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Jak przyjmowanie antykoagulantów wpływa na gojenie ran pourazowych u osób starszych?

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Osoby starsze są szczególnie narażone na rany i urazy spowodowane upadkami. Częste przyjmowanie antykoagulantów w tej grupie pacjentów zwiększa ryzyko powikłań pourazowych, takich jak krwotoki czy zakażenia.

Proces starzenia się organizmu wiąże się z postępującą dysfunkcją narządów. U osób po 65 roku życia odnotowuje się wzrost chorobowości i częstsze niż u osób młodszych jednoczesne występowanie kilku schorzeń. Z danych zebranych podczas projektu badawczego „Aspekty medyczne, psychologiczne, socjologiczne i ekonomiczne starzenia się ludzi w Polsce” (PolSenior) wynika, że ok. 60 proc. osób w podeszłym wieku choruje na miażdżycę i nadciśnienie tętnicze, a co piąta osoba w tej grupie wiekowej cierpi na cukrzycę. Wraz z wiekiem zwiększa się ryzyko choroby wieńcowej i migotania przedsionków.

Zdolność gojenia u osób po 65 roku życia jest zmniejszona ze względu na wiek i choroby współistniejące, m.in. cukrzycę. Podeszły wiek w połączeniu z wielochorobowością i stosowaniem leków przeciwkrzepliwych sprawia, że rany w tej grupie pacjentów mogą być szczególnie trudne do leczenia.

Najczęstsze rany pourazowe osób starszych

Z badania PolSenior wynika, że co czwarta osoba powyżej 65 roku życia przynajmniej raz w roku doświadcza upadku. Ryzyko upadku wzrasta wraz z wiekiem – po 80 roku życia problem ten dotyczy co trzeciej osoby. Aż 48 proc. upadków osób starszych prowadzi do powstania urazu.

Najczęstszymi urazami po upadkach są zranienia i stłuczenia, następnie złamania i uszkodzenia głowy. Do otarć naskórka i zranień skóry dochodzi w 35 proc. przypadków. Krwiaki pojawiają się u ponad 42 proc. osób.

Leczenie ran pourazowych osób starszych

Leczenie ran pourazowych u osób starszych jest utrudnione ze względu na wspomniane wyżej schorzenia współistniejące, które mogą powodować m.in. zaburzenia krążenia, niedotlenienie tkanek, neuropatię, spowolnienie metabolizmu i zwiększoną skłonność do infekcji. W leczeniu ran kluczowe jest realizowanie przez pacjenta zaleceń lekarskich. Współpraca z osobami starszymi często jest jednak utrudniona ze względu na rozwijające się w tym wieku zaburzenia funkcji poznawczych.

Przyjmowanie doustnych antykoagulantów jest dodatkowym czynnikiem zaburzającym proces gojenia ran wśród osób starszych. Leki te zwiększają ryzyko nadmiernego krwawienia i powstawania obrzęków. Wydłużony proces gojenia rany sprzyja występowaniu zakażeń i stanów zapalnych. Pacjenci stosujący doustne antykoagulanty mogą wymagać hospitalizacji i wdrożenia inwazyjnego leczenia, nawet jeśli uraz początkowo wydawał się niegroźny.

W wielu przypadkach konieczne okazuje się chirurgiczne opróżnienie krwiaka i oczyszczenie rany, a także przeprowadzenie transfuzji krwi. Narastające obrzęki wymagają zastosowania terapii uciskowej. Leczenie rany powinno być prowadzone zgodnie ze strategią TIME.

Lekarz może zdecydować też o odstawieniu leków przeciwkrzepliwych. W zależności od indywidualnego stanu pacjenta należy rozważyć, czy korzyści profilaktyki udarów i zakrzepicy żylnej przeważają nad ryzykiem wystąpienia działań niepożądanych.

Źródła: „Rana pourazowa – zagrożenia zdrowotne i problemy pielęgnacyjne osób w podeszłym wieku”, w: „Leczenie Ran”, 2019;16(2), s. 35-40.

„Aspekty medyczne, psychologiczne, socjologiczne i ekonomiczne starzenia się ludzi w Polsce”, red. M. Mossakowska, A. Więcek, P. Błędowski, Poznań 2012.

 

Przeczytaj także: Rodzaje ran przewlekłych u osób starszych

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