medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-388medsovet-8612Research ArticleАРИТМИИARRHUTHMIASФибрилляция предсердий и полиморбидность: как выбрать идеальный прямой оральный антикоагулянт?Atrial fibrillation and multimorbidity: How to choose the perfect direct oral anticoagulant?https://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Остроумова Ольга Дмитриевна, д.м.н., профессор, заведующий кафедрой терапии и полиморбидной патологии имени академика М.С. Вовси, Российская медицинская академия непрерывного профессионального образования; профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1,

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Olga D. Ostroumova, Dr. Sci. (Med.), Professor, Head of the Department of Therapy and Polymorbid Pathology named after Acad. M.S. Vovsi, Russian Medical Academy of Continuous Professional Education; Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov First Moscow State Medical University (Sechenov University)

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993,

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ostroumova.olga@mail.ruhttps://orcid.org/0009-0008-6383-0016ДубининаА. В.DubininaA. V.

Дубинина Анна Владимировна, аспирант кафедры терапии и полиморбидной патологии имени академика М.С. Вовси

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Anna V. Dubinina, Postgraduate Student of the Department of Therapy and Polymorbid Pathology named after Acad. M.S. Vovsi

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

dubinina_anna2023@mail.ruhttps://orcid.org/0000-0003-1439-7371ТелковаС. С.TelkovaS. S.

Телкова Светлана Сергеевна, старший лаборант кафедры терапии и полиморбидной патологии имени академика М.С. Вовси

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Svetlana S. Telkova, Senior Laboratory Assistant, Department of Therapy and Polymorbid Pathology named after Acad. M.S. Vovsi

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

svetlana.t03@yandex.ruhttps://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Кочетков Алексей Иванович, к.м.н., доцент, доцент кафедры терапии и полиморбидной патологии имени академика М.С. Вовси

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Alexey I. Kochetkov, Cand. Sci. (Med.), Associate Professor of the Department of Therapy and Polymorbid Pathology named after Acad. M.S. Vovsi

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

ak_info@list.ruhttps://orcid.org/0000-0003-4624-9189ГавриловаН. Е.GavrilovaN. E.

Гаврилова Наталья Евгеньевна, д.м.н., профессор кафедры терапии и полиморбидной патологии имени академика М.С. Вовси, Российская медицинская академия непрерывного профессионального образования; генеральный директор – главный врач, ООО «Скандинавский центр здоровья»

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1,

111024, Москва, ул. 2-я Кабельная, д. 2, стр. 25

Natalia E. Gavrilova, Dr. Sci. (Med.), Professor of the Department of Therapy and Polymorbid Pathology named after Acad. M.S. Vovsi, Russian Medical Academy of Continuous Professional Education; General Director – Chief Physician, Scandinavian Health Center LLC

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993,

2, Bldg. 25, 2nd Kabelnaya St., Moscow, 111024

natysja2004@yandex.ruhttps://orcid.org/0000-0001-6573-4169ЭбзееваЕ. Ю.EbzeevaE. Yu.

Эбзеева Елизавета Юрьевна, к.м.н., доцент, заведующий учебной частью кафедры терапии и полиморбидной патологии имени академика М.С. Вовси

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Elizaveta Yu. Ebzeeva, Cand. Sci. (Med.), Associate Professor, Head of the Academic Department of the Department of Therapy and Polymorbid Pathology named after Acad. M.S. Vovsi

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

veta-veta67@mail.ruhttps://orcid.org/0000-0002-2117-5016АраблинскийА. В.ArablinskiyA. V.

Араблинский Александр Владимирович, д.м.н., профессор, профессор кафедры терапии и полиморбидной патологии, Российская медицинская академия непрерывного профессионального образования; заведующий отделением рентгенхирургических методов диагностики и лечения, Городская клиническая больница имени С.П. Боткина

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1,

125284, Москва, 2-й Боткинский пр-д, д. 5

Alexander V. Arablinskiy, Dr. Sci. (Med.), Professor of the Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; Head of the Department of X-ray Surgical Diagnostic and Treatment Methods, Botkin City Clinical Hospital

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993,

5, 2nd Botkinsky Proezd, Moscow, 125284

alexar-card@mail.ruhttps://orcid.org/0000-0002-6260-6193МиловановаО. А.MilovanovaO. A.

