ПРОБЛЕМЫ ВЫБОРА АНТИТРОМБОТИЧЕСКОЙ ТЕРАПИИ У БОЛЬНЫХ С НЕКЛАПАННОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ И КОМОРБИДНОЙ ПАТОЛОГИЕЙ
https://doi.org/10.15829/1728-8800-2015-4-75-85
Аннотация
Как показывает клиническая практика, врач часто сталкивается с проблемой непереносимости любых пероральных антикоагулянтов, как антагонистов витамина К, так и новых пероральных антикоагулянтов, или отказа пациентов от их применения. Поэтому перед врачом встает вопрос выбора антитромботической терапии у больных с фибрилляцией предсердий (ФП), и, прежде всего, на фоне ишемической болезни сердца, сахарного диабета, перенесенного ишемического инсульта. В литературе остро обсуждается проблема целесообразности назначения таким больным аспирина в виде монотерапии с целью профилактики инсульта и инфаркта миокарда. В статье представлен клинический пример больной с неклапанной ФП, перенесшей ишеми- ческий инсульт, острый коронарный синдром на фоне множественной коморбидной патологии, показаны ошибки в тактике ведения больной в выборе антитромботической терапии и даны варианты решения проблемы вторичной профилактики тромбоэмболических осложнений, повторных ишемических событий с научно-обоснованной аргументацией в соответствии с Международными и Российскими рекомендациями.
Об авторах
Н. А. Козиолова
ГБОУ ВПО "Пермский государственный медицинский университет имени академика Е. А. Вагнера" Минздрава России. Пермь, Россия
Россия
д. м.н., профессор, зав. кафедрой пропедевтики внутренних болезней №2
Россия
д. м.н., профессор, зав. кафедрой пропедевтики внутренних болезней №2
Е. А. Полянская
ГБОУ ВПО "Пермский государственный медицинский университет имени академика Е. А. Вагнера" Минздрава России. Пермь, Россия
Россия
к. м.н., доцент кафедры
Россия
к. м.н., доцент кафедры
Список литературы
1. Camm J, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology. Eur Heart J 2010; 31: 2369-429.
2. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138: 1093-100.
3. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114: e257-354.
4. Lip G, 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: 263-72. 5. Lip G, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke 2010; 41: 2731-8.
5. 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: 857-67.
6. Olesen JB, Lip GY, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ 2011; 31:d124.
7. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-51.
8. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.N Engl J Med 2011; 365: 883-91.
9. Granger C, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation.N Engl J Med 2011; 365: 981-92.
10. Diagnosis and treatment of atrial fibrillation. The recommendations of the RSC, VNOA, ASSH 2012. Russ J Cardiol 2013: 4 (102), Suppl. 3. Russian (Диагностика и лечение фибрилляции предсердий. Рекомендации РКО, ВНОА, АССХ 2012г. Российский кардиологический журнал 2013: 4 (102), приложение 3).
11. 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: 2066-78.
12. Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. JACC 2011; 57(11): e101-98.
13. Aguilar M, Hart R. Antiplatelet therapy for preventing stroke in patients with nonvalvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. Cochrane Database Syst Rev 2005; (4):CD001925.
14. Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011; 364: 806-17.
15. 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(9586): 493-503.
16. 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 Hear J 2012; 33: 1500-10.
17. Valkhoff VE, Sturkenboom MC, Kuipers EJ. Risk factors for gastrointestinal bleeding associated with low-dose aspirin. Best Pract Res Clin Gastroenterol 2012; 26(2): 125-40.
18. Charlot M, Grove EL, Hansen PR, et al. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study. BMJ 2011; 342: d2690.
19. Arbel Y, Birati EY, Finkelstein A, et al. Platelet inhibitory effect of clopidogrel in patients treated with omeprazole, pantoprazole, and famotidine: a prospective, randomized, crossover study. Clin Cardiol 2013; 36(6): 342-6.
20. Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(12): 3754-832.
21. Alonso-Coello P, Bellmunt S, McGorrian C, et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e669S-90S.
22. Hira RS, Kennedy K, Nambi V, et al. Frequency and practice-level variation in inappropriate aspirin use for the primary prevention of cardiovasculardisease: insights from the National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence registry. JACC 2015; 65(2): 111-21.
23. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160-236.
24. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32(23): 2999-3054.
25. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. JACC 2014; 64(24): e139-228.
26. Collinson J, Bakhai A, Flather MD, Fox KA. The management and investigation of elderly patients with acute coronary syndromes without ST elevation: an evidencebased approach? Results of the Prospective Registry of Acute Ischaemic Syndromes in the United Kingdom (PRAIS-UK). Eur Heart J 2000; 21: 1450-7.
27. Charlot M, Nielsen LH, Lindhardsen J, et al. Clopidogrel discontinuation after myocardial infarction and risk of thrombosis: a nationwide cohort study. Eur Heart J 2012; 33(20): 2527-34.
28. Lip GY, Windecker S, Huber K, et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 2014; 35(45): 3155-79.
29. Gao F, Zhou YJ, Wang ZJ, et al. Meta-analysis of the combination of warfarin and dual antiplatelet therapy after coronary stenting in patients with indications for chronic oral anticoagulation. Int J Cardiol 2011; 148: 96-101.
30. Zhao HJ, Zheng ZT, Wang ZH, et al. “Triple therapy” rather than “triple threat”: a metaanalysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest 2011; 139: 260-70.
31. Rubboli A. The risk of bleeding of triple therapy with vitamin K-antagonists, aspirin and clopidogrel after coronary stent implantation: facts and questions. J Geriatr Cardiol 2011; 8: 207-14.
32. Tantry US, Bonello L, Aradi D, et al. Consensus and update on the definition of ontreatment platelet reactivity to ADP associated with ischemia and bleeding. JACC 2013; 62: 2261-73.
33. Lip GY, Huber K, Andreotti F, et al. European Society of Cardiology Working Group on Thrombosis. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Thromb Haemost 2010; 103: 1328.
34. Faxon DP, Eikelboom JW, Berger PB, et al. Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A NorthAmerican perspective. Thromb Haemost 2011; 106: 572-84.
35. Dewilde WJ, Oirbans T, Verheugt FW, et al. WOEST study investigators. 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: 1107-15.
36. Lamberts M, Gislason GH, Olesen JB, et al. Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention. JACC 2013; 62: 981-9.
Рецензия
Для цитирования:
Козиолова Н.А., Полянская Е.А. ПРОБЛЕМЫ ВЫБОРА АНТИТРОМБОТИЧЕСКОЙ ТЕРАПИИ У БОЛЬНЫХ С НЕКЛАПАННОЙ ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ И КОМОРБИДНОЙ ПАТОЛОГИЕЙ. Кардиоваскулярная терапия и профилактика. 2015;14(4):75-85. https://doi.org/10.15829/1728-8800-2015-4-75-85
For citation:
Koziolova N.A., Polyanskaya Е.А. THE SELECTION PROBLEMS OF ANTITHROMBOTIC THERAPY IN NONVALVULAR ATRIAL FIBRILLATION WITH COMORBIDITIES. Cardiovascular Therapy and Prevention. 2015;14(4):75-85. (In Russ.) https://doi.org/10.15829/1728-8800-2015-4-75-85
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