускает систему свертывания крови в ответ на протезы в колене, рассказываем в рубрике «Чем нас лечат».
В июльском отчете компании DSM Group, известных аналитиков российского фармацевтического рынка, указан огромный (108,7% по сравнению с июлем 2017 года) прирост продаж препарата Эликвис, предназначенного для уменьшения свертываемости крови и борьбы с тромбозом. Ему мы и решили посвятить сегодняшний материал рубрики.
Попади в крестик
Препарат напрямую воздействует на фактор Xa — одно из звеньев цепочки, участвующей в свертывании крови (далеко не единственной из подобных цепочек, надо заметить). Об этом факторе и механизме мы уже писали в статье про Ксарелто (действующее вещество — ривароксабан), а сейчас расскажем с картинками.
Когда появляется рана, и организму угрожает потеря крови и заражение, грудью на амбразуру бросаются тромбоциты — бесцветные кровяные клетки-пластинки, которые готовы заткнуть пробоину собой (как в эпизоде «Ну, погоди!», где Волк и Заяц забрасывают дыру в борту корабля мешками). Но клетки не просто сваливаются в кучу в месте бреши, для упрочнения дамбы служат молекулы белка фибрина (фактор Ia). Этот белок должен постоянно присутствовать в крови, чтобы быстрее поспеть на помощь тромбоцитам. Чтобы не создавать тромбы повсюду на своем пути, изначально он присутствует в крови в виде растворимого предшественника, фибриногена («рождающий фибрин», фактор I). Протромбин («предшественник тромбина», фактор II), тоже присутствующий в крови, в случае опасности превращается в тромбин (фактор IIa), который отщепляет от фибриногена четыре маленьких фрагмента. Фибриноген превращается в фибрин и сплетается в сеть, которая укрепляется дополнительными связями, цементируя тромбоцитную дамбу. Вот тромб и готов.
Фактор Xa — это не просто крестик на карте каскадов, а важнейшее звено на перекрестке нескольких путей, ведущих к свертыванию крови, что делает его идеальной мишенью для препаратов нового поколения (ривароксабан, одобренный четырьмя годами раньше героя этой статьи, в 2008 году, связывается с ним же).
Из чего же, из чего
Действующее вещество Эликвиса — апиксабан — как раз относится к представителям нового поколения. И на ривароксабан, кстати, оно похоже не только по механизму действия, но и по структуре (не случайно совпадают буквосочетания в названии). Сравните:
Однако для препаратов важно не только время появления и родство. Главное — это все-таки связи. Связи с фактором Xa обычно осуществляются с участием его «кармашков» — мест, которыми он в норме взаимодействует с соседями по каскаду. Таких «кармашков» у него четыре, и апиксабан связывается с первым и четвертым, так как второй очень мал, а третий быстро занимают молекулы растворителя. Важные аминокислоты, с которыми взаимодействует апиксабан: аспарагин в позиции 189, глутамин-192, глицин-216, фенилаланин-174, триптофаны 215 и 99.
Апиксабан подавляет действие фактора Xa обратимо, не подпуская никого взаимодействовать с активными сайтами этого белка. Такой механизм называется конкурентным ингибированием и похож на игру в стулья: кто первый сел, того и место, но через некоторое время все опять бегают кругами под музыку и испытывают удачу.
Статья о первых исследованиях безопасности апиксабана на людях, опубликованная в British Journal of Clinical Pharmacology, гласит, что при приеме внутрь в виде таблеток организм усваивает примерно 50% лекарства, а через 11,5 часа выводится примерно половина от этого количества. Выполнив свою работу, препарат расщепляется ферментами печени (преимущественно цитохромами P450 3A) и покидает организм с мочой или через пищеварительный тракт, возвращаясь в него из крови через желчный пузырь.
Опасность свободного плавания
Со здоровыми пациентами понятно, но что рекомендуется лечить при помощи Эликвиса? У препарата в инструкции значатся три основных показания:
1)профилактика венозной тромбоэмболии (острая закупорка сосуда тромбом, который оторвался от места своего образования) после установки протеза тазобедренного или коленного сустава;
2)профилактика инсульта и системной тромбоэмболии у взрослых пациентов с неклапанной фибрилляцией предсердий (или мерцательной аритмией, то есть когда помимо основных сокращений по предсердиям пробегает мелкая и очень быстрая «дрожь» не в такт общему ритму, и эта дрожь не связана с искусственными клапанами сердца или сужением митрального клапана). О рекомендации по диагностике и лечению на основе европейских гайдлайнов можно почитать здесь;
3)лечение тромбоза глубоких вен (ТГВ), тромбоэмболии легочной артерии (ТЭЛА), а также профилактика рецидивов.
