Применение антикоагулянтов при лечении легочной артериальной гипертенз

Как сохранить здоровье</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="patients-spend-2-years-and-150k-to-get-the-right-diagnosis-after-feeling-short-of-breath" data-product-id="7467738005660" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7467738005660 small--hide" title=" Quick shop " data-handle="patients-spend-2-years-and-150k-to-get-the-right-diagnosis-after-feeling-short-of-breath"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/pulmonary-arterial-hypertension/products/patients-spend-2-years-and-150k-to-get-the-right-diagnosis-after-feeling-short-of-breath" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="150px" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Пациенты тратят два года и 150 тысяч долларов на установление точного диагноза после возникновения одышки.</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="stem-cells-heart-failure-pulmonary-arterial-hypertension-how-research-helps-patients-10" data-product-id="7374950596764" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374950596764 small--hide" title=" Quick shop " data-handle="stem-cells-heart-failure-pulmonary-arterial-hypertension-how-research-helps-patients-10"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/pulmonary-arterial-hypertension/products/stem-cells-heart-failure-pulmonary-arterial-hypertension-how-research-helps-patients-10" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.011_3aa76c20-4b2b-4180-845b-63c34812cf1b.jpg?v=1660993601&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.011_3aa76c20-4b2b-4180-845b-63c34812cf1b.jpg?v=1660993601&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.011_3aa76c20-4b2b-4180-845b-63c34812cf1b.jpg?v=1660993601&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.011_3aa76c20-4b2b-4180-845b-63c34812cf1b.jpg?v=1660993601&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.011_3aa76c20-4b2b-4180-845b-63c34812cf1b.jpg?v=1660993601&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.011_3aa76c20-4b2b-4180-845b-63c34812cf1b.jpg?v=1660993601&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="150px" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Стволовые клетки, сердечная недостаточность, легочная артериальная гипертензия. Как исследования помогают пациентам.</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> </div> </div> </div> <div class="cart__footer"> <div class="cart__item-sub cart__item-row cart__item--subtotal"> <div> Subtotal </div> <div data-subtotal>руб0,00</div> </div> <div data-discounts></div> <div class="cart__item-row cart__terms"> <input type="checkbox" id="CartTermsHeader" class="cart__terms-checkbox"> <label for="CartTermsHeader" class="text-label"> <small> I agree with the terms and conditions </small> </label> </div> <div class="cart__item-row cart__checkout-wrapper payment-buttons"> <button type="submit" name="checkout" data-terms-required="true" class="btn cart__checkout" > Check out </button> </div> <div class="cart__item-row--footer text-center"> <small> Shipping, 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class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> <span class="icon__fallback-text visually-hidden"> Expand submenu </span> </span> </button> <ul class="slide-nav__dropdown" data-parent="tier-3-heart1" data-level="3" > <li class="slide-nav__item"> <button type="button" class="slide-nav__button js-toggle-submenu" data-target="tier-2-expert-masterclasses1" > <span class="slide-nav__link slide-nav__link--back"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 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1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> <span>Special Topics</span> </span> </button> </li> <li class="slide-nav__item"> <a href="/collections/public-health" class="slide-nav__link"> <span> View all </span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/womens-health" class="slide-nav__link"> <span>Women's Health. Infertility.</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/elderly-patients" class="slide-nav__link"> <span>Elderly Patients</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/integrative-medicine" class="slide-nav__link"> <span>Integrative Medicine</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/nutrition" class="slide-nav__link"> <span>Nutrition</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> 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aria-hidden="true">/</span> </nav> <div class="product-block" data-section-id="template--18622507942044__main" > <h1 class="h2 product-single__title">Применение антикоагулянтов при лечении легочной артериальной гипертензии (ЛАГ) считается устаревшим подходом.</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div> <div class="grid__item one-whole"> <div class="product-summary--wide"> <div class="dd-article-summary rte"> <p>Ведущий эксперт по легочной сосудистой патологии, доктор медицинских наук Аарон Ваксман, объясняет снижение применения антикоагулянтов при лечении легочной артериальной гипертензии (ЛАГ). Он подробно описывает значительные риски кровотечений, связанные с использованием таких препаратов, как варфарин. Доктор Ваксман рассматривает историческое обоснование антикоагулянтной терапии, основанное на феномене in-situ тромбоза. Современные данные регистров показывают ограниченную клиническую пользу пожизненной антикоагуляции. Большинство специалистов отказались от рутинного применения антикоагулянтов у пациентов с ЛАГ. Лечение назначается только тем, у кого подтверждена тромбоэмболическая болезнь.