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ВЫБОР ПРЯМЫХ ОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ С УЧЕТОМ ИНДИВИДУАЛЬНЫХ ОСОБЕННОСТЕЙ ПАЦИЕНТА

https://doi.org/10.18705/2311-4495-2018-5-6-10-22

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Аннотация

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.

Об авторах

О. И. Ефимова
ФГБОУ ВО «Самарский Государственный Медицинский Университет» ГБУЗ «Самарская областная клиническая больница имени В.Д. Середавина»,
Россия

соискатель кафедры кардиологии и сердечно-сосудистой хирургии ИПО СамГМУ,

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



Т. В. Павлова
ФГБОУ ВО «Самарский Государственный Медицинский Университет»
Россия
профессор, доктор медицинских наук, профессор кафедры кардиологии и сердечно-сосудистой хирургии ИПО СамГМУ


Список литературы

1. Алферова В.В., Белкин А.А., Вознюк И.А. и др. Клинические рекомендации по ведению больных с ишемическим инсультом и транзиторными ишемическими атаками. / под ред. В. И. Скворцовой Москва 2017, с 208.

2. Снижение заболеваемости, смертности и инвалидности от инсультов в Российской Федерации : сб. метод. рек. / под ред. В. И. Скворцовой ; Минздравсоцразвития РФ, ГОУ "РГМУ", НИИ инсульта. - Москва: Литтерра, 2008. - 192 с: табл.

3. Adams HP Jr, Bendixen BH, Kappele LJ et al. Classification of sybtype of acute stroke: Definituin for use in a multicentre clinical trial, TOAST, Trial of Org 10172 in Acute Stroke Treatment. Stroke.1993; 24(1):35–41.

4. Кузнецов А.Н., Виноградов О.И., Кучеренко С.С. Ишемический инсульт. Диагностика. Лечение. Профилактика: карманный справочник. Mосква: РАЕН; 2012.

5. Наnna JP, Furlan AJ. Cardiac disease and embolic sources. Brain ischemia: Basic concepts and clinical relevalence. Caplan-Lond LD, editor. Springer-Verlag. 1995; 299–315.

6. Choudhury A, Lip GY. Atrial fibrillation and the hypercoagulable state: from basic science to clinical practice. Pathophysiol Haemost Thromb 2003–2004; 33: 282–89.

7. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146:857–867.

8. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383: 955–962.

9. Lip GY, Laroche C, Ioachim PM, et al. Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EUR Observational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry). Eur Heart J 2014; 35:3365–3376.

10. Kirchhof P, Ammentorp B, Darius H, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events—European Registry in Atrial Fibrillation (PREFER in AF). Europace 2014; 16:6–14.

11. Nabauer M, Gerth A, Limbourg T, et al. The Registry of the German Competence NETwork on Atrial Fibrillation: Patient characteristics and initial management. Europace 2009; 11:423–434.

12. Kirchhof P, Nabauer M, Gerth A, et al. Impact of the type of centre on management of AF patients: surprising evidence for differences in antithrombotic therapy decisions. Thromb Haemost 2011; 105:1010–1023.

13. Alonso-Coello P, Montori VM, Sola I, et al. Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians’ and patients’ perspectives: protocol for a two-phase study. BMC Health Serv Res 2008; 8:221.

14. Lip GY, Al-Khatib SM, Cosio FG, et al. Contemporary management of atrial fibrillation: what can clinical registries tell us about stroke prevention and current therapeutic approaches? J Am Heart Assoc 2014; 3:e001179.

15. Gorst-Rasmussen A, Skjoth F, Larsen TB, et al. Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study. J Thromb Haemost 2015;13: 495–504.

16. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137:263–272.

17. Lip GY, Lane DA. Modern management of atrial fibrillation requires initial identification of “low-risk” patients using the CHA2DS2-VASc score, and not focusing on “high-risk” prediction. Circ J 2014; 78:1843–1845.

18. Lip GY, Lane DA. Stroke prevention in atrial fibrillation: a systematic review. JAMA 2015; 313:1950–1962.

19. Pisters R, Lane DA, Nieuwlaat R, et al. A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138:1093–1100.

20. Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J 2006; 151:713–719.

21. Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol 2011; 58:395–401.

22. Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 2012; 33:1500–1510.

23. Hijazi Z, Oldgren J, Lindback J, et al. The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet 2016; 387:2302–2311.

