medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-16-34-41medsovet-3735Research ArticleИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦАISHEMIC HEART DISEASEМесто ривароксабана в лечении пациентов со стабильными формами ишемической болезни сердцаThe Role of Rivaroxaban in the Treatment of Patients with Stable Coronary Artery Diseasehttps://orcid.org/0000-0002-3010-755XАверковО. В.AverkovO. V.

Аверков Олег Валерьевич, д.м.н., заместитель главного врача, руководитель регионального сосудистого центра

профессор кафедры госпитальной терапии №1 лечебного факультета

Oleg V. Averkov, Dr. of Sci. (Med.), Deputy Chief Physician, Head of Regional Vascular Center, State Budgetary Healthcare Institution 

Professor, Chair for Hospital Therapy No. 1 at Medical Faculty

oleg.averkov@gmail.comГородская клиническая больница № 15 им. О.М. Филатова; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияMunicipal Clinical Hospital No. 15 named after О.М. Filatov; Pirogov Russian National Research Medical UniversityRussian Federation2019091020190163441Copyright © Аверков О.В., 20192019Аверков О.В.Averkov 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/3735

В аналитической статье обсуждаются замысел и результаты недавнего исследования COMPASS. Особое внимание уделено деталям сравнения эффективности и безопасности сочетания ривароксабана и ацетилсалициловой кислоты с таковыми при использовании только ацетилсалициловой кислоты у больных со стабильной ишемической болезнью сердца. Среди аргументов в пользу достаточно широкого длительного использования комбинации антиагреганта и антикоагулянта, помимо существенного снижения риска суммы традиционно учитываемых событий (инфаркт миокарда, инсульт, сердечно-сосудистая смертность), выделено привлекательное влияние обсуждаемой антитромботической стратегии на общую смертность больных, приемлемое соотношение эффективности и геморрагической безопасности, прежде всего отсутствие увеличения риска кровотечений со смертельным исходом и риска внутричерепных кровотечений. Описаны подходы к отбору больных ишемической болезнью сердца для участия в длительном лечении сочетанием риваркосабана и ацетилсалициловой кислоты. Упомянуты альтерантивные возможности усиления вторично-профилактических эффектов ацетилсалициловой кислоты, приведены аргументы в пользу предпочтительности обсуждаемого в статье подхода.

An analytical article discusses the design and results of the recent COMPASS study. Particular attention is paid to the details of comparison of the efficacy and safety of rivaroxaban combined with acetylsalicylic acid and the efficacy and safety of drugs containing acetylsalicylic acid only in patients with stable coronary artery disease. In addition to a significant reduction in the risk of the sum of traditionally recognizable events (myocardial infarction, stroke, cardiovascular mortality), among the arguments in favour of fairly widespread prolonged use of the antiplatelet agent combined with anticoagulant is an attractive effect of the debated antithrombotic strategy on the overall mortality of patients, an acceptable ratio of efficacy and hemorrhagic safety, first of all the absence of the increased risk of fatal bleeding and the risk of intracranial bleeding. The article describes approaches to the selection of patients with coronary artery disease for the participation in the long-term treatment with rivaroxaban combined with acetylsalicylic acid. Alternative possibilities for enhancement of the secondary prophylactic effects of acetylsalicylic acid are mentioned, the arguments supporting the preference of the approach discussed in the article are presented.

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