Тромбоэмболия — очень коварное состояние. Пока тромб растет где-нибудь в глубоких или поверхностных венах ног (а там тромбы появляются сравнительно часто), конечности могут болеть и опухать, но кроме дискомфорта это мало чем грозит пациенту. Если же тромб отрывается и с током крови попадает в сердце, мозг или легочную артерию, исход может быть летальным (по одной из версий, именно легочная тромбоэмболия убила Достоевского). Но как, спросите вы, это связано с внутренним протезированием тазобедренного или коленного сустава?
На каскаде с картинки в начале статьи есть tissue factor, или тканевый фактор. Он активирует систему свертывания крови гораздо раньше, чем к ней подключается фактор Xa, а тканевым называется потому, что сигналом к его работе становятся кусочки пострадавшей ткани — обрывки отрицательно заряженных клеточных мембран. Но небольшие разрушения клеточного масштаба происходят и во время хирургической операции, а установленные элементы протеза тоже часто приобретают отрицательный заряд, что и провоцирует ложную тревогу.
В списках (не) значился
Эливиксу посвящены полсотни двойных слепых контролируемых исследований, информацию о которых можно найти в англоязычной базе медицинских статей PubMed, причем многие из них проведены на довольно большом количестве пациентов.
Применение Эликвиса у пациентов с фибрилляцией предсердий хорошо изучено. В исследовании, проспонсированном производителями и опубликованном в New England Journal of Medicine, поучаствовало 993 ученых-медиков и 5599 пациентов с фибрилляцией предсердий. Их разделили на две группы: одним давали аспирин, известный своим антикоагулянтным (разжижающим кровь) действием, а другим — 5 мг апиксабана дважды в день. В группе апиксабана уровень первичных исходов (за них принимали инсульт или системный эмболизм) составил 1,6%, тогда как в группе аспирина — 3,7%. По остальным показателям группы различались меньше: у принимавших апиксабан смертность была на уровне 3,5%, 44 случая общих кровотечений и 11 внутричерепных кровоизлияний, а в группе аспирина смертность составила 4,7%, 31 кровотечение и 13 мозговых кровоизлияний.
В другой работе с апиксабаном сравнивали варфарин (лекарство старого поколения). Испытания, проведенные на 18 201 пациенте, показали, что смертность и случаи системной тромбоэмболии и инсульта в группе апиксабана были на треть ниже, чем в группе варфарина, однако и в группе варфарина эти цифры были невелики: 3,09% в год (смертность) и 1,6% в год (первичные исходы).
В исследовании, результаты которого были опубликованы в Journal of American Heart Association, обнаружено, что пациенты с тромбоэмболией и тромбозом нижних конечностей, принимающие апиксабан (2676 человек), реже попадали в больницу и реже страдали от кровотечений, чем люди, которым назначали варфарин или эноксапарин (2689 человек), и оставались в госпитале менее продолжительное время. Правда, здесь не совсем понятно, почему результаты по эноксапарину смешали с варфарином, ведь варфарин относится к старому поколению, а эноксапарин — к новому, и ингибирует он, как и апиксабан, фактор Xa, но необратимо. При этом эноксапарин еще и входит в перечень важнейших препаратов по версии Всемирной организации здравоохранения.
В исследовании по профилактике тромбоэмболии после замены коленного или тазобедренного сустава, проведенном на 8464 пациентах, ученые снова сравнили апиксабан (таблетки по 2,5 мг дважды в день, в отличие от частой терапевтической дозы, 5 мг дважды в день) с эноксапарином. Обратите внимание на дизайн эксперимента: второй препарат вводили подкожно, но, чтобы исключить эффект плацебо и не лишить объективности это клиническое испытание, группе эноксапарина давали также таблетку-пустышку, а группе апиксабана делали плацебо-инъекции. Если исследования, о которых мы написали выше, имели терапевтическую цель и длились около года, то здесь профилактика продолжалась 10-14 дней после операции на коленном суставе и 32-35 дней после установки тазобедренного протеза. В группе апиксабана системная венозная тромбоэмболия возникла в 0,7% случаев, тогда как в группе эноксапарина — в 1,5% случаев. Риск кровотечения и других побочных эффектов апиксабан, по сравнению с эноксапарином, не увеличивал.