</p> </div> </div> </div></div> </div> </section> <script type="application/ld+json"> {"@context":"http:\/\/schema.org\/","@id":"\/products\/pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4#product","@type":"Product","brand":{"@type":"Brand","name":"Diagnostic Detectives Network"},"category":"","description":"Пересмотр антикоагулянтной терапии при лечении легочной артериальной гипертензии\nПерейти к разделу\n\nИсторическое применение антикоагулянтов при ЛАГ\nРиски кровотечений при антикоагулянтной терапии\nОграниченные данные об эффективности антикоагулянтов\nСовременные подходы к лечению ЛАГ\nИзменение клинических рекомендаций по терапии ЛАГ\nПолная расшифровка\n\nИсторическое применение антикоагулянтов при ЛАГ\nАнтикоагулянты, такие как варфарин и кумадин, исторически использовались в терапии легочной артериальной гипертензии. Доктор Аарон Ваксман, MD, объясняет первоначальное обоснование этого подхода. Патологические исследования 1950-х годов впервые выявили in-situ тромбоз у пациентов с легочной гипертензией. Это наблюдение привело к эмпирическому назначению антикоагулянтов клиницистами. В то время других эффективных методов лечения легочной артериальной гипертензии не существовало.\nРиски кровотечений при антикоагулянтной терапии\nАнтикоагулянтная терапия сопряжена со значительными рисками для пациентов с легочной гипертензией. Доктор Аарон Ваксман, MD, подчеркивает, что основным побочным эффектом является кровотечение, включая потенциально жизнеугрожающие внутричерепные и желудочно-кишечные кровотечения. Анализ соотношения риска и пользы становится критически важным при пожизненной антикоагуляции. Доктор Антон Титов, MD, обсуждает этот баланс со специалистами. Для многих пациентов эти риски теперь, по-видимому, перевешивают любую потенциальную пользу.\nОграниченные данные об эффективности антикоагулянтов\nНедавние исследования ставят под сомнение эффективность антикоагулянтов при легочной артериальной гипертензии. Доктор Аарон Ваксман, MD, ссылается на данные европейских и американских регистров пациентов. Исследования собственной популяции пациентов его учреждения подтверждают эти выводы. Первоначально наблюдаемое преимущество в выживаемости было минимальным. Современный анализ свидетельствует об ограниченной клинической пользе рутинной антикоагуляции. Эти данные коренным образом изменили подходы к лечению.\nСовременные подходы к лечению ЛАГ\nСовременная терапия легочной артериальной гипертензии вышла за рамки антикоагулянтов. Доктор Аарон Ваксман, MD, отмечает появление новых таргетных препаратов. Эти лекарственные средства специфически воздействуют на сосудистую патологию ЛАГ. Эмпирическое применение старых препаратов, таких как варфарин, постепенно прекращается. Лечение теперь сосредоточено на болезнь-модифицирующей терапии, а не на антикоагуляции. Это представляет значительный прогресс в лечении легочной гипертензии.\nИзменение клинических рекомендаций по терапии ЛАГ\nКлиническая практика кардинально изменилась в отношении применения антикоагулянтов при ЛАГ. Доктор Аарон Ваксман, MD, заявляет, что большинство специалистов больше не используют рутинную антикоагулянтную терапию. Исключение составляют пациенты с подтвержденной хронической тромбоэмболической болезнью. Те, у кого были выявлены тромбы, по-прежнему нуждаются в антикоагулянтной терапии. Доктор Антон Титов, MD, исследует эти развивающиеся стандарты лечения с экспертами. Это отражает продолжающиеся исследования и углубленное понимание сосудистых заболеваний легких.\nПолная расшифровка\nВарфарин и кумадин применялись в терапии легочной гипертензии, однако существуют ограниченные данные об их эффективности. Объясняет ведущий эксперт по заболеваниям легких и сердца.\nАнтикоагулянты используются в клинической практике у пациентов с легочной артериальной гипертензией, но разжижающие кровь препараты, как их также называют, имеют множество значительных побочных эффектов.\nДоктор Аарон Ваксман, MD: Основной побочный эффект — это риск кровотечения. Он включает внутричерепные и желудочно-кишечные кровотечения.\nДоктор Антон Титов, MD: Как балансировать риски и пользу антикоагулянтов при их применении для легочной артериальной гипертензии?\nДоктор Аарон Ваксман, MD: Вся роль антикоагулянтов при легочной артериальной гипертензии теперь ставится под вопрос. Первоначально антикоагулянты начали применять потому, что патологически была признана in-situ тромботическая микроангиопатия при легочной гипертензии.\nТромбоз был замечен, когда легочная артериальная гипертензия впервые была описана в 1950-х годах. Как следствие, люди начали задаваться вопросами.\nУ нас не было других вариантов лечения легочной артериальной гипертензии. Может быть, нам следует назначать пациентам кумадин. Окажет ли это влияние на заболевание?