medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-179medsovet-9116Research ArticleАРИТМИИARRHUTHMIASБезопасность как критерий выбора антикоагулянта для профилактики инсультов и тромбоэмболий у пациентов с неклапанной фибрилляцией предсердийSafety as a criterion for choosing an anticoagulant to prevent strokes and thromboembolism in patients with non-valvular atrial fibrillationhttps://orcid.org/0000-0002-1174-2574ПанченкоЕ. П.PanchenkoE. P.

Панченко Елизавета Павловна, д.м.н., профессор, руководитель отдела клинических проблем атеротромбоза 

121552, Россия, Москва, ул. Академика Чазова, д. 15а 

Elizaveta P. Panchenko, Dr. Sci. (Med.), Professor, Head of the Department of Clinical Problems of Atherothrombosis

15a, Academician