Xa против K: взгляд Кохрейновского сотрудничества
Целых шесть Кохрейновских обзоров так или иначе упоминают апиксабан, хотя в основном обзоры посвящены не одному веществу, а всей группе антикоагулянтов, действующих на фактор Xa и принимаемых в виде таблеток.
В одном обзоре принимаемые внутрь антикоагулянты сравнили с существовавшей прежде терапией в виде инъекций при легочной тромбоэмболии. Новая терапия оказалась не хуже и не опаснее стандартной, однако она имеет свои преимущества: принимать таблетки удобнее, чем делать уколы, кроме того, у этих антикоагулянтов проще рассчитать необходимую дозировку, и корректировать ее, скорее всего, тоже не понадобится.
Похожий обзор рассматривает 11 исследований с 27 945 участниками, страдавшими от тромбоза глубоких вен. В этом случае ученые обнаружили, что эффективность обоих вариантов лечения примерно одинакова, однако антикоагулянты, подавляющие работу фактора Xa, реже вызывали кровотечения.
Обзор, посвященный эффективности апиксабана, дабигатрана, эдоксабана и ривароксабана против инсульта и тромбоэмболии у 12 545 пациентов с фибрилляцией предсердий и хроническими болезнями почек, показал, что эти лекарства не менее эффективны, чем варфарин. В относительно свежем обзоре 2018 года лекарства, воздействующие на фактор Xa, немного лучше снижают риски инсультов и тромбоэмболии, чем препараты, использующие в качестве мишени витамин К (тот же варфарин). Лекарства нового поколения также должны ненамного снижать количество смертей и обширных кровоизлияний, но здесь доказательства внушают меньше уверенности. К такому заключению авторы пришли, изучив 13 исследований в сумме на 67 688 пациентах.
Авторы двух обзоров (1 и 2) действия апиксабана и других антикоагулянтов на пациентов с гипертонией не нашли никаких вразумительных доказательств пользы или вреда такой терапии: рандомизированных контролируемых испытаний на эту тему практически не проводилось.
Indicator.Ru рекомендует: принимайте под наблюдением врача
Эликвис (апиксабан) — один из примеров исследованного лекарства, которое с честью выдержало клинические испытания с хорошим дизайном на десятках тысяч людей (хотя многие из этих испытаний, заметим в скобках, проведены или проспонсированы производителем). Вам могут сказать, что он работает в полтора-два раза лучше великого и ужасного варфарина и других ингибиторов витамина К, но не забывайте, что в большинстве случаев это «в два раза» означает разницу примерно в 1% (и что из этого простая случайность, тоже было бы интересно узнать). Впрочем, Эликвис точно не хуже стандартной терапии, и в отличие от нее может применяться в более удобной форме (в таблетках). Он не требует частой «калибровки» дозы, а его действие более прицельно и предсказуемо, чем у варфарина, и с увеличением дозировки растет равномерно, а не скачками.
Список противопоказаний и лекарственных взаимодействий Эликвиса заметно короче, чем у старой стандартной терапии. К противопоказаниям относят гиперчувствительность; кровотечения или их повышенный риск; заболевания печени, ведущие к проблемам со свертыванием крови; тяжелые нарушения работы почек, диализ; детский возраст, беременность и кормление ребенка (в последних случаях нет исследований, подтверждающих безопасность на людях). Препараты, с которыми опасно сочетать Эликвис, — это аспирин и другие лекарства, увеличивающие риск развития кровотечений, а также ингибиторы CYP3A4 и Р-гликопротеина, которые отвечают за расщепление апиксабана в организме.
Поэтому неудивительно, что апиксабан был одобрен американским Управлением по санитарному надзору за качеством пищевых продуктов и медикаментов (Food and Drug Administration, FDA) и включен в рекомендации для врачей от британского Национального института здоровья и клинического совершенствования (National Institute for Health and Care Excellence).
Несмотря на это, свертывание крови всегда палка о двух концах. Эта система очень сложна, и некоторые ее механизмы до сих пор остаются непонятными. Поэтому влияющие на нее препараты нужно принимать под постоянным наблюдением специалистов: грань между тромбоэмболией и кровотечениями бывает довольно тонка, при этом оба эти варианта могут закончиться летальным исходом.