\nДоктор Антон Титов, MD: Это было предположение.\nДоктор Аарон Ваксман, MD: Разжижение крови оказало небольшое влияние на выживаемость при легочной артериальной гипертензии. С того времени и за последние пять лет мы осознали, что, вероятно, нет значительной клинической пользы от антикоагулянтов при легочной артериальной гипертензии.\nЭти сомнения основаны на исследованиях, опубликованных по данным европейских регистров, американских регистров и даже по данным нашей собственной популяции пациентов.\nМы больше не убеждены, что риски антикоагуляции перевешивают пользу при легочной артериальной гипертензии. Особенно если это пожизненная антикоагулянтная терапия.\nМногие из нас прекратили использовать рутинную антикоагуляцию. Для тех пациентов с легочной артериальной гипертензией, у которых может быть хроническая тромбоэмболическая болезнь или которые имели известные тромбы, очевидно, они будут получать антикоагулянтную терапию.\nНо теперь мы все реже назначаем антикоагулянты пациентам с легочной артериальной гипертензией. У нас нет указаний на то, что от этого есть большая польза.\nЭто также свидетельствует о том, что проводится много исследований сосудистых заболеваний легких. Становятся доступны новые лекарственные средства для лечения легочной артериальной гипертензии.\nСтарые препараты применялись эмпирически. Теперь они, в некотором смысле, выводятся из употребления. Во многих отношениях это так.","image":"https:\/\/diagnosticdetectives.ru\/cdn\/shop\/products\/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543\u0026width=1920","name":"Применение антикоагулянтов при лечении легочной артериальной гипертензии (ЛАГ) считается устаревшим подходом.","offers":{"@id":"\/products\/pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4?variant=41852121972892#offer","@type":"Offer","availability":"http:\/\/schema.org\/InStock","price":"0.00","priceCurrency":"RUB","url":"https:\/\/diagnosticdetectives.ru\/products\/pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4?variant=41852121972892"},"url":"https:\/\/diagnosticdetectives.ru\/products\/pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4"} </script> </div><section id="shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q" class="shopify-section index-section"> <section class="section section--tight" data-section-id="template--18622507942044__product_expert_masterclass_teaser_GQjD4Q"> <div class="page-width"><div class="emc"> <a href="/pages/expert-masterclass/dr-aaron-waxman" class="emc__media" style="--emc-max-w: 960px; 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'&' : '?') + 't=' + Date.now(); }); } // Promise wrapper around your JSONP + quality upgrade + safe fallbacks function fetchBestVimeoThumb(id){ // Wrap existing JSONP in a Promise function oEmbedOnce(){ return new Promise(function(resolve){ fetchVimeoThumbJSONP(id, function(u){ resolve(u || null); }); }); } return (async function(){ var small = await oEmbedOnce(); // this is what already works for you (last resort) // Build candidates (highest quality first) var candidates = []; // Clean frame from vumbnail (large, then default) candidates.push(`https://vumbnail.com/${id}_large.jpg`); candidates.push(`https://vumbnail.com/${id}.jpg`); // Try to upgrade oEmbed path to 1280 and keep the original last if (small){ var upgraded = small .replace(/_640\.(jpg|png|webp)(\?.*)?$/i, '_1280.$1') .replace(/_\d+x\d+\.(jpg|png|webp)(\?.*)?$/i, '_1280.jpg') .replace(/_\d+\.(jpg|png|webp)(\?.*)?$/i, '_1280.jpg'); if (upgraded && upgraded !== small) candidates.push(upgraded); candidates.push(small); // last: whatever oEmbed gave us (works today) } // Return the first URL that actually loads for (var i=0;i<candidates.length;i++){ var url = candidates[i]; if (!url) continue; if (await imageExists(url)) return url; } return null; })(); } function findVimeoId(rootEl){ // 1) data-vimeo on placeholder var seeded = rootEl.querySelector('.js-vimeo-thumb[data-vimeo]'); if(seeded){ var id = vimeoIdFromUrl(seeded.getAttribute('data-vimeo')); if(id){ log('EMC: using ID from data-vimeo:', id); return id; } } // 2) iframe inside section var ifr = rootEl.querySelector('iframe[src*="vimeo.com"]'); if(ifr){ var id2 = vimeoIdFromUrl(ifr.getAttribute('src') || ''); if(id2){ log('EMC: found ID via iframe in section:', id2); return id2; } } // 3) any iframe on page (product media outside the section) var ifrGlobal = document.querySelector('iframe[src*="vimeo.com"]'); if(ifrGlobal){ var id3 = vimeoIdFromUrl(ifrGlobal.getAttribute('src') || ''); if(id3){ log('EMC: found ID via iframe on page:', id3); return id3; } } return null; } function runOnce(){ var r = root(); if(!r) return true; // nothing to do var holders = r.querySelectorAll('.js-vimeo-thumb'); log('EMC: placeholders found:', holders.length); if(!holders.length) return true; var id = findVimeoId(r); if(!id){ log('EMC: no Vimeo ID yet'); return false; } // Try best-quality candidates; safely fall back to what already works fetchBestVimeoThumb(id).then(function(thumbUrl){ if(!thumbUrl){ // one last guard using your previous single vumbnail path if (ALLOW_VIMBNAIL) thumbUrl = vumbnailUrl(id); } if(!thumbUrl){ log('EMC: no thumbnail URL