cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-4-101-106cardiovascular-1904Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMВенозные тромбозы и эмболии у больных с сердечной недостаточностьюVenous thromboembolism in patients with heart failureАверковО. В.AverkovO. V.

профессор кафедры пропедевтики внутренних болезней

Москва

ШевченкоИ. В.ShevchenkoI. V.

клинический ординатор кафедры факультетской терапии

Москва

МирилашвилиТ. Ш.MirilashviliT. Sh.

зав. 18 терапевтическим отделением ГКБ № 64, доцент кафедры пропедевтики внутренних болезней

Москва

КобалаваЖ. Д.KobalavaZh. D.

зав. кафедрой пропедевтики внутренних болезней

Москва

zkobalava@mail.ruРоссийский университет дружбы народов на базе ГКБ № 64Russian University of People’s Friendship, City Clinical Hospital No. 64201120082011104101106Copyright © Аверков О.В., Шевченко И.В., Мирилашвили Т.Ш., Кобалава Ж.Д., 20112011Аверков О.В., Шевченко И.В., Мирилашвили Т.Ш., Кобалава Ж.Д.Averkov O.V., Shevchenko I.V., Mirilashvili T.S., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1904

Статья посвящена проблемам профилактики венозных тромбозов и эмболий у больных с сердечной недостаточностью (СН). Представлены данные основных исследований с использованием антитромботических средств, в которых участвовали пациенты с СН. Обсуждается сравнительная эффективность, безопасность и переносимость нефракционированных гепаринов, низкомолекулярных гепаринов и фондапаринукса. Ожидаются результаты двух исследований: MAGELLAN и ADOPT, в которых может определиться перспектива использования более удобных для применения per os антикоагулянтов — ингибиторов Ха фактора свертывания крови: ривароксабана и апиксабана. Привлечено внимание к низкой частоте применения антитромботических средств в профилактических целях.

This review is focussed on the problem of venous thromboembolism in patients with heart failure (HF). The results of the major clinical trials of antithrombotic therapy in HF patients are presented. The authors discuss comparative effectiveness, safety, and tolerability of unfractionated heparins, low molecular weight heparins, and fondaparinux. The results of the two trials, MAGELLAN and ADOPT, are expected to clarify the clinical potential of such oral anticoagulants as rivaroxaban and apixaban (Factor Xa inhibitors). The problem of low rates e of preventive antithrombotic administration is emphasized.

