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Кардиоваскулярная терапия и профилактика

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К вопросу применения аспирина для профилактики тромбоэмболических осложнений при сердечно-сосудистой патологии: оптимизация дозы и пути преодоления побочных эффектов

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Аннотация

Обзор посвящен применению ацетилсалициловой кислоты (АСК) в кардиологии. Эпидемиологические исследования последних десятилетий показали важную роль тромбоза как фактора, провоцирующего обострение коронарной болезни сердца, ишемического инсульта, заболеваний периферических сосудов. В этой связи в лечении указанных заболеваний и во вторичной профилактике сосудистой окклюзии важнейшее значение приобретают методы антитромботической и антитромбоцитарной терапии. Многочисленные исследования показали, что ежедневный прием аспирина в дозе 75-325 мг / сут. снижает риск инфаркта миокарда, инсульта и смертности от сердечно-сосудистых заболеваний на ~ 25%. Приведены результаты наиболее авторитетных исследований, посвященных обоснованию применения АСК, дается сравнение с другими антитромбоцитарными методами терапии. Особое внимание уделяется безопасности лечении АСК. Описывается относительно новый препарат Кардиомагнил®, который представляет собой комбинацию АСК с невсасывающимся антацидом – гидроокисью магния. Такая комбинация позволяет свести до минимума возможность осложнений со стороны желудочно-кишечного тракта, в т.ч. кровотечения и перфорации.

Об авторе

А. Н. Бритов
Государственный научно-исследовательский центр профилактической медицины Росздрава. Москва
Россия


Список литературы

1. Levy D, Garrison R, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Eng J Med 1990; 322: 1561-6.

2. Lip GYH, Blann AD. Does hypertension confer a prothrombotic state? Circulation 2000; 101: 218-20.

3. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Eng J Med 1992; 329: 381-6.

4. Ridker PM. The pathogenesis of atherosclerosis and acute thrombosis: relevance to strategies of cardiovascular prevention. In: Manson JE, Ridker PM, Gaziano JM, Hennekens CH, eds. Prevention of Myocardial Infarction. N-Y, Oxford University Press, 1996: 32-54.

5. Wong ND, Ridker PM. Thrombosis, inflammation, and infection. In: Preventive cardiology. A Practical Approach, 2-nd editon, Wong ND, Black HR, Gardin JM, eds. McGraw-Hill Co. Inc., 2005; 321-37.

6. Dalen JE, Aspirin to Prevent Heart Attack and Stroke: What’s the Right Dose? Am J Med 2006; 119(3): 198-202.

7. Metha J, Metha P. Platelet function studies in heart disease. VI. Enhanced platelet aggregate formation activity in congestive heart falure. Circulation 1979; 60: 497-503.

8. Patrono C. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation 1985; 72: 1177-84.

9. Heavy DJ. Aspirin causes short-lived inhibition of bradykininstimulated prostacyclin production in man. Nature 1985; 318: 186-8.

10. Davie AP, Love MP, McMurray JV. Even low dose aspirin inhibits arachidonic acid-induced vasodilatation in heart failure. Clin Pharm Ther 2000; 67: 530-7.

11. Cleland JGF Anticoagulant and antiplatelet agents. In: PooleWilson P., Collucci WS, Massie BM et al.(eds.): Heart Failure, 1st ed. London, Churchill Livingstone, 1997; 759-73.

12. Cleland JGF. Aspirin, In: D.L. Mann. Heart Failure, 2004, Elsevier Inc.; 660-9.

13. Jansson J-H, Nilsson TK, Jonson O. Von Willebrand factor, tissue plasminogen activator, and dehydroepiandrosterone sulphate predict cardiovascular death in 10-year follow-up of survivors of acute myocardial infarction. Heart 1998; 80: 334-7.

14. Grosser N, Schr der H. Aspirin Protects Endothelial Cells From Oxidant Damage Via the Nitric Oxide-cGMP Pathway. Arterios Thromb Vasc Biol 2003; 23: 1345-8.

15. Antithrombotic Trialists’ Collaboration Group. Collaborative meta analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86. 1

16. ISIS-2 (Second Internatonal Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2i: 349-60. 1

17. Chadow HL, Feit A, Rafii S. Ischemic heart disease. In: “Hypertension” ed/ by S. Oparil & M.A. Weber; W.B. Saunders Co., 2000, pp 539-46.

18. Rasoul S, Ottervager JP, de Boer M-J, et al. A comparison of dual vs. triple antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndrome: results of the ELISA-2 trial. Eur Heart J 2006; 27: 1401-7.

19. Lewis HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against myocardial infarction and death in men with unstable angina. Results of a Veteran Administration cooperative study. N Engl J Med 1983; 309: 396-403.

20. The RISC Group. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1988; 336: 827- 30.

21. Juul-Moller S, Edvardsson N, Jahanmatz B, et al. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable angina pectoris. Lancet 1992; 340: 1421-5.

22. Rosenson RS, Tangney CC. Antiatherotrombotic properties of statins – implicationsfor cardiovascular event reduction. JAMA 1998; 279: 1643-50.

23. Kearney D, Fitgerald D. The antitrombotic effects of statins. JACC 1999; 33: 1305-7.

24. Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardiovascular events and deaths with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-57.

25. Sacs FM, Pfefer MA, Moye LA, et al. For the Cholesterol and Recurrent Events trial investigator. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001-19.

26. Jukema JW, Bruschke AVG, van Boven AJ, et al. Effect of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderate elevated serum cholesterol levels: the regression Growth Statin Study (REGRESS). Circulation 1995; 91: 2528-40.