available'); return; } for(var i=0;i<holders.length;i++){ upgradeThumb(holders[i], thumbUrl); } }); return true; } function start(){ if(runOnce()) return; // Poll up to MAX_WAIT_MS for lazy iframes to appear var elapsed = 0; var interval = setInterval(function(){ elapsed += POLL_EVERY_MS; if(runOnce() || elapsed >= MAX_WAIT_MS){ clearInterval(interval); } }, POLL_EVERY_MS); // React instantly to DOM insertions var obs = new MutationObserver(function(){ runOnce(); }); try { obs.observe(document.body, { childList:true, subtree:true }); } catch(e){} setTimeout(function(){ try{ obs.disconnect(); }catch(e){} }, MAX_WAIT_MS + 500); } if(document.readyState === 'loading') document.addEventListener('DOMContentLoaded', start); else start(); document.addEventListener('shopify:section:load', function(e){ if(e && e.detail && e.detail.sectionId === 'template--18622507942044__product_expert_masterclass_teaser_GQjD4Q'){ start(); } }); })(); </script> </section></section><div id="shopify-section-template--18622507942044__more-products-collection" class="shopify-section"> <div data-subsection data-section-id="template--18622507942044__more-products-collection" data-section-type="collection-template" > <div class="index-section index-section--sub-product"> <div class="page-width"> <header class="section-header"> <div class="h3 section-header__title"> More from <a href="/collections/pulmonary-arterial-hypertension">Легочная артериальная гипертензия</a> </div> </header> </div> <div class="page-width page-width--flush-small"> <div class="new-grid product-grid scrollable-grid--small" data-view="medium" > <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="pulmonary-arterial-hypertension-therapy-dysfunction-of-mitochondria-in-lung-diseases-clinical-case-11" data-product-id="7374950695068" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374950695068 small--hide" title=" Quick shop " data-handle="pulmonary-arterial-hypertension-therapy-dysfunction-of-mitochondria-in-lung-diseases-clinical-case-11"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/pulmonary-arterial-hypertension/products/pulmonary-arterial-hypertension-therapy-dysfunction-of-mitochondria-in-lung-diseases-clinical-case-11" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.012.jpg?v=1660993618&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.012.jpg?v=1660993618&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.012.jpg?v=1660993618&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.012.jpg?v=1660993618&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.012.jpg?v=1660993618&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.012.jpg?v=1660993618&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="30vw" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Терапия легочной артериальной гипертензии. Митохондриальная дисфункция при заболеваниях легких. Клинический случай. 11</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="how-to-keep-lungs-healthy-advice-from-a-leading-lung-disease-expert-9" data-product-id="7374950531228" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374950531228 small--hide" title=" Quick shop " data-handle="how-to-keep-lungs-healthy-advice-from-a-leading-lung-disease-expert-9"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/pulmonary-arterial-hypertension/products/how-to-keep-lungs-healthy-advice-from-a-leading-lung-disease-expert-9" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.010.jpg?v=1660993581&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.010.jpg?v=1660993581&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.010.jpg?v=1660993581&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.010.jpg?v=1660993581&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.010.jpg?v=1660993581&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.010.jpg?v=1660993581&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="30vw" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title"><!DOCTYPE html> <html lang="ru"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>Как сохранить здоровье</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="patients-spend-2-years-and-150k-to-get-the-right-diagnosis-after-feeling-short-of-breath" data-product-id="7467738005660" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7467738005660 small--hide" title=" Quick shop " data-handle="patients-spend-2-years-and-150k-to-get-the-right-diagnosis-after-feeling-short-of-breath"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/pulmonary-arterial-hypertension/products/patients-spend-2-years-and-150k-to-get-the-right-diagnosis-after-feeling-short-of-breath" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Diagnostic_Detectives_Network_Presentation_2020.007.jpg?v=1666374982&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="30vw" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Пациенты тратят два года и 150 тысяч долларов на установление точного диагноза после возникновения одышки.