transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2018-5-6-10-22transmed-444Research ArticleСЕРДЕЧНО-СОСУДИСТЫЕ ЗАБОЛЕВАНИЯCARDIOVASCULAR MEDICINEВЫБОР ПРЯМЫХ ОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ С УЧЕТОМ ИНДИВИДУАЛЬНЫХ ОСОБЕННОСТЕЙ ПАЦИЕНТАCHOICE OF DIRECT ORAL ANTICOAGULANTS BASED ON THE INDIVIDUAL APPROACHЕфимоваО. И.EfimovaO. I.

соискатель кафедры кардиологии и сердечно-сосудистой хирургии ИПО СамГМУ,

врач терапевт-кардиолог неврологического отделения для больных с острыми нарушениями мозгового кровообращения

PhD student of the Department of Cardiology and Cardiovascular Surgery, Institute of post-graduate education,

Russian Federation, 443099, Samara, Chapaevskaya str., 89

 Physician of the neurological department for patients with acute disorders of cerebral circulation

Russian Federation, 443095, Samara, Tashkentskaya str., 159

tel. 89276563471

kcycha@rambler.ruПавловаТ. В.PavlovaT. V.

профессор, доктор медицинских наук, профессор кафедры кардиологии и сердечно-сосудистой хирургии ИПО СамГМУ

Doctor of Medical Sciences, Professor of the Department of Cardiology and Cardiovascular Surgery

Russian Federation, 443099, Samara, Chapaevskaya str., 89

ptvsam63@mail.ruФГБОУ ВО «Самарский Государственный Медицинский Университет» ГБУЗ «Самарская областная клиническая больница имени В.Д. Середавина»,РоссияFederal State Budgetary Educational Institution of Higher Education "Samara State Medical University" of the Ministry of Health of the Russian Federation, State Budgetary Health Care Institution “Samara Regional Clinical Hospital named after V.D. Seredavina”Russian FederationФГБОУ ВО «Самарский Государственный Медицинский Университет»РоссияFederal State Budgetary Educational Institution of Higher Education "Samara State Medical University" of the Ministry of Health of the Russian FederationRussian Federation201809022019561022Copyright © Ефимова О.И., Павлова Т.В., 20192019Ефимова О.И., Павлова Т.В.Efimova O.I., Pavlova T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/444

Данная обзорная статья посвящена сравнению различных режимов антикоагулянтной терапии с учетом профиля риска и индивидуальных особенностей пациентов с фибрилляцией предсердий. В работе анализируется эффективность и безопасность прямых оральных антикоагулянтов в разных клинических ситуациях. Оцениваются модифицируемые и немодифицируемые факторы риска кровотечения, основанные на шкалах оценки риска геморрагических осложнений у пациентов, принимающих антикоагулянты. Приводится доказательная база по назначению антикоагулянтной терапии при наличии единственного эпизода фибрилляции предсердий. Рассматриваются режимы и сроки инициации антикоагулянтной терапии после кардиоэмболического инсульта или транзиторной ишемической атаки. Кроме того, уделяется большое внимание проблеме раннего назначения антикоагулянтов после перенесенного внутричерепного кровоизлияния. Для пациентов с высоким риском желудочно-кишечного кровотечения или нарушением функции почек проводится оценка оптимальной стратегии снижения тромбоэмболических осложнений. Отдельно рассматриваются подходы к назначению антикоагулянтной терапии у пациентов со стабильной ишемической болезнью сердца, в том числе после проведения коронарного стентирования.

 This review article deals with the comparison of different modes of anticoagulant therapy, taking into account the risk profile and the individual characteristics of patients with atrial fibrillation. This paper analyzes the efficacy and safety of direct oral anticoagulants in different clinical situations. Modifiable and unmodifiable bleeding risk factors are evaluated based on the hemorrhagic complication risk assessment scales for patients taking anticoagulants. The evidence base for anticoagulant therapy in the presence of a single episode of atrial fibrillation is represented. Regimens and terms of initiation of anticoagulant therapy after a cardioembolic stroke or transient ischemic attack are considered. In addition, great attention is paid to the problem of early prescription of anticoagulants after intracranial hemorrhage. For patients at high risk of gastrointestinal bleeding or impaired renal function, an optimal strategy for reducing thromboembolic complications is evaluated. Anticoagulant therapy is also evaluated in patients with stable coronary heart disease, including after coronary stenting.

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The authors declare that there are no conflicts of interest present.