medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-5-30-35medsovet-2911Research ArticleАнтитромботическая терапияAntithrombotic therapyВозможность использования дабигатрана у пациентов с фибрилляцией предсердий и острым коронарным синдромом и ЧКВPossibility of using dabigatran in patients with atrial fibrillation and acute coronary syndrome and PCIЭрлихА. Д.ErlichA. D.

Эрлих Алексей Дмитриевич – д.м.н., заведующий отделением кардиореанимации.

 111020, г. Москва, Госпитальная площадь, 2. 

Erlich Alexey Dmitrievich – Dr. of Sci. (Med.), Head of the Cardio-reanimation Department.

 2, Gospitalnaya Ploschad, Moscow, 111020.

alexeyerlikh@gmail.comГосударственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница №29 им. Н.Э. Баумана Департамента здравоохранения города Москвы».РоссияState Budgetary Healthcare Institution of Moscow «Bauman City Clinical Hospital No. 29 of the Moscow Department of Health».Russian Federation201902042019053035Copyright © Эрлих А.Д., 20192019Эрлих А.Д.Erlich A.D.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/2911

Настоящая статья посвящена проблеме сочетания различных антитромботических препаратов у пациентов с фибрилляцией предсердий (ФП), которым выполняется чрескожное коронарное вмешательство (ЧКВ) по поводу острого коронарного синдрома (ОКС). Традиционно таким пациентам требуется оральный антикоагулянт (ОАК) для предотвращения инсульта и двойная антитромбоцитарная терапия (ДАТ) для предупреждения коронарных осложнений. Важной клинической проблемой является необходимость сочетания различных антитромботических препаратов, так как это значительно повышает риск кровотечений. Показано, что продленная «тройная терапия» в виде сочетания ОАК и ДАТ не приносит дополнительную пользу пациентам, но, наоборот, потенциально опасна. В настоящее время для нескольких новых оральных антикоагулянтов (НОАК) доказана возможность их применения у пациентов с ФП и ОКС/ЧКВ в виде «двойной терапии»: сочетание НОАК с ингибитором p2Y12. В материале акцентируется внимание на исследовании RE-DUAL PCI, в котором использование препарата дабигатран в обеих разрешенных при ФП дозах (150 мг 2 раза в день и 110 мг 2 раза в день) в сочетании с ингибитором p2Y12 было связано с меньшим числом кровотечений по сравнению с «тройной терапией» в виде ОАК+ДАТ.

В материале представлен клинический пример возможности лечения пациента с ФП и ОКС в рамках современных клинических руководств, а также представлен обзор существующих в настоящее время рекомендаций по использованию ОАК и ДАТ у пациентов с ФП, которым выполняется ЧКВ. 

This article is devoted to the problem of combined antithrombotic therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS). Traditionally, these patients require an oral anticoagulant (OAC) to prevent stroke and dual anti-platelet therapy (DAT) to prevent coronary complications. The necessity of combining various antithrombotic drugs, since this greatly increases the risk of bleeding is becoming an increasing relevant clinical problem. The prolonged triple therapy in the form of a combination of OAC and DAT does not bring additional benefit to the patients, but, on the contrary, may be potentially dangerous. Currently, the possibility of using several new oral anticoagulants (NOAC) in patients with AF and ACS/PCI in the form of dual therapy has been proven: combination of OAC and p2Y12 inhibitor. The article focuses on the RE-DUAL PCI study, in which the use of dabigatran at both doses permitted in AF (150 mg twice daily and 110 mg twice daily) in combination with the p2Y12 inhibitor was associated with fewer bleeding complications than during the triple therapy in the form of OAK + DAT.

The article presents a clinical case of the possibility of management of a patient with AF and ACS under the modern clinical guidelines, as well as an overview of current guidelines for the use of OAC and DAT in patients with AF undergoing PCI. 

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