</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> </div> </div> </div> </div> </div><div id="shopify-section-template--18622507942044__more-products-vendor" class="shopify-section"> <is-land on:visible> <vendor-products data-subsection data-section-id="template--18622507942044__more-products-vendor" data-section-type="vendor-products" data-product-id="7374950203548" data-vendor-url="/collections/vendors?q=Diagnostic%20Detectives%20Network" data-max-products="3" > <div class="index-section index-section--sub-product"> <div class="page-width"> <header class="section-header"> <div class="h3 section-header__title"> More from <a href="/collections/vendors?q=Diagnostic%20Detectives%20Network" title="Diagnostic Detectives Network">Diagnostic Detectives Network</a> </div> </header> </div> <div class="page-width page-width--flush-small"> <div id="VendorProducts-template--18622507942044__more-products-vendor" class="new-grid product-grid scrollable-grid--small" data-view="medium" > <div class="visually-invisible"> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4" data-product-id="7374950203548" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374950203548 small--hide" title=" Quick shop " data-handle="pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/pulmonary-arterial-hypertension/products/pulmonary-arterial-hypertension-therapy-with-anticoagulants-is-outdated-4" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Aaron_Waxman_Diagnostic_Detectives_Network_Medical-Second_Opinion_Shortness-of-breath-diagnosis-Pulmonary-arterial-hypertension-treatment-options.005.jpg?v=1660993543&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="30vw" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Применение антикоагулянтов при лечении легочной артериальной гипертензии (ЛАГ) считается устаревшим подходом.</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> </div> </div> </div> </div> </vendor-products> <template data-island> <script type="module"> import 'components/section-more-products-vendor' </script> </template> </is-land> </div><div id="shopify-section-template--18622507942044__collection-return" class="shopify-section"> <div class="return-section color-scheme-none"><div class="page-width text-center"> <a href="/collections/pulmonary-arterial-hypertension" class="btn return-link" > <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon--wide icon-arrow-left" viewbox="0 0 50 15" fill="currentColor" width="20" height="20" > <path d="M50 5.38v4.25H15V15L0 7.5 15 0v5.38Z" /> </svg> Back to Легочная артериальная гипертензия </a> </div> </div> </div><div id="shopify-section-template--18622507942044__featured_product_LHGeFD" class="shopify-section index-section"> <section class="page-content page-content--product page-content--partial" data-section-id="template--18622507942044__featured_product_LHGeFD" data-product-id="7374955085980" > <div class="page-width"> <div class="product-grid__container product--images float-grid grid--product-images--partial clearfix"><div class="grid__item medium-up--one-half product-single__sticky"> <product-images data-product-images data-zoom="false" data-has-slideshow="false" data-media-gallery-layout="" data-modal="false" data-product-id="7374955085980" data-section-id="template--18622507942044__featured_product_LHGeFD" > <div class="product__photos product__photos-template--18622507942044__featured_product_LHGeFD product__photos--beside"> <div class="product__main-photos" data-product-single-media-group> <div data-product-photos data-zoom="false" class="product-slideshow" id="ProductPhotos-template--18622507942044__featured_product_LHGeFD" > <div class="product-main-slide starting-slide" data-index="0" data-media-id="26893580828828" > <div data-product-image-main class="product-image-main" ><div class="image-wrap hide" style="height: 0; padding-bottom: 41.666666666666664%;" > <is-land on:visible data-image-type="photoswipe"> <img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1080" alt="Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю." srcset="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1080 1080w" width="1080" height="450.0" loading="eager" class=" image-element" data-photoswipe-src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1800" data-photoswipe-width="1920" data-photoswipe-height="800" data-index="1" sizes=" (min-width: 769px) 50vw, 75vw" data-animate="none"> </is-land> </div><div class="product__video-wrapper"> <is-land on:idle> <div class="video-media aspect-ratio--16-9" data-background="false" ><video-media defer-hydration > <video playsinline="true" controls="controls" preload="metadata" aria-label="Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю." poster="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002_500x.jpg?v=1666367638"><source src="//diagnosticdetectives.ru/cdn/shop/videos/c/vp/a22b0d50e4c64d9c8b0a558888197f4a/a22b0d50e4c64d9c8b0a558888197f4a.HD-720p-4.5Mbps-8813343.mp4?v=0" type="video/mp4"><img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002_500x.jpg?v=1666367638"></video> </video-media></div> <template data-island> <script type="module"> import 'components/video-media' </script> </template> </is-land> </div></div> </div> </div></div> <div data-product-thumbs class="product__thumbs product__thumbs--beside product__thumbs-placement--left medium-up--hide small--hide" data-position="beside" data-arrows="false" ><div