24. ACTIVE Writing Group of the ACTIVE Investigators, Connolly S, Pogue J, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367:1903–1912.

25. Connolly SJ, Pogue J, Hart RG, et al. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360:2066–2078.

26. Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011; 364:806–817.

27. Mant J, Hobbs FD, Fletcher K, et al.Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007; 370:493–503.

28. van Walraven C, Hart RG, Connolly S, Austin PC, et al. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators. Stroke 2009; 40:1410–1416.

29. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fbrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37:2893–2962. doi: 10.1093/eurheartj/ehw210.

30. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361:1139–1151.

31. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Newly identified events in the RE-LY trial. N Engl J Med 2010; 363:1875–1876.

32. Graham DJ, Reichman ME,Wernecke M, et al. Cardiovascular, bleeding, and mortality risks in elderly medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation. Circulation 2015; 131:157–164.

33. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365:883–891.

34. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365:981–992.

35. Hylek EM, Held C, Alexander JH, et al. Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes. J Am Coll Cardiol 2014; 63:2141–2147.

36. Flaker GC, Eikelboom JW, Shestakovska O, et al. Bleeding during treatment with aspirin versus apixaban in patients with atrial fibrillation unsuitable for warfarin: the apixaban versus acetylsalicylic acid to prevent stroke in atrial fibrillation patients who have failed or are unsuitable for vitamin K antagonist treatment (AVERROES) trial. Stroke 2012; 43:3291–3297.

37. Hohnloser SH, Pajitnev D, Pogue J, et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy. J Am Coll Cardiol 2007; 50:2156–2161.

38. Friberg L, Hammar N, Pettersson H, et al. Increased mortality in paroxysmal atrial fibrillation: report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF). Eur Heart J 2007; 28:2346–2353.

39. Vanassche T, Lauw MN, Eikelboom JW, et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J 2015; 36: 281–288.

40. Steinberg BA, Hellkamp AS, Lokhnygina Y, et al. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J 2015; 36: 288–296.

41. Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366:120–129.

42. Binici Z, Intzilakis T, Nielsen OW, et al. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation 2010; 121:1904–1911.

43. Hans-Christoph Diener, James Aisenberg, Jack Anse, et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part1. European Heart Journal, 2016 doi:10.1093/eurheartj/ehv643

44. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013; 369:2093–2104.

45. Heidbuchel H, Verhamme P, Alings M, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015; 17:1467–1507.

46. Paciaroni M, Agnelli G. Should oral anticoagulants be restarted after warfarin-associated cerebral haemorrhage in patients with atrial fibrillation? Thromb Haemost 2014; 111:14–18.

47. Kuramatsu JB, Gerner ST, Schellinger PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulationrelated intracerebral hemorrhage. JAMA 2015; 313:824–836.

48. Nielsen PB, Larsen TB, Skjoth F, et al. Restarting Anticoagulant Treatment After Intracranial Hemorrhage in Patients With Atrial Fibrillation and the Impact on Recurrent Stroke, Mortality, and Bleeding: A Nationwide Cohort Study. Circulation 2015; 132:517–525.

49. Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 2011; 123:2363–2372.

50. Vaughan Sarrazin MS, Jones M, Mazur A, et al. Bleeding rates in Veterans Affairs patients with atrial fibrillation who switch from warfarin to dabigatran. Am J Med 2014; 127:1179–1185.

51. Hernandez I, Baik SH, Pinera A, et al. Risk of bleeding with dabigatran in atrial fibrillation. JAMA Internal Medicine 2015; 175:18–24.

52. Abraham NS, Singh S, Alexander GC, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ 2015; 350:h1857.

53. Chang HY, Zhou M, TangW, et al. Risk of gastrointestinal bleeding associated with oral anticoagulants: population based retrospective cohort study. BMJ 2015; 350:h1585.

54. Larsen TB, Gorst-Rasmussen A, Rasmussen LH, et al. Bleeding events among new starters and switchers to dabigatran compared with warfarin in atrial fibrillation. Am J Med 2014; 127:650–656 e5, doi: 10.1016/ j.amjmed.2014.01.031.

55. Larsen TB, Rasmussen LH, Skjoth F, et al. Efficacy and safety of dabigatran etexilate and warfarin in “real-world” patients with atrial fibrillation: a prospective nationwide cohort study. J Am Coll Cardiol 2013; 61:2264–2273.