27. Pitt B, Mancini GB, Ellis SG, et al. Pravastatin limitation of Atherosclerosis in the Coronary Arteries (PLAC-I): reduction in atherosclerosis progression and clinical events. JACC 1995; 26: 1133-9.

28. Crouse Jr, Byiton RP, Bond MG, et al. Pravastatin, Lipid, and Atherosclerosis in the Carotid Arteries (PLAC-II). Am J Cardiol 1995; 75: 455-9.

29. Hennekens CH, Sacks FM, Tonkin A, et al. Additive benefits of pravastatin and aspirin to decrease risks of cardiovascular disease. Randomized and observational comparisons of secondary prevention trials and their meta-analyses. Arch Intern Med 2004; 164: 40-4.

30. Diener HC, Cunha L, Forbes C, et al. Europen stroke prevention study-2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143: 1-13.

31. Urbano LA, Bogousslavsky J. Antiplatelet drugs in ischemic stroke prevention: from monotherapy to combined treatment. Cerebrovasc Dis 2004; 17(Suppl 1):74-80.

32. Ridker PM, Cook NR, Lee IM, et al. A randomized trial of lowdose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005; 352: 1293-304.

33. Hansson L, Zanchetti A, Carruders SG, et al. Effects of intensive blood-pressure lowering and low doses of aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomized trial. Lancet 1988; 351: 1755-62.

34. Collaborative Group of the Primary Prevention Project (PPP). Low-dose aspirin and vitamine E in people at cardiovascular risk: randomized trial in general practice. Lancet 2001; 357: 89-95.

35. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomized placebo-controlledtrial of early aspirin use in 20000 patients with acute ischemic stroke. Lancet 1997; 349: 1641-9.

36. Steering Committee of the physicians’ Health Study Group. Final report of the aspirin component of the on going physicians’ health study. N Engl J Med 1989; 321: 129-35.

37. Peto R, Gray R, Collins R, et al. Randomized trial of prophylactic daily aspirin in British male doctors. BMJ 1988; 296: 313-6.

38. Gorelick PB, Sacco RL, Smith DB, et al. Prevention of a first stroke. A review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 1999; 281: 1112-20.

39. Stroke Prevention in Atrial Fibrillation Investigators. Adjusteddose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: stroke prevention in atrial fibrillation III randomized clinical trial. Lancet 1996; 348: 633-8.

40. The ACC/AHA Task Force for the Management of Patients with Valvular Heart Disease. JACC 1998; 32(5): 1486-580 & ACC/ AHA Task Force Practice Guidelines 2000.

41. Balsano F, Violi F, ADEP Croup. Effect of picotamide on the clinical progression of peripheral vascular disease. A doubleblind placebo-controlled study. Circulation 1993; 87: 1563-9.

42. Pulmonary Embolism Prevention (PEP) Trial Collaborative Group. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet 2000; 355: 1295-302. [Medline].

43. ETDRS Investigators. Aspirin effects on mortality and morbidity in patients with diabetes mellitus. Early treatment diabetic retinopathy study. JAMA 1992; 268: 1292-300.

44. Chew EY, Klein ML, Murphy RP, et al. Early Treatment Diabetic Retinopathy Study Research Group. Effects of aspirin on vitreous/preretinal hemorrhage in patients with diabetes mellitus. Arch Ophthalmol 1995; 113: 52 5.

45. Colwell JA. Aspirin therapy in diabetes (Technical review). Diabet Care 1997; 20: 1767-71.

46. Haffner SM, Lehto S, Ronnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229-34.

47. Hansson L, Zanchetti A, Carruthers SG, for the HOT Study Group. Effects of intensive blood-pressure lowering and lowdose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755-62.

48. The Dutch TIA Study Group. The Dutch TIA trial: protective effects of low-dose aspirin and atenolol in patients with transient ischemic attacks or nondisabling stroke. Stroke 1988; 19(4): 512-7.

49. Behan MWH, Storey RF. Antiplatelet therapy in cardiovascular disease. Postgraduate Medical J 2004; 80: 155-64.

50. Scrutinio D, Cimminiello C, Marubini E, et al. Ticlopidine versus aspirin after myocardial infarction (STAMI) trial. JACC 2001; 37(5): 1259-65.

51. CAPRIE StudyGroup. Clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Final results Lancet 1996; 348(9038): 1329-39.

52. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354(16): 1706-17.

53. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.

54. Henry D, Lim LLY, Garcia Rodriguez LA, et al. Variability in risk of gastrointestinal complications with individual NSAIDs. Results of a collaborative meta-analysis. Br Med J 1996; 312: 1563-6.

55. DerryS, LokeYK. Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. Brit Med J 2000; 321: 1183-7.

56. Abajo F J, Rodriguez L A. Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations BMC. Clin Pharmac 2001; 1: 1-9.

57. Kelly JP, Kaufman DW, Jurgelon JM, et al. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996; 348: 1413-6.

58. Anderson LA, Johnston BT, Watson RGP, et al. Nonsteroidal Anti-inflammatory Drugs and the Esophageal InflammationMetaplasia-Adenocarcinoma Sequence. Cancer Research 2006; 66: 4975-82.


Для цитирования:


Бритов А.Н. К вопросу применения аспирина для профилактики тромбоэмболических осложнений при сердечно-сосудистой патологии: оптимизация дозы и пути преодоления побочных эффектов. Кардиоваскулярная терапия и профилактика. 2006;5(6):70-80.

For citation:


Britov A.N. Aspirin for thromboembolic complication prevention in cardiovascular disease: dose optimization and adverse effect minimization. Cardiovascular Therapy and Prevention. 2006;5(6):70-80. (In Russ.)

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