class="product__thumbs--scroller"></div></div> </div> <script type="application/json" data-current-variant-json>{"id":41852130001052,"title":"Default Title","option1":"Default Title","option2":null,"option3":null,"sku":"","requires_shipping":false,"taxable":false,"featured_image":null,"available":true,"name":"Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю.","public_title":null,"options":["Default Title"],"price":0,"weight":0,"compare_at_price":null,"inventory_management":null,"barcode":"","requires_selling_plan":false,"selling_plan_allocations":[]}</script> <script type="application/json" data-product-options-json>["Title"]</script> </product-images> <script type="module"> import 'components/product-images' </script> <script type="application/json" id="ModelJson-template--18622507942044__featured_product_LHGeFD"> [] </script><div class="localized-video-iframe-container" style="margin-top: 1.5rem;"> <div id="language-selector-wrapper"> <label for="language-selector">🎧 Select dubbed video language:</label> <select id="language-selector"> <option value="">Choose dubbed language</option> <option value="de" >Deutsch</option> <option value="fr" >Français</option> <option value="ru" selected>Русский</option> <option value="it" >Italiano</option> <option value="es" >Español</option> <option value="pt" >Português</option> <option value="ar" >العربية</option> <option value="zh" >中文</option> <option value="ja" >日本語</option> <option value="ko" >한국어</option> </select> </div> <iframe id="localized-video-iframe" src="https://player.vimeo.com/video/1113043591?autoplay=0&title=0&byline=0&portrait=0" data-selected-lang="ru" frameborder="0" allow="autoplay; fullscreen" allowfullscreen loading="lazy" style="width:100%; aspect-ratio:16/9; margin-top: 0.5rem;"> </iframe> </div></div><div class="product-grid__content product--description product-single__sticky grid__item medium-up--one-half"> <div class="product-single__meta"> <div class="product-block" data-section-id="template--18622507942044__featured_product_LHGeFD" > <h1 class="h2 product-single__title">Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю.</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div></div> </div> </section> <script> document.addEventListener("DOMContentLoaded", function () { const selector = document.getElementById("language-selector"); const iframe = document.getElementById("localized-video-iframe"); if (!selector || !iframe) return; // 🧠 Detect the language used in video (via data attribute from Liquid) const loadedLang = iframe.getAttribute("data-selected-lang"); if (loadedLang) { selector.value = loadedLang; } // 🧠 On dropdown change, switch video selector.addEventListener("change", function () { const lang = selector.value; if (!lang) return; const metafieldUrl = {"vimeo_url_ar":"https:\/\/player.vimeo.com\/video\/1113042680","vimeo_url_de":"https:\/\/player.vimeo.com\/video\/1113042888","vimeo_url_es":"https:\/\/player.vimeo.com\/video\/1113043009","vimeo_url_fr":"https:\/\/player.vimeo.com\/video\/1113043115","vimeo_url_it":"https:\/\/player.vimeo.com\/video\/1113043209","vimeo_url_ja":"https:\/\/player.vimeo.com\/video\/1113043318","vimeo_url_ko":"https:\/\/player.vimeo.com\/video\/1113043403","vimeo_url_pt":"https:\/\/player.vimeo.com\/video\/1113043502","vimeo_url_ru":"https:\/\/player.vimeo.com\/video\/1113043591","vimeo_url_zh":"https:\/\/player.vimeo.com\/video\/1113042779"}; const urlKey = "vimeo_url_" + lang; const newUrl = metafieldUrl[urlKey]; if (newUrl) { iframe.src = newUrl + "?autoplay=0&title=0&byline=0&portrait=0"; } }); }); </script> </div><div id="shopify-section-template--18622507942044__featured_product_ik9hhY" class="shopify-section index-section"> <section class="page-content page-content--product page-content--partial" data-section-id="template--18622507942044__featured_product_ik9hhY" data-product-id="7374955151516" > <div class="page-width"> <div class="product-grid__container product--images float-grid grid--product-images-right grid--product-images--partial clearfix"><div class="product-grid__content product--description product-single__sticky grid__item medium-up--one-half"> <div class="product-single__meta"> <div class="product-block" data-section-id="template--18622507942044__featured_product_ik9hhY" > <h1 class="h2 product-single__title">Подбор идеальных хирургов или медицинских специалистов для проведения вашего лечения.