56. Chan EW, Lau WC, Leung WK, et al. Prevention of dabigatran-related gastrointestinal bleeding with gastroprotective agents: a population-based study. Gastroenterology 2015; 149:586–595.e3.

57. Goodman SG, Wojdyla DM, Piccini JP, et al. Factors associated with major bleeding events: insights from the ROCKET AF trial (rivaroxaban once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation). J Am Coll Cardiol 2014; 63:891–900.

58. Halperin JL, Hankey GJ, Wojdyla DM, et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation 2014; 130: 138–146.

59. Piccini JP, Garg J, Patel MR, et al. Management of major bleeding events in patients treated with rivaroxaban vs. warfarin: results from the ROCKET AF trial. Eur Heart J 2014; 35:1873–1880.

60. Hori M, Matsumoto M, Tanahashi N, et al. Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation – the J-ROCKET AF study. Circ J 2012; 76:2104–2111.

61. Laliberte F, Cloutier M, Nelson WW, et al. Real-world comparative effectiveness and safety of rivaroxaban and warfarin in nonvalvular atrial fibrillation patients. Curr Med Res Opin 2014; 30:1317–1325.

62. Piccini JP, Stevens SR, Chang Y, et al. Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (rivaroxaban once-daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation 2013; 127:224–232.

63. Eikelboom JW, Connolly SJ, Gao P, et al. Stroke risk and efficacy of apixaban in atrial fibrillation patients with moderate chronic kidney disease. J Stroke Cerebrovasc Dis 2012; 21:429–435.

64. Fox KA, Piccini JP, Wojdyla D, et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J 2011; 32:2387–2394.

65. Hijazi Z, Hohnloser SH, Oldgren J, et al. Efficacy and safety of dabigatran compared with warfarin in relation to baseline renal function in patients with atrial fibrillation: A RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial analysis. Circulation 2014; 129:961–970.

66. Hohnloser SH, Hijazi Z, Thomas L, et al. Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J 2012; 33:2821–2830.

67. Bohula EA, Giugliano RP, Ruff CT, et al. Impact of renal function on outcomes with edoxaban in the ENGAGE AF-TIMI 48 Trial. Circulation 2016; 134: 24–36.

68. Jan Steffel, Peter Verhamme, Tatjana S. Potpara, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. European Heart Journal (2018) 00, 1–64 doi:10.1093/eurheartj/ehy136

69. Dans AL, Connolly SJ, Wallentin L, et al. Concomitant use of antiplatelet therapy with dabigatran or warfarin in the randomized evaluation of long-term anticoagulation therapy (RE-LY) trial. Circulation 2013; 127:634–640.

70. Rubboli A, Faxon DP, Juhani Airaksinen KE, et al. The optimal management of patients on oral anticoagulation undergoing coronary artery stenting. The 10th Anniversary Overview. Thromb Haemost 2014; 112: 1080–1087.

71. Mega JL, Braunwald E, Mohanavelu S, et al. Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS-TIMI 46): a randomised, double-blind, phase II trial. Lancet 2009; 374:29–38.

72. Sarafoff N, Martischnig A,Wealer J, et al. Triple therapy with aspirin, prasugrel, and vitamin K antagonists in patients with drug-eluting stent implantation and an indication for oral anticoagulation. J Am Coll Cardiol 2013; 61:2060–2066.

73. Jackson LR II, Ju C, Zettler M, et al. Outcomes of Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Receiving an Oral Anticoagulant and Dual Antiplatelet Therapy: A Comparison of Clopidogrel Versus Prasugrel From the TRANSLATE-ACS Study. JACC Cardiovasc Interv 2015; 8: 1880–1889.

74. Dewilde WJM, Oirbans T, Verheugt FWA, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013; 381:1107–1115.


Для цитирования:


Ефимова О.И., Павлова Т.В. ВЫБОР ПРЯМЫХ ОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ С УЧЕТОМ ИНДИВИДУАЛЬНЫХ ОСОБЕННОСТЕЙ ПАЦИЕНТА. Трансляционная медицина. 2018;5(6):10-22. https://doi.org/10.18705/2311-4495-2018-5-6-10-22

For citation:


Efimova O.I., Pavlova T.V. CHOICE OF DIRECT ORAL ANTICOAGULANTS BASED ON THE INDIVIDUAL APPROACH. Translational Medicine. 2018;5(6):10-22. (In Russ.) https://doi.org/10.18705/2311-4495-2018-5-6-10-22

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ISSN 2311-4495 (Print)
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