References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/ms2026-220

medsovet-10188

Research Article

КОМОРБИДНЫЙ ПАЦИЕНТ

COMORBID PATIENT

Антикоагулянтная терапия венозных тромбозов у пациентов с сопутствующей кардиологической патологией

Anticoagulant therapy for venous thrombosis in patients with concomitant cardiac pathology

https://orcid.org/0000-0003-3811-5156

Дженина

О. В.

Dzhenina

O. V.

Дженина Ольга Вадимовна, к.м.н., врач-флеболог, ведущий специалист

117447, Москва, ул. Дмитрия Ульянова, д. 31

Olga V. Dzhenina, Cand. Sci. (Med.), Phlebologist, Leading Specialist

31, Dmitry Ulyanov St., Moscow, 117447

helgelman@mail.ru

Первый флебологический центрРоссияFirst Phlebological CenterRussian Federation

2026

26062026

07256266

2026

Дженина О.В.

Dzhenina O.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/10188

Венозные тромбоэмболические осложнения (ВТЭО) могут развиваться в любой период жизни, однако их частота увеличивается с возрастом. Прогрессивный рост ежегодной заболеваемости как тромбозом глубоких вен и тромбоэмболией легочных артерий по отдельности, так и всеми случаями ВТЭО в совокупности отмечается после 50 лет. Пациенты с множественными клиническими факторами риска как тромботического и/или ишемического события, так и кровотечения представляют одну из наиболее сложных категорий в реальной клинической практике. Выбор оптимального объема антитромботической терапии часто не опирается на готовые алгоритмы и утвержденные рекомендации. В обзорной статье рассматриваются особенности проведения антикоагулянтной терапии при развитии венозных тромбозов у пациентов с сопутствующими сердечно-сосудистыми заболеваниями, в частности при фибрилляции предсердий, ишемической болезни сердца и артериальной гипертензии. Для оценки современного состояния проблемы был проведен анализ публикаций в базах данных PubMed/ MEDLINE и eLIBRARY.RU, а также клинических руководств Европейского общества кардиологов, Европейского общества сосудистой хирургии, Американской кардиологической ассоциации, Американской коллегии кардиологов и национальных клинических рекомендаций по тромбозу глубоких вен, фибрилляции предсердий и ишемической болезни сердца. В обзоре обсуждаются нюансы выбора режима терапии с учетом не только особенностей инцидентного венозного события, но и кардиологических показаний к использованию антикоагулянтов и/или антитромбоцитарных препаратов. Рассматриваются варианты определения оптимальной длительности антикоагуляции и дозы антикоагулянтов, в том числе при планировании пролонгированной терапии с учетом баланса риска и пользы. Также анализируются клиническая целесообразность и риск геморрагических осложнений при совместном применении антикоагулянтов и антитромбоцитарных препаратов у пациентов с кардиологической мультиморбидностью.

Venous thromboembolic events (VTE) can occur at any time in life, but the incidence of VTE increases with age. A progressive increase in the annual incidence of both deep vein thrombosis (DVT) and pulmonary embolism (PE), both individually and cases of VTE in the aggregate are reported after age 50 years. Patients with multiple clinical risk factors for both thrombotic and/or ischemic events, as well as bleeding, are one of the most challenging categories in real-world clinical practice. The choice of the optimal antithrombotic therapy volume is often not based on the established algorithms and approved guidelines. This review examines the features of the anticoagulant therapy for venous thrombosis occurred in patients with concomitant cardiovascular diseases, especially in atrial fibrillation, coronary heart disease, and hypertension. To assess the current status of the issue, we analysed published literature from the PubMed/MEDLINE and eLIBRARY.RU databases, as well as clinical guidelines of the European Society of Cardiology, the European Society for Vascular Surgery, the American Heart Association, the American College of Cardiology, and national clinical guidelines on the management of deep vein thrombosis, atrial fibrillation, and coronary heart disease. This review discusses the nuances of choosing a treatment regimen, taking into account not only the clinical features of the incident venous events, but also the cardiac indications for the use of anticoagulants and/or antiplatelet agents. Options for the optimal duration of anticoagulation and anticoagulant agent dosages including those used when planning the prolonged therapy with a good balance between risks and benefits are considered. We also evaluated the clinical feasibility and risk of hemorrhagic complications associated with the combined use of anticoagulants and antiplatelet agents in patients with cardiac multimorbidity.

венозный тромбозфибрилляция предсердийишемическая болезнь сердцаострый коронарный синдромартериальная гипертензияантикоагулянтная терапияантиагрегантычрескожное коронарное вмешательство

venous thrombosisatrial fibrillationcoronary artery diseaseacute coronary syndromearterial hypertensionanticoagulant therapyantiplatelet agentspercutaneous coronary intervention

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