</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div><div class="grid__item medium-up--one-half product-single__sticky"> <product-images data-product-images data-zoom="false" data-has-slideshow="false" data-media-gallery-layout="" data-modal="false" data-product-id="7374955151516" data-section-id="template--18622507942044__featured_product_ik9hhY" > <div class="product__photos product__photos-template--18622507942044__featured_product_ik9hhY product__photos--beside"> <div class="product__main-photos" data-product-single-media-group> <div data-product-photos data-zoom="false" class="product-slideshow" id="ProductPhotos-template--18622507942044__featured_product_ik9hhY" > <div class="product-main-slide starting-slide" data-index="0" data-media-id="26893628440732" > <div data-product-image-main class="product-image-main" ><div class="image-wrap hide" style="height: 0; padding-bottom: 41.666666666666664%;" > <is-land on:visible data-image-type="photoswipe"> <img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=1080" alt="Подбор идеальных хирургов или медицинских специалистов для проведения вашего лечения." srcset="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=1080 1080w" width="1080" height="450.0" loading="eager" class=" image-element" data-photoswipe-src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1.jpg?v=1660755068&width=1800" data-photoswipe-width="1920" data-photoswipe-height="800" data-index="1" sizes=" (min-width: 769px) 50vw, 75vw" data-animate="none"> </is-land> </div><div class="product__video-wrapper"> <is-land on:idle> <div class="video-media aspect-ratio--16-9" data-background="false" ><video-media defer-hydration > <video playsinline="true" controls="controls" preload="metadata" aria-label="Подбор идеальных хирургов или медицинских специалистов для проведения вашего лечения." poster="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1_500x.jpg?v=1660755068"><source src="//diagnosticdetectives.ru/cdn/shop/videos/c/vp/2784406d62054c4da459927e30451d40/2784406d62054c4da459927e30451d40.HD-720p-4.5Mbps-8813682.mp4?v=0" type="video/mp4"><img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhD_2.002_3c4586c3-94b5-47b0-a751-2a382ef567a1_500x.jpg?v=1660755068"></video> </video-media></div> <template data-island> <script type="module"> import 'components/video-media' </script> </template> </is-land> </div></div> </div> </div></div> <div data-product-thumbs class="product__thumbs product__thumbs--beside product__thumbs-placement--right medium-up--hide small--hide" data-position="beside" data-arrows="false" ><div class="product__thumbs--scroller"></div></div> </div> <script type="application/json" data-current-variant-json>{"id":41852130066588,"title":"Default Title","option1":"Default Title","option2":null,"option3":null,"sku":"","requires_shipping":false,"taxable":false,"featured_image":null,"available":true,"name":"Подбор идеальных хирургов или медицинских специалистов для проведения вашего лечения.","public_title":null,"options":["Default Title"],"price":0,"weight":0,"compare_at_price":null,"inventory_management":null,"barcode":"","requires_selling_plan":false,"selling_plan_allocations":[]}</script> <script type="application/json" data-product-options-json>["Title"]</script> </product-images> <script type="module"> import 'components/product-images' </script> <script type="application/json" id="ModelJson-template--18622507942044__featured_product_ik9hhY"> [] </script></div></div> </div> </section> <script> document.addEventListener("DOMContentLoaded", function () { const selector = document.getElementById("language-selector"); const iframe = document.getElementById("localized-video-iframe"); if (!selector || !iframe) return; // 🧠 Detect the language used in video (via data attribute from Liquid) const loadedLang = iframe.getAttribute("data-selected-lang"); if (loadedLang) { selector.value = loadedLang; } // 🧠 On dropdown change, switch video selector.addEventListener("change", function () { const lang = selector.value; if (!lang) return; const metafieldUrl = {}; const urlKey = "vimeo_url_" + lang; const newUrl = metafieldUrl[urlKey]; if (newUrl) { iframe.src = newUrl + "?autoplay=0&title=0&byline=0&portrait=0"; } }); }); </script> </div><div id="shopify-section-template--18622507942044__sub" class="shopify-section product-full-width"> <div class="page-width page-width--narrow"> <div class="product-block" > <at-rte class="at-rte rte clearfix"> <h1>Пересмотр антикоагулянтной терапии при лечении легочной артериальной гипертензии</h1> <h3>Перейти к разделу</h3> <ul> <li><a href="#historical-use-anticoagulants">Историческое применение антикоагулянтов при ЛАГ</a></li> <li><a href="#bleeding-risks-anticoagulation">Риски кровотечений при антикоагулянтной терапии</a></li> <li><a href="#limited-evidence-effectiveness">Ограниченные данные об эффективности антикоагулянтов</a></li> <li><a href="#modern-treatment-approaches">Современные подходы к лечению ЛАГ</a></li> <li><a href="#changing-clinical-guidelines">Изменение клинических рекомендаций по терапии ЛАГ</a></li> <li><a href="#full-transcript">Полная расшифровка</a></li> </ul> <h2 id="historical-use-anticoagulants">Историческое применение антикоагулянтов при ЛАГ</h2> <p>Антикоагулянты, такие как варфарин и кумадин, исторически использовались в терапии легочной артериальной гипертензии. Доктор Аарон Ваксман, MD, объясняет первоначальное обоснование этого подхода. Патологические исследования 1950-х годов впервые выявили in-situ тромбоз у пациентов с легочной гипертензией. Это наблюдение привело к эмпирическому назначению антикоагулянтов клиницистами. В то время других эффективных методов лечения легочной артериальной гипертензии не существовало.