Наши рекомендации нельзя приравнивать к назначению врача. Перед тем как начать принимать тот или иной препарат, обязательно посоветуйтесь со специалистом.
Эликвис – антикоагулянт с прямым воздействием. Лекарство назначается в терапевтических и профилактических целях людям с проблемами сосудистой системы. Препарат обладает некоторыми противопоказаниями к использованию, способен вызвать развитие побочных реакций, поэтому принимать данный медикамент без консультации врача не рекомендуется.
Форма выпуска и состав
Производится в виде округлых или овальных двояковыпуклых таблеток, которые покрывает плёночная оболочка. Активная составляющая препарата – апиксабан. В таблетках это вещество содержится в дозировке 2,5 либо 5 мг.
В качестве дополнительных компонентов при изготовлении препарата воспользовались:
- кроскармеллозой натрия;
- лаурилсульфатом натрия;
- стеаратом магния;
- микрокристаллической целлюлозой;
- лактозой.
Показания к применению
Беременным женщинам и детям препарат принимать нельзя
Прием рекомендован людям с нарушением агрегации тромбоцитов. Принимать таблетки разрешено лишь по назначению лечащего врача в таких случаях:
- если диагностирована тромбоэмболия легочного артериального сосуда;
- при тромбозе венозных сосудов;
- с целью профилактики тромбофлебита после протезирования суставной ткани ног;
- чтобы предотвратить формирование тромбоза на фоне фибрилляции предсердий, образовавшейся в качестве сопутствующей патологии при сахарном диабете, инсульте, недостаточности в сердце и артериальной гипертензии.
Стоит отметить, что лечение медсредством женщинам во время вынашивания будущего ребенка и при грудном вскармливании, а также пациентам, не достигшим 18-летнего возраста, категорически запрещается.
Инструкция по применению
Прием осуществляется перорально, независимо от употребления пищи. Дозировка и кратность использования зависит от цели назначения препарата:
Заболевание | Дозировка |
---|---|
Во время реабилитации после протезирования суставной ткани нижних конечностей. | 2,5 мг дважды в день (первично принять таблетку нужно спустя 12-24 часа после проведения операции). Продолжительность лечения примерно 2 недели при хирургическом вмешательстве в коленный сустав, 32-38 суток – при протезировании тазобедренной суставной ткани. |
При фибрилляции предсердий. | Дважды в день по 5 мг. Уменьшить дневную дозировку до 2,5 мг 2 раза в день необходимо людям с сочетанием не менее двух факторов риска: вес меньше – 60 кг, возрастная категория – старше 80 лет, уровень креатинина в кровотоке – более 133 мкмоль/л. |
При тромбоэмболии легочного артериального сосуда и тромбозе глубоких вен. | В течение первой недели – 10 мг дважды в день, в дальнейшем дозировка снижается до 5 мг с той же кратностью приема. Продолжительность курсовой терапии – минимум 90 дней, что обусловлено симптоматикой патологии, соотношением предполагаемого результата и вероятным риском формирования кровопотери, наличием и обратимостью факторов, которые предполагают повторное развитие заболевания (травматизм, недавно перенесенная операция, продолжительная обездвиженность и пр.). |
В профилактических целях, чтобы предупредить повторное проявление ТЭЛА и тромбофлебита глубоких вен. | 2,5 мг дважды в день. Такое лечение показано минимум спустя полгода после терапии подобных патологий. |
Примечание! Если пропущен прием таблетки, выпить препарат в прописанной дозе нужно сразу после того, как больной вспомнил о пропуске. В последующее время необходимо соблюдать назначенную врачом схему лечения с принятием лекарства 2 раза на протяжении дня. Когда терапевтические действия прерываются на некоторое время, повышается опасность формирования тромбов. Больные должны учесть, что принимать антикоагулянты надо беспрерывно.
Если проводилась терапия антикоагулянтами для парентерального применения, переводить человека на лечение в форме таблеток осуществляется при следующем запланированном принятии лекарства, которое подлежит замене, без его очередного приёма.
Побочные реакции и передозировка
В процессе лечения возможно развитие некоторых негативных патологических реакций, а именно:
- анемии;
- тромбоцитопении;
- рвотных позывов;
- артериальной гипотонии;
- кровопотери (из анального отверстия, десен, носа, рта);
- повышенной чувствительности;
- кровоизлияний в глаза и в мышцы;
- гематурии.
