medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2019-21-44-50medsovet-5473Research ArticleКАРДИОЛОГИЯCARDIOLOGYПерспективы применения ривароксабана в лечении больных с хронической ишемической болезнью сердцаProspects of rivaroxaban application in treatment of patients with chronic ischemic heart diseasehttps://orcid.org/0000-0003-4057-5813ПерепечН. Б.PerepechN. B.

Перепеч Никита Борисович, д.м.н., профессор, руководитель научно-клинического и образовательного центра «Кардиология»

199034, Россия, Санкт-Петербург, Университетская наб., д. 7/9

Nikita B. Perepech, Dr. of Sci. (Med), Professor, Head of the Cardiology Research and Educational Center

7/9, Universitetskaya Emb., Saint Petersburg, 199034, Russia

nikita_perepech@mail.ruСанкт-Петербургский государственный университетРоссияSaint-Petersburg State UniversityRussian Federation2019250120200214450Copyright © Перепеч Н.Б., 20202020Перепеч Н.Б.Perepech N.B.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/5473

Обзор посвящен анализу способов воздействия на гемостаз с целью улучшения прогноза больных с хронической ишемической болезнью сердца (ИБС). Обсуждены результаты наиболее значимых рандомизированных клинических исследований, в которых оценивалась эффективность и безопасность применения двойной антитромбоцитарной терапии в лечении больных с хронической ИБС. Обосновано применение ривароксабана в дополнение к АСК с целью уменьшения риска развития сердечно-сосудистых событий у больных с хронической ИБС. Подробно рассмотрены результаты исследования COMPASS, в котором получено подтверждение положительного влияния на прогноз пациентов с хронической ИБС или заболеванием периферических артерий комбинированной терапии ривароксабаном в низкой дозе и АСК. Обсуждены аспекты безопасности этой терапии. Сопоставлены результаты применения двойной антитромбоцитарной терапии и комбинации ривароксабана с АСК у пациентов, ранее перенесших инфаркт миокарда. Определена позиция ривароксабана в лечении больных с хронической ИБС и синусовым ритмом согласно рекомендациям Европейского общества кардиологов по диагностике и лечению хронической ИБС 2019 г. Представлены критерии высокого ишемического и высокого геморрагического рисков, которые необходимо учитывать, принимая решение о добавлении ривароксабана к терапии АСК. Обоснована целесообразность широкого применения комбинации ривароксабана и АСК в составе комплексной фармакотерапии больных с хронической ИБС высокого ишемического риска для предотвращения сердечно-сосудистых осложнений и снижения смертности.

The review is devoted to the analysis of the methods of hemostasis treatment in order to improve the prognosis of patients with chronic ischemic heart disease (IHD). The results of the most significant randomized clinical studies, which evaluated the effectiveness and safety of double antiplatelet therapy in the treatment of patients with chronic IHD, were discussed. The use of rivaroxaban in addition to ASA was justified in order to reduce the risk of cardiovascular events in patients with chronic IHD. The results of the COMPASS study, which confirmed the positive effect on the prognosis of patients with chronic IHD or peripheral artery disease of low-dose rivaroxaban and ASA combination therapy, were reviewed in detail. Safety aspects of this therapy were discussed. The results of double antiplatelet therapy and the combination of rivaroxaban and ASA in patients who had previously undergone myocardial infarction are compared. The position of rivaroxaban in the treatment of patients with chronic IHD and sinus rhythm was determined in accordance with the recommendations of the European Society of Cardiologists for the diagnosis and treatment of chronic IHD in 2019. The criteria of high ischemic and high hemorrhagic risks, which should be taken into account when deciding to add rivaroxaban to the ASA therapy, were presented. The expediency of wide application of the combination of rivaroxaban and ASA as a part of complex pharmacotherapy of patients with chronic IHD with high ischemic risk for prevention of cardiovascular complications and reduction of mortality is justified.

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