</p> <h2 id="bleeding-risks-anticoagulation">Риски кровотечений при антикоагулянтной терапии</h2> <p>Антикоагулянтная терапия сопряжена со значительными рисками для пациентов с легочной гипертензией. Доктор Аарон Ваксман, MD, подчеркивает, что основным побочным эффектом является кровотечение, включая потенциально жизнеугрожающие внутричерепные и желудочно-кишечные кровотечения. Анализ соотношения риска и пользы становится критически важным при пожизненной антикоагуляции. Доктор Антон Титов, MD, обсуждает этот баланс со специалистами. Для многих пациентов эти риски теперь, по-видимому, перевешивают любую потенциальную пользу.</p> <h2 id="limited-evidence-effectiveness">Ограниченные данные об эффективности антикоагулянтов</h2> <p>Недавние исследования ставят под сомнение эффективность антикоагулянтов при легочной артериальной гипертензии. Доктор Аарон Ваксман, MD, ссылается на данные европейских и американских регистров пациентов. Исследования собственной популяции пациентов его учреждения подтверждают эти выводы. Первоначально наблюдаемое преимущество в выживаемости было минимальным. Современный анализ свидетельствует об ограниченной клинической пользе рутинной антикоагуляции. Эти данные коренным образом изменили подходы к лечению.</p> <h2 id="modern-treatment-approaches">Современные подходы к лечению ЛАГ</h2> <p>Современная терапия легочной артериальной гипертензии вышла за рамки антикоагулянтов. Доктор Аарон Ваксман, MD, отмечает появление новых таргетных препаратов. Эти лекарственные средства специфически воздействуют на сосудистую патологию ЛАГ. Эмпирическое применение старых препаратов, таких как варфарин, постепенно прекращается. Лечение теперь сосредоточено на болезнь-модифицирующей терапии, а не на антикоагуляции. Это представляет значительный прогресс в лечении легочной гипертензии.</p> <h2 id="changing-clinical-guidelines">Изменение клинических рекомендаций по терапии ЛАГ</h2> <p>Клиническая практика кардинально изменилась в отношении применения антикоагулянтов при ЛАГ. Доктор Аарон Ваксман, MD, заявляет, что большинство специалистов больше не используют рутинную антикоагулянтную терапию. Исключение составляют пациенты с подтвержденной хронической тромбоэмболической болезнью. Те, у кого были выявлены тромбы, по-прежнему нуждаются в антикоагулянтной терапии. Доктор Антон Титов, MD, исследует эти развивающиеся стандарты лечения с экспертами. Это отражает продолжающиеся исследования и углубленное понимание сосудистых заболеваний легких.</p> <h2 id="full-transcript">Полная расшифровка</h2> <p>Варфарин и кумадин применялись в терапии легочной гипертензии, однако существуют ограниченные данные об их эффективности. Объясняет ведущий эксперт по заболеваниям легких и сердца.</p> <p>Антикоагулянты используются в клинической практике у пациентов с легочной артериальной гипертензией, но разжижающие кровь препараты, как их также называют, имеют множество значительных побочных эффектов.</p> <p><strong>Доктор Аарон Ваксман, MD:</strong> Основной побочный эффект — это риск кровотечения. Он включает внутричерепные и желудочно-кишечные кровотечения.</p> <p><strong>Доктор Антон Титов, MD:</strong> Как балансировать риски и пользу антикоагулянтов при их применении для легочной артериальной гипертензии?</p> <p><strong>Доктор Аарон Ваксман, MD:</strong> Вся роль антикоагулянтов при легочной артериальной гипертензии теперь ставится под вопрос. Первоначально антикоагулянты начали применять потому, что патологически была признана in-situ тромботическая микроангиопатия при легочной гипертензии.</p> <p>Тромбоз был замечен, когда легочная артериальная гипертензия впервые была описана в 1950-х годах. Как следствие, люди начали задаваться вопросами.</p> <p>У нас не было других вариантов лечения легочной артериальной гипертензии. Может быть, нам следует назначать пациентам кумадин. Окажет ли это влияние на заболевание?</p> <p><strong>Доктор Антон Титов, MD:</strong> Это было предположение.</p> <p><strong>Доктор Аарон Ваксман, MD:</strong> Разжижение крови оказало небольшое влияние на выживаемость при легочной артериальной гипертензии. С того времени и за последние пять лет мы осознали, что, вероятно, нет значительной клинической пользы от антикоагулянтов при легочной артериальной гипертензии.</p> <p>Эти сомнения основаны на исследованиях, опубликованных по данным европейских регистров, американских регистров и даже по данным нашей собственной популяции пациентов.</p> <p>Мы больше не убеждены, что риски антикоагуляции перевешивают пользу при легочной артериальной гипертензии. Особенно если это пожизненная антикоагулянтная терапия.</p> <p>Многие из нас прекратили использовать рутинную антикоагуляцию. Для тех пациентов с легочной артериальной гипертензией, у которых может быть хроническая тромбоэмболическая болезнь или которые имели известные тромбы, очевидно, они будут получать антикоагулянтную терапию.</p> <p>Но теперь мы все реже назначаем антикоагулянты пациентам с легочной артериальной гипертензией. У нас нет указаний на то, что от этого есть большая польза.</p> <p>Это также свидетельствует о том, что проводится много исследований сосудистых заболеваний легких. Становятся доступны новые лекарственные средства для лечения легочной артериальной гипертензии.</p> <p>Старые препараты применялись эмпирически. Теперь они, в некотором смысле, выводятся из употребления. 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