Главный признак превышения дозировки – появление кровотечения. В этом случае рекомендовано принимать активированный уголь в большом количестве.
Аналоги
Если прием Эликвиса в силу каких-либо причин противопоказан, врач подбирает пациенту лекарство с аналогичным действием. Ознакомимся с наиболее популярными аналогами данного препарата.
Эликвис или Прадакса: что лучше
Прадакса – это антикоагулянт с прямым действием, активная составляющая в препарате – дабигатран. В сравнении с Эликвисом назначается только с целью предупреждения развития тромбоза вен после ортопедических операций. Принимать Прадакса не рекомендуется пациентам с кровотечениями, проблемами в работе почек и печени, геморрагическими нарушениями, а также в педиатрии.
Какое именно лекарство выбрать в каждом конкретном случае может решить только лечащий врач, учитывая самочувствие и особенности организма пациента.
Эликвис или Ксалерто: сравнительная характеристика
С целью сравнения, какой препарат лучше, надо подробно ознакомиться с характеристиками Эликвиса и Ксарелто.
И один, и другой препарат – это антикоагулянты прямого воздействия. Эти медикаменты непосредственно влияют на свертывание Xa. Разница между ними лишь в действующих составляющих: Эликвис содержит в составе апиксабан, а Ксарелто – ривароксабан. Форма выпуска данных лекарственных средств – таблетки. Их назначают в терапевтических и профилактических целях при сходных патологиях.
Прием Эликвиса и Ксарелто показан, чтобы предотвратить венозную тромбоэмболию после плановых ортопедических операций на ногах, например, после протезирования тазобедренной или коленной суставной ткани. Также эти лекарства помогают предотвратить формирование таких заболеваний, как инсульт, системная тромбоэмболия на фоне фибрилляции.
Относительно инструкции по применению данных медикаментов: приём Ксарелто осуществляется однократно в течение дня в процессе еды, доза не должна превышать 15 или 20 мг. Суточная дозировка Эликвиса после планового хирургического вмешательства составляет 5 мг, деленные на 2 приема, а на фоне фибрилляции предсердий дневная доза увеличивается до 10 мг. В случае необходимости лечащий врач корректирует количество принимаемого лекарства.
Важно! Что касается развития вероятных негативных реакций, под действием данных препаратов увеличивается риск появления внутреннего или внешнего кровотечения, из-за чего может образоваться постгеморрагическая анемия.
Помимо этого, на фоне лечения Ксарелто иногда появляется тахикардия, гипотония, рвотные позывы, запор, боль в области живота, диспепсические явления, сухость в ротовой полости. Также есть вероятность возникновения головокружения и головной боли а в редких случаях краткосрочной потери сознания. Кроме прочего, из-за Ксарелто способны развиться такие симптомы:
- почечная недостаточность;
- кожный зуд;
- аллергический дерматит;
- болевой синдром в области конечностей;
- лихорадка;
- отечность.
Относительно лечения Эликвисом, помимо кровопотери и анемии, есть возможность проявления таких признаков:
- понижение АД;
- тошнота;
- кожная сыпь;
- зуд;
- анафилаксии;
- отечности и т.д.
Что касается противопоказаний, Эликвис и Ксарелто не рекомендуются к использованию на фоне клинически значимой кровопотери, тяжёлом нарушении печеночной функции, сильном нарушении печеночной работы. Также препараты не назначают пациентам младше 18-летнего возраста, будущим матерям и в лактационный период.
Лекарства нельзя принимать при наличии личной непереносимости любой составляющей данных медикаментов, причем важно учесть, что в них содержится лактоза.
Как следствие, принимать Ксарелто более удобно, так как его надо пить только однократно в течение суток, хотя при лечении Эликвисом наблюдается формирование негативных реакций в меньшем количестве. Оба препарата помогают предупредить формирование тромбов. Выбирать наиболее подходящее средство в каждом конкретном случае должен специалист.
Список дешёвых отечественных заменителей
Так как стоимость Эликвиса довольно высокая, врач может выписать пациенту один из аналогов отечественных производителей:
Таблица сравннения аналогов препарата по стоимости. Последнее обновление данных было 03.08.2019 00:00.