венозный тромбоэмболизмтромбоэмболия легочной артериисердечная недостаточностьнизкомолекулярный гепариннефракционированный гепаринингибиторы Ха фактораVenous thromboembolismpulmonary artery thromboembolismheart failurelow molecular weight heparinunfractionated heparinFactor Xa inhibitorsReferencesBaker DW, Einstadter D, Thomas C, Cebul RD. Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991 to 1997. Am Heart J 2003; 146: 258-64.Baker DW, Einstadter D, Thomas C, Cebul RD. Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991 to 1997. Am Heart J 2003; 146: 258-64.Fonarow GC, Adams KF Jr, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. J Am Med Assoc 2005; 293: 572-80.Fonarow GC, Adams KF Jr, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. J Am Med Assoc 2005; 293: 572-80.Alikhan R, Spyropoulos AC. Epidemiology of venous thromboembolism in cardiorespiratory and infectious disease. Am J Med 2008; 121: 935-42.Alikhan R, Spyropoulos AC. Epidemiology of venous thromboembolism in cardiorespiratory and infectious disease. Am J Med 2008; 121: 935-42.Beemath A, Stein PD, Skaf E, et al. Risk of venous thromboembolism in patients hospitalized with heart failure. Am J Cardiol 2006; 98: 793-5.Beemath A, Stein PD, Skaf E, et al. Risk of venous thromboembolism in patients hospitalized with heart failure. Am J Cardiol 2006; 98: 793-5.Alikhan R, Cohen AT, Combe S, et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis 2003; 14: 341-6.Alikhan R, Cohen AT, Combe S, et al. Prevention of venous thromboembolism in medical patients with enoxaparin: a subgroup analysis of the MEDENOX study. Blood Coagul Fibrinolysis 2003; 14: 341-6.Leizorovicz A, Cohen AT, Turpie AG, et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110: 874-9.Leizorovicz A, Cohen AT, Turpie AG, et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110: 874-9.Cohen AT, Davidson BL, Gallus AS, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 2006; 332: 325-9.Cohen AT, Davidson BL, Gallus AS, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 2006; 332: 325-9.Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: a retrospective, case-control study. J Clin Epidemiol 2001; 54: 810-6.Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: a retrospective, case-control study. J Clin Epidemiol 2001; 54: 810-6.Терещенко С.Н., Демидова И.В., Левчук Н.Н., Кобалава Ж.Д. Клинико-статистический анализ хронической сердечной недостаточности. Тер архив 1999; 1: 42-6.Терещенко С.Н., Демидова И.В., Левчук Н.Н., Кобалава Ж.Д. Клинико-статистический анализ хронической сердечной недостаточности. Тер архив 1999; 1: 42-6.Lindblad B, Sternby NH, Bergqvist D: Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ 1991; 302: 709-11.Lindblad B, Sternby NH, Bergqvist D: Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ 1991; 302: 709-11.Goldhaber SZ, Savage DD, Garrison RJ, et al: Risk factors for pulmonary embolism: the Framingham study. Am J Med 1983;74: 1023-8.Goldhaber SZ, Savage DD, Garrison RJ, et al: Risk factors for pulmonary embolism: the Framingham study. Am J Med 1983;74: 1023-8.Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. J Am Med Assoc 1995; 273: 1450-6.Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. J Am Med Assoc 1995; 273: 1450-6.Darze ES, Latado AL, Guimaraes AG, et al. Acute pulmonary embolism is an independent predictor of adverse events in severe decompensated heart failure patients. Chest 2007; 131: 1838-43.Darze ES, Latado AL, Guimaraes AG, et al. Acute pulmonary embolism is an independent predictor of adverse events in severe decompensated heart failure patients. Chest 2007; 131: 1838-43.Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. Am J Cardio 1987; 60: 1340-55.Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. Am J Cardio 1987; 60: 1340-55.Heit JA. Venous thromboembolism epidemiology: implications for prevention and management. Semin Thromb Hemost 2002; 28 (suppl 2): 3-13.Heit JA. Venous thromboembolism epidemiology: implications for prevention and management. Semin Thromb Hemost 2002; 28 (suppl 2): 3-13.Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 2257-64.Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350: 2257-64.Samama MM; An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000;160: 3415-20.Samama MM; An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med 2000;160: 3415-20.Di Minno G, Mannucci PM, Tufano A, et al: The first ambulatory screening on thromboembolism: a multicenter, crosssectional, observational study on risk factors of venous thromboembolism. J Thromb Haemost 2005;3: 1459-66.Di Minno G, Mannucci PM, Tufano A, et al: The first ambulatory screening on thromboembolism: a multicenter, crosssectional, observational study on risk factors of venous thromboembolism. J Thromb Haemost 2005;3: 1459-66.Samama M, Cohen A, Darmon M, et al: A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med 1999; 341: 793-800.Samama M, Cohen A, Darmon M, et al: A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med 1999; 341: 793-800.Darze ES, Latado AL, Guimaraes AG, et al: Incidence and clinical predictors of pulmonary embolism in severe heart failure patients admitted to a coronary care unit. Chest 2005; 128: 2576-80.Darze ES, Latado AL, Guimaraes AG, et al: Incidence and clinical predictors of pulmonary embolism in severe heart failure patients admitted to a coronary care unit. Chest 2005; 128: 2576-80.Cohen AT, Turpie AG, Leizorovicz A, et al: Thromboprophylaxis with dalteparin in medical patients: which patients benefit? Vase Med 2007; 12: 123-8.Cohen AT, Turpie AG, Leizorovicz A, et al: Thromboprophylaxis with dalteparin in medical patients: which patients benefit? Vase Med 2007; 12: 123-8.Kleber EX, Witt C, Vogel G, et al., THE-PRINCE Study Group: Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J 2003; 145: 614-21.Kleber EX, Witt C, Vogel G, et al., THE-PRINCE Study Group: Randomized comparison of enoxaparin with unfractionated heparin for the prevention of venous thromboembolism in medical patients with heart failure or severe respiratory disease. Am Heart J 2003; 145: 614-21.Gruppo di lavoro per lc linee guida sul tromboembolismo venoso delta Societa Italiana per lo Studio del’Emostasi e deila Trombosi: Profilassi del