Милованова Ольга Андреевна, д.м.н., профессор, профессор кафедры неврологии детского возраста

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Olga A. Milovanova, Dr. Sci. (Med.), Professor of the Department of Childhood Neurology

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

milovanova_olga@yahoo.comРоссийская медицинская академия непрерывного профессионального образования; Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияRussian Medical Academy of Continuous Professional Education; Sechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationРоссийская медицинская академия непрерывного профессионального образования; ООО «Скандинавский центр здоровья»РоссияRussian Medical Academy of Continuous Professional Education; Scandinavian Health Center LLCRussian FederationРоссийская медицинская академия непрерывного профессионального образования; Городская клиническая больница имени С.П. БоткинаРоссияRussian Medical Academy of Continuous Professional Education; Botkin City Clinical HospitalRussian Federation2024301020240165462Copyright © Остроумова О.Д., Дубинина А.В., Телкова С.С., Кочетков А.И., Гаврилова Н.Е., Эбзеева Е.Ю., Араблинский А.В., Милованова О.А., 20242024Остроумова О.Д., Дубинина А.В., Телкова С.С., Кочетков А.И., Гаврилова Н.Е., Эбзеева Е.Ю., Араблинский А.В., Милованова О.А.Ostroumova O.D., Dubinina A.V., Telkova S.S., Kochetkov A.I., Gavrilova N.E., Ebzeeva E.Y., Arablinskiy A.V., Milovanova O.A.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/8612

Фибрилляция предсердий является одной из наиболее часто встречаемых тахиаритмий, распространенность которой в связи с увеличением доли пожилого населения неуклонно растет. Наличие большого числа сопутствующей патологии у пожилых пациентов с фибрилляцией предсердий, увеличивая риск тромбоэмболических событий, оказывает значимое влияние на клиническое течение фибрилляции предсердий, а также на выбор терапевтической тактики, в особенности антикоагулянтной терапии с доказанной эффективностью и низким риском развития кровотечений. Одними из частых сопутствующих заболеваний у пациентов с фибрилляцией предсердий являются нарушение функции почек, анемия, а также ишемическая болезнь сердца, которые не только повышают риск развития инсульта и (или) системной эмболии, но и сопровождаются увеличением риска сердечно-сосудистой смертности, смертности от всех причин, развития геморрагических событий. При этом, по данным исследований, около половины полиморбидных пациентов с фибрилляцией предсердий не получают антикоагулянтную терапию, что свидетельствует о низкой информированности врачей о рациональной, основанной на клинических рекомендациях фармакотерапии данной когорты пациентов. Препаратом выбора с наиболее изученным профилем безопасности и высокой степенью эффективности у таких пациентов является апиксабан из группы прямых оральных антикоагулянтов. В отличие от антагонистов витамина K и других представителей прямых оральных антикоагулянтов, апиксабан, по данным проведенных исследований, ассоциирован с более значимым снижением риска развития тромбоэмболических событий, а главное, в меньшей степени оказывает влияние на риски кровотечений у пациентов с фибрилляцией предсердий и сопутствующей ишемической болезнью сердца, анемией, хронической болезнью почек, и так предрасположенных к возникновению геморрагических осложнений.

Atrial fibrillation is one of the most common tachyarrhythmias, the prevalence of which is steadily increasing due to an increase in the proportion of the elderly population. The presence of a comorbidities in elderly patients with atrial fibrillation, increasing the risk of thromboembolic events, has a significant impact on the clinical strategy of atrial fibrillation, as well as on the choice of therapeutic tactics, especially anticoagulant therapy with proven efficacy and low risk of bleeding. One of the most common concomitant diseases in patients with atrial fibrillation are chronic kidney disease, anemia and coronary artery disease. These comorbidities in patients with atrial fibrillation not only increase the risk of stroke and/or systemic embolism, but are also accompanied by an increased risk of cardiovascular mortality, all causes mortality, and hemorrhagic events. At the same time, according to research data, about half of polymorbid patients with atrial fibrillation do not receive anticoagulant therapy, which indicates a low awareness of physicians about rational pharmacotherapy based on clinical recommendations for this cohort of patients. The drug of choice with the most studied safety profile and a high degree of efficacy in these patients is apixaban from the group of direct oral anticoagulants. Unlike vitamin K antagonists and other representatives of direct oral anticoagulants, apixaban, according to the conducted studies, is associated with a more significant reduction in the risk of thromboembolic events, and most importantly, has a lesser effect on the risks of bleeding in patients, predisposing to hemorrhagic complications, with atrial fibrillationand concomitant coronary artery disease, anemia, chronic kidney disease.

 

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