Название | Цена | |
---|---|---|
Гепарин | от 46.00 руб. до 506.00 руб. | спрятать смотреть цены детально |
Аптека | Наименование | Цена | Производитель |
---|---|---|---|
Аптека Диалог | Гепариновая мазь (туба 25г) | 46.00 руб. | РОССИЯ |
Аптека Диалог | Гепариновая мазь (туба 25г) | 72.00 руб. | РОССИЯ |
Evropharm RU | гепариновая мазь 25 г нижфарм | 80.00 руб. | Нижфарм ОАО |
Evropharm RU | гепариновая мазь 25 г | 85.00 руб. | РУП "Белмедпрепараты" |
количество в упаковке — 5 | |||
Аптека Диалог | Гепарин (р-р в/в,п/к 5тМЕ/мл 5мл амп. №5) | 426.00 руб. | РОССИЯ |
Аптека Диалог | Гепарин (фл. в/в и п/к введ. 5тМЕ/мл 5мл №5) | 506.00 руб. | Беларусь |
Цена и условия отпуска в аптеке
Отпуск препарата в аптечных пунктах осуществляется по предоставлению рецепта. В среднем Эликвис за упаковку с 20 таблетками стоит: с дозировкой 2,5 мг – 800-850 рублей, с дозой 5 мг – 820-860 рублей.
Таблица акутальных цен на препарат Эликвис в интернет-аптеках. Последнее обновление данных было 03.08.2019 00:00.
количество в упаковке — 20 шт | |||
---|---|---|---|
Аптека | Наименование | Цена | Производитель |
Аптека Диалог | Эликвис таблетки 5мг №20 | 835.00 руб. | Италия |
Аптека Диалог | Эликвис таблетки 2,5мг №20 | 839.00 руб. | Италия |
Evropharm RU | эликвис 5 мг 20 табл | 871.60 руб. | Бристол-Майерс Сквибб С.р.Л. |
Evropharm RU | эликвис 2,5 мг 20 табл | 882.70 руб. | Бристол-Майерс Сквибб Мэнюфэкчуринг Комп |
количество в упаковке — 60 шт | |||
Аптека | Наименование | Цена | Производитель |
Аптека Диалог | Эликвис таблетки 5мг №60 | 2431.00 руб. | Италия |
Аптека Диалог | Эликвис таблетки 2,5мг №60 | 2448.00 руб. | Италия |
Evropharm RU | эликвис 2,5 мг 60 табл | 2605.30 руб. | Бристол-Майерс Сквибб С.р.Л. |
Evropharm RU | эликвис 5 мг 60 табл | 2617.60 руб. | Бристол-Майерс Сквибб С.р.Л. |
Отзывы
Пациенты отзываются об Эликвисе по большей степени позитивно. Лишь в некоторых случаях больные отмечали появление негативных патологических реакций.
«Бристол-Майерс Сквибб» — мировая или, как сейчас модно говорить, глобальная фармацевтическая компания, которая занимается открытием, разработкой и выпуском инновационных лекарств, помогающих людям преодолевать серьезные заболевания такие как рак, гепатит В, ВИЧ/СПИД, психические расстройства, ревматоидный артрит.Не остались в стороне и сердечно-сосудистые заболевания. Именно для этой сферы разработан препарат Эликвис.У лекарства широкий спектр показаний для применения. Мне его назначили для профилактики инсульта и тромбообразования, а также снижения риска пароксизмальной мерцательной аритмии на фоне артериальной гипертензии.На Эликвис я перешёл с дешёвого Варфарина, замучался сдавать кровь на МНО, который никак не хотел подниматься до 2. Когда даже небольшие синяки стали вырастать в огром . читать ещё ные гематомы, понял, что экономией надо заканчивать.Кардиолог в поликлинике не стала переводить на Ксарелто, по её мнению слишком жёсткий, а посоветовала именно Эликвис.Принимаю препарат утром и вечером во время еды по 5 мг. Пилюли небольшие, проглатываются легко. Запиваю половиной стакана воды. Приём препарата к еде не привязан, но мне так удобно.Принимаю около месяца, забыл про гематомы, учащённый пульс и высокое давление. Правда, вместе с Эликвисом идут Конкор, Аторвастатин и Лизиноприл. К тому же, приходится постоянно контролировать своё состояние, но это дело привычки. Короче говоря, снова зажил полноценной жизнью. Опять взялся за плавание, постепенно увеличиваю дистанцию. Осенью пойду к кардиологу, интересно, что скажет. Подводя итоги, скажу, Эликвис — очень приличный современный антикоагулянт, не требующий контроля за МНО. Показан для профилактики многих сердечно-сосудистых заболеваний. Доза и длительность лечения назначаются врачом индивидуально.Конечно, цена великовата для небогатого российского пенсионера, но нормальная жизнь дороже. Противопоказаний и побочных эффектов указано множество, а мне препарат подошёл идеально.Заказывал в аптеке. ру, дали нормальную скидку. Рецепт не потребовался.
