Баланс эффективности и безопасности профилактики инсульта при неклапанной фибрилляции предсердий: возможности апиксабана. Вопросы и ответы

СтатьяМЕД СОВЕТ. 2015; № 2: 36–45. DOI:10.21518/2079-701X-2015-2-36-45

Явелов И.С.^[1]

^[1]«Российский национальный исследовательский медицинский университет имени Н.И.Пирогова»

Тромбоэмболические нарушения представляют серьезную проблему здравоохранения. Одно из наиболее значимых заболеваний, ассоциированных с тромбозом и имеющих серьезные клинические последствия, является инсульт. Фибрилляция предсердий увеличивает частоту возникновения инсульта, что определяет актуальность антикоагуляции при этом заболевании. В последнее время для профилактики тромбозов все большее распространение приобретают новые пероральные антикоагулянты. В связи с этим предлагаем обсудить некоторые вопросы применения антикоагулянтов для профилактики инсульта при фибрилляции предсердий.

stroke

atrial fibrillation

new oral anticoagulants

apixaban

инсульт

фибрилляция предсердий

новые оральные антикоагулянты

апиксабан

Антикоагулянты

Безопасность

Больные

Варфарин

Время

Геморрагии

Геморрагический инсульт

Здравоохранение

Ишемический инсульт

Постуральное равновесие

Предсердие

Риск

Смертность

Тромбоз

Guidelines for the management of atrial fibrillation. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J., 2010, 31: 23692429.

focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Europace, 2012, 14: 1385-1413.

AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, 2014, 130: 20712104.

Chao TF, Liu CJ, Wang KL et al. Should Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA2DS2-VASc Score (Beyond Sex) Receive Oral Anticoagulation? JACC, 2015, 65: 635-642.

You JJ, Singer DE, Howard PA et al. Antithrombotic Therapy for Atrial Fibrillation. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141: 531S-575S.

Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis. Ann Intern Med., 1999; 131: 492-501.

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,

Connolly SJ, Eikelboom J, Joyner C et al. For the AVERROES Steering Committee and Investigators. Apixaban in patients with atrial fibrillation. N Engl J Med 2011, 364: 806-817,

The ACTIVE Writing Group on behalf of the ACTIVE Investigators. 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.

Hart RG, Diener H-C, Yang S et al. Intracranial Hemorrhage in Atrial Fibrillation Patients During Anticoagulation With Warfarin or Dabigatran. The RE-LY Trial. Stroke 2012, 43: 1511-1517.

Eikelboom JW, Connolly SJ, Hart RG et al. Balancing the benefits and risks of 2 doses of dabigatran compared with warfarin in atrial fibrillation. JACC, 2013, 62: 900-988.

ACTIVE Writing Group of the ACTIVE Investigators. 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.

Gomes T, Mamdani MM, Holbrook AM et al. Rates of hemorrhage during warfarin therapy for atrial fibrillation. CMAJ 2013, 185: 121-127.

Azoulay L, Dell'Aniello S, Simon TA et al. Initiation of warfarin in patients with atrial fibrillation: early effects on ischaemic strokes. Eur Heart J 2014, 35: 1881-1887.

Ghate SR, Biskupiak JE, Ye X et al. Hemorrhagic and Thrombotic Events Associated with Generic Substitution of Warfarin in Patients with Atrial Fibrillation: A Retrospective Analysis. Ann Pharmacother 2011, 45: 701-712.

Granger CB, Alexander JH, McMurray JJ et al. For the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med, 2011, 365: 981-992.

Connolly SJ, Connolly SJ, Ezekowitz MD et al. For the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009? 361: 1139-1351.

Patel MR, Mahaffey KW, Garg J et al. For the ROCKET-AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011, 365: 883-891.

Hylek EM, Held C, Alexander JH. et al. Major Bleeding in Patients with Atrial Fibrillation Receiving Apixaban or Warfarin in the ARISTOTLE Trial: Predictors, Characteristics, and Clinical Outcomes. JACC 2014, 63: 2141-2147.

Lopes RD, Al-Khatib SM, Wallentin L et al. Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fibrillation: a secondary analysis of a randomized controlled trial. Lancet 2012, 380: 1749-1758.

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

Wallentin L, Lopes RD, Hanna M et al. Efficacy and safety of apixaban compared with warfarin in different levels of predicted INR control for stroke prevention in atrial fibrillation. Circulation, 2013, 127: 2166-2176.

Язык текста: Русский

ISSN: 2079-701X