cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2016-2-83-92cardiovascular-333Research ArticleОБЗОРЫREVIEWSПодходы к выбору антикоагулянтной терапии у больных с неклапанной фибрилляцией предсердий и ишемической болезнью сердцаApproaches to anticoagulation therapy selection in patients with non-valvular atrial fibrillation and ischemic heart diseaseКозиоловаН. А.KoziolovaN. A.

кафедра пропедевтики внутренних болезней №2

д.м.н., профессор, заведующая 

nakoziolova@mail.ruСуровцеваМ. В.SurovtsevaM. V.

кафедра пропедевтики внутренних болезней №2

д.м.н., доцент 

face@neicon.ruГБОУ ВПО Пермский государственный медицинский университет имени академика Е.А. Вагнера Минздрава России, ПермьE.A. Wagner Perm State Medical University of the Ministry of Health, Perm2016200420161528392Copyright © Козиолова Н.А., Суровцева М.В., 20162016Козиолова Н.А., Суровцева М.В.Koziolova N.A., Surovtseva M.V.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/333

В статье представлены подходы к выбору антитромботической терапии (АТ) у больных неклапанной фибрилляцией предсердий (ФП) и ишемической болезнью сердца (ИБС) как при остром коронарном синдроме (ОКС), так и стабильных формах, в т.ч. у перенесших чрескожное коронарное вмешательство. Определение режимов и длительность АТ зависят от формы ИБС, риска кровотечений, анатомии имплантированных стентов в коронарных артериях. В составе АТ в современных регламентирующих документах больным ИБС и ФП рекомендуется любой оральный антикоагулянт: антагонисты витамина К, прямой ингибитор тромбина — дабигатран, селективные ингибиторы Xa фактора свертывания — ривароксабан, апиксабан. Наибольшая доказательная база среди новых оральных антикоагулянтов при данной клинической ситуации представлена для дабигатрана. Выбор двойного и тройного режимов АТ для больных ИБС и с ФП дискутируется. Среди антитромбоцитарных препаратов для комбинации с антикоагулянтом предпочтителен клопидогрел как более безопасный препарат в сравнении с аспирином. Возможность использования для комбинированной терапии с антикоагулянтами тикагрелора и прасугрела ограничена. Указывается на необходимость применения ингибиторов протонной помпы при назначении как двойной, так и тройной АТ больным с неклапанной ФП и ИБС. 

In the article, approaches presented to antithrombotic therapy (AT) in patients with non-valvular atrial fibrillation (AF) and coronary heart disease (CHD), in acute coronary syndrome (ACS), as in stable forms, incl. those underwent percutaneous coronary intervention. Regimens selection and duration of AT depend on the type of CHD, bleeding risks, anatomy of implanted stents in coronary arteries. As AT, in recent guidelines, for patients with AF and CHD any oral anticoagulant is recommended: vitamin K antagonists, direct thrombin inhibitor dabigatran, selective Xa factor inhibitors rivaroxaban, apixaban. Largest evidence among the novel oral anticoagulants is available for dabigatran. Choice from double or triple AT regimens for CHD patients with AF is under discussion. Among antiplatelet drugs for combination with anticoagulant, clopidogrel is preferred, as safer comparing to aspirin. Possibility to use combination therapy with anticoagulants, of ticagrelor and prasugrel is restricted. It is also pointed on the necessity of proton pump inhibitors usage during double or triple AT for patients with non-valvular fibrillation and CHD. 

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