«Бристол-Майерс Сквибб» — мировая или, как сейчас модно говорить, глобальная фармацевтическая компания, которая занимается открытием, разработкой и выпуском инновационных лекарств, помогающих людям преодолевать серьезные заболевания такие как рак, гепатит В, ВИЧ/СПИД, психические расстройства, ревматоидный артрит.Не остались в стороне и сердечно-сосудистые заболевания. Именно для этой сферы разработан препарат Эликвис.У лекарства широкий спектр показаний для применения. Мне его назначили для профилактики инсульта и тромбообразования, а также снижения риска пароксизмальной мерцательной аритмии на фоне артериальной гипертензии.На Эликвис я перешёл с дешёвого Варфарина, замучался сдавать кровь на МНО, который никак не хотел подниматься до 2. Когда даже небольшие синяки стали вырастать в огромные гематомы, понял, что экономией надо заканчивать.Кардиолог в поликлинике не стала переводить на Ксарелто, по её мнению слишком жёсткий, а посоветовала именно Эликвис.Принимаю препарат утром и вечером во время еды по 5 мг. Пилюли небольшие, проглатываются легко. Запиваю половиной стакана воды. Приём препарата к еде не привязан, но мне так удобно.Принимаю около месяца, забыл про гематомы, учащённый пульс и высокое давление. Правда, вместе с Эликвисом идут Конкор, Аторвастатин и Лизиноприл. К тому же, приходится постоянно контролировать своё состояние, но это дело привычки. Короче говоря, снова зажил полноценной жизнью. Опять взялся за плавание, постепенно увеличиваю дистанцию. Осенью пойду к кардиологу, интересно, что скажет. Подводя итоги, скажу, Эликвис — очень приличный современный антикоагулянт, не требующий контроля за МНО. Показан для профилактики многих сердечно-сосудистых заболеваний. Доза и длительность лечения назначаются врачом индивидуально.Конечно, цена великовата для небогатого российского пенсионера, но нормальная жизнь дороже. Противопоказаний и побочных эффектов указано множество, а мне препарат подошёл идеально.Заказывал в аптеке. ру, дали нормальную скидку. Рецепт не потребовался.
Моей маме после произошедшего микроинсульта выписали эти таблетки. Пользуемся в течение полугода.За это время значительно реже стали приступы мерцательной аритмии, а давление при приеме тех же антигипертензионных средств(лизинорил и физиотенз) стало ближе к норме. Короче, заметна положительнаядинамика предупреждения инсульта и приступов мерцательной аритмии. Нам прописали принимать по 2,5 мгдва раза в день. Стоимость лекарства около 2500 рублей за 60 таблеток, причем цена практически одинаковадля таблеток 2,5 мг и 5 мг. Таблетки 5 мг не имеют ризки, из-за этого приходится брать 2,5 мг. Одинаковая стоимость таблеток 2,5 и 5 мг указывает на то, что цена явно завышена и не определяется количеством действующего вещества.
Моей маме после произошедшего микроинсульта выписали эти таблетки. Пользуемся в течение полугода.За это время значительно реже стали приступы мерцательной аритмии, а давление при приеме тех же антигипертензионных средств(лизинорил и физиотенз) стало ближе к норме. Короче, заметна положительнаядинамика предупреждения инсульта и приступов мерцательной аритмии. Нам прописали принимать по 2,5 мгдва раза в день. Стоимость лекарства около 2500 рублей за 60 таблеток, причем цена практически одинаковадля таблеток 2,5 мг и 5 мг. Таблетки 5 мг не имеют ризки, из-за этого приходится брать 2,5 мг. Одинаковая стоимость таблеток 2,5 и 5 мг указывает на то, что цена явно завышена и не определяется количеством действующего вещества.
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