trombocmbolismo venoso in medicina. Haematologica 2003; 88(suppl 18): 50-3.Gruppo di lavoro per lc linee guida sul tromboembolismo venoso delta Societa Italiana per lo Studio del’Emostasi e deila Trombosi: Profilassi del trombocmbolismo venoso in medicina. Haematologica 2003; 88(suppl 18): 50-3.Geerts WH, Pineo GP, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(suppl): 338S-400.Geerts WH, Pineo GP, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(suppl): 338S-400.Cardiovascular Disease Educational and Research Trust, Cyprus Cardiovascular Disease Educational and Research Trust, European Venous Forum, International Surgical Thrombosis Forum; International Union of Angiology, Union Internationale de Phlebologie: Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol 2006; 25: 101-61.Cardiovascular Disease Educational and Research Trust, Cyprus Cardiovascular Disease Educational and Research Trust, European Venous Forum, International Surgical Thrombosis Forum; International Union of Angiology, Union Internationale de Phlebologie: Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol 2006; 25: 101-61.Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Ches. 2008; 133 (6 suppl): 381S-453.Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Ches. 2008; 133 (6 suppl): 381S-453.Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119(14): e391-479.Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119(14): e391-479.Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology: developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10: 933-89.Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology: developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10: 933-89.Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Диагностика и лечение хронической сердечной недостаточности. Сердечная недостаточность 2010; 11 1 (57).Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П. и др. Диагностика и лечение хронической сердечной недостаточности. Сердечная недостаточность 2010; 11 1 (57).Моисеев B.C., Терещенко С.Н., Павликова Е. П., Явелов И.С. Диагностика и лечение острой сердечной недостаточности. Кардиоваск тер профил 2006; 5(6): Приложение 1.Моисеев B.C., Терещенко С.Н., Павликова Е. П., Явелов И.С. Диагностика и лечение острой сердечной недостаточности. Кардиоваск тер профил 2006; 5(6): Приложение 1.Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология 2010; 4 (2); 26, 28-35.Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология 2010; 4 (2); 26, 28-35.Ageno W, Squizzato A, Ambrosini F, et al: Thrombosis prophylaxis in medical patients: a retrospective review of clinical practice patterns. Haematologica 2002; 87: 746-50.Ageno W, Squizzato A, Ambrosini F, et al: Thrombosis prophylaxis in medical patients: a retrospective review of clinical practice patterns. Haematologica 2002; 87: 746-50.Hull R, Schellong S, Tapson V, et al: Extended thromboprophylaxis with enoxaparin in acutely ill patients with prolonged periods of immobilisation: the EXCLAIM Study. I Thromb Thrombolysis 2006; 22: 31-8.Hull R, Schellong S, Tapson V, et al: Extended thromboprophylaxis with enoxaparin in acutely ill patients with prolonged periods of immobilisation: the EXCLAIM Study. I Thromb Thrombolysis 2006; 22: 31-8.Hull R, Schellong S, Tapson V, et al: Extended-duration venous thromboembolism (VTE) prophylaxis in acutely ill medical patients with recent reduced mobility: the EXCLAIM study. I Thromb Haemost 2007; 5(suppl 2): OS00L.Hull R, Schellong S, Tapson V, et al: Extended-duration venous thromboembolism (VTE) prophylaxis in acutely ill medical patients with recent reduced mobility: the EXCLAIM study. I Thromb Haemost 2007; 5(suppl 2): OS00L.Alehagen U, Dahlstrom U, Lindahl TL: Elevated D-dimer levels is an independent risk factor of cardiovascular death in outpatients with symptoms compatible with heart failure. Thromb Haemost 2004; 92: 1250-8.Alehagen U, Dahlstrom U, Lindahl TL: Elevated D-dimer levels is an independent risk factor of cardiovascular death in outpatients with symptoms compatible with heart failure. Thromb Haemost 2004; 92: 1250-8.Fraisse F, Holzapfel L, Couland JM, et al: Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPI). The Association of Non-University Affiliated Intensive Care Specialist Physicians of France. Am J Respir Crit Care Med 2000; 161: 1109-14.Fraisse F, Holzapfel L, Couland JM, et al: Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPI). The Association of Non-University Affiliated Intensive Care Specialist Physicians of France. Am J Respir Crit Care Med 2000; 161: 1109-14.Jois-Bilowich P, Michota F, Bartholomew JR, et al.; Adhere Scientific Advisory Committee and Investigators. Venous thromboembolism prophylaxis in hospitalized heart failure patients. J Card Fail 2008; 14: 127-32.Jois-Bilowich P, Michota F, Bartholomew JR, et al.; Adhere Scientific Advisory Committee and Investigators. Venous thromboembolism prophylaxis in hospitalized heart failure patients. J Card Fail 2008; 14: 127-32.Amin AN, Lin J, Yang G, Stemkowski S. Examining the rate of appropriate, ACCP-recommended VTE prophylaxis use in heart failure patients. J Card Fail 2008; 14: S83.Amin AN, Lin J, Yang G, Stemkowski S. Examining the rate of appropriate, ACCP-recommended VTE prophylaxis use in heart failure patients. J Card Fail 2008; 14: S83.Rashid ST, Thursz MR, Razvi NA, et al. Venous thromboprophylaxis in UK medical inpatients. J R Soc Med 2005; 98: 507-12.Rashid ST, Thursz MR, Razvi NA, et al. Venous thromboprophylaxis in UK medical inpatients. J R Soc Med 2005; 98: 507-12.Stinnett JM, Pendleton R, Skordos L, et al. Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol 2005; 78: 167-72.Stinnett JM, Pendleton R, Skordos L, et al. Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol 2005; 78: 167-72.Kahn SR, Panju A, Geerts W, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 2007; 119: 145-55.Kahn SR, Panju A, Geerts W, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 2007; 119: 145-55.Yu HT, Dylan ML, Lin J, et al. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm 2007; 64: 69-76.Yu HT, Dylan ML, Lin J, et al. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm 2007; 64: 69-76.

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