medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-12-128-133medsovet-2022Research ArticleТРОМБОЗЫ И ТРОМБОЭМБОЛИИTHROMBOSIS AND THROMBOEMBOLISMСОВРЕМЕННЫЕ ПОДХОДЫ К АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ ТРОМБОЭМБОЛИИ ВЕТВЕЙ ЛЕГОЧНОЙ АРТЕРИИ: ФОКУС НА РИВАРОКСАБАНMODERN APPROACHES TO ANTICOAGULANT THERAPY OF PULMONARY EMBOLISM: FOCUS ON RIVAROXABANАверковО. В.AverkovO. V.

д.м.н., профессор

MD, Prof.

ВечоркоВ. И.VechorkoV. I.

к.м.н. 

PhD in medicine

Городская клиническая больница №15 им. О.М. Филатова Департамента здравоохранения г. МосквыРоссияFilatov Municipal Clinical Hospital No.15 of the Moscow Healthcare DepartmentRussian Federation201703112017012128133Copyright © Аверков О.В., Вечорко В.И., 20172017Аверков О.В., Вечорко В.И.Averkov O.V., Vechorko V.I.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/2022

В аналитической статье представлено современное состояние антикоагулянтной терапии при тромбоэмболии легочной артерии. Отчетливо обозначены основные преимущества и предпочтительное использование прямых селективных пероральных антикоагулянтов, представленных ингибитором тромбина дабигатраном и группой ингибиторов фактора Xa в составе апиксабана, эдоксабана и ривароксабана. Основное внимание уделено ривароксабану, доказательная база которого при тромбоэмболии легочной артерии пополнилась в 2017 г. данными исследования EINSTEIN CHOICE. Результаты этого исследования позволяют рассматривать использование дозы ривароксабана 10 мг 1 раз в день как возможность длительной, фактически многолетней профилактики рецидива тромбоэмболии легочной артерии после окончания стандартного курса лечебной антикоагуляции, включающей применение высокой дозы препарата (15 мг 2 раза в день) в течение 3 недель, фактически с момента диагностики болезни, и продолжение в течение 6–12 месяцев приема препарата в дозе 20 мг 1 раз в день. В итоге для многих больных с тромбоэмболией легочной артерии применение ривароксабана в различных дозах без перехода на другой антикоагулянт позволяет полностью закрыть потребность в антитромботическом лечении на разных этапах ведения таких больных.

 

The analytical article provides a modern state of the anticoagulant therapy in pulmonary thromboembolism. Major advantages and preferential use of direct selective peroral anticoagulants represented by thrombin inhibitor dabigatran and a Xa factor inhibitors composed of apixaban, edoxaban and rivaroxaban. Attention is focused on rivaroxaban the evidence base of which in pulmonary thromboembolism was widened in 2017 by data of the EINSTEIN CHOICE study. Its results allow considering the use of the rivaroxaban 10 mg 1 time per day as a possibility of long-term, actually many year prevention of the pulmonary thromboembolism after the end of the standard course of the therapeutic anticoagulation involving use of a high dosage of the drug (15 mg 2 times per day) for 3 weeks actually from the moment of the disease diagnostics and continuation for 6-12 months of the drug administration at a dose of 20 mg 1 time per day. As a result for many patients with pulmonary thromboembolism use of rivaroxaban at various dosages without transfer to another coagulant allows considerably satisfying the requirements in antithrombotic therapy at various stages of such patients management.

тромбоэмболия легочной артериилечениевторичная профилактикаантикоагулянтыривароксабанpulmonary artery embolismtherapysecondary preventionanticoagulantsrivaroxabanReferencesCohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost, 2007, 98: 756-764Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost, 2007, 98: 756-764Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med, 2013, 126(832): e13–e21.Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med, 2013, 126(832): e13–e21.Buller HR, Prins MH, Lensin AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366: 1287–1297.Buller HR, Prins MH, Lensin AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med, 2012, 366: 1287–1297.Bauersachs R, Berkowitz SD, Brenner B, et al.. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med, 2010, 363: 2499–2510.Bauersachs R, Berkowitz SD, Brenner B, et al.. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med, 2010, 363: 2499–2510.Prins MH, Lensing AW, Bauersachs R, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEINDVT and PE randomized studies. Thromb J, 2013, 11: 21.Prins MH, Lensing AW, Bauersachs R, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEINDVT and PE randomized studies. Thromb J, 2013, 11: 21.Buller HR, Decousus H, Grosso MA, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med, 2013, 369: 1406–1415.Buller HR, Decousus H, Grosso MA, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med, 2013, 369: 1406–1415.Agnelli G, Buller HR, Cohen A, et al. Oral apixa-ban for the treatment of acute venous thromboembolism. N Engl J Med, 2013, 369: 799–808.Agnelli G, Buller HR, Cohen A, et al. Oral apixa-ban for the treatment of acute venous thromboembolism. N Engl J Med, 2013, 369: 799–808.Schulman S, Kearon C, Kakkar AK et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N. Engl. J. Med., 2009, 361: 2342-2352.Schulman S, Kearon C, Kakkar AK et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N. Engl. J. Med., 2009, 361: 2342-2352.Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation, 2014, 129: 764–772.Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation, 2014, 129: 764–772.van der Hulle T, Kooiman J, den Exter PL, Dekkers OM, Klok FA, Huisman MV. Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost, 2014, 12: 320–328.van der Hulle T, Kooiman J, den Exter PL, Dekkers OM, Klok FA, Huisman MV. Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis. J Thromb Haemost, 2014, 12: 320–328.Schulman S, Kearon C, Kakkar AK, et al, RE-MEDY Trial Investigators, RE-SONATE Trial Investigators. Extended use of dabigatran, war-farin, or placebo in venous thromboembolism. N Engl J Med, 2013, 368: 709-718.Schulman S, Kearon C, Kakkar AK, et al, RE-MEDY Trial Investigators, RE-SONATE Trial Investigators. Extended use of dabigatran, war-farin, or placebo in venous thromboembolism. N Engl J Med, 2013, 368: 709-718.Agnelli G, Buller HR, Cohen A, et al. AMPLIFY-EXT Investigators. Apixaban for extended treatment of venous thromboembolism. N Engl J Med, 2013, 368: 699-708.Agnelli G, Buller HR, Cohen A, et al. AMPLIFY-EXT Investigators. Apixaban for extended treatment of venous thromboembolism. N Engl J Med, 2013, 368: 699-708.Weitz JI, Lensing AW, Prins MH, et al. for the EINSTEIN CHOICE Investigators. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med, 2017. doi: 10.1056/NEJMoa1700518.Weitz JI, Lensing AW, Prins MH, et al. for the EINSTEIN CHOICE Investigators. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med, 2017. doi: 10.1056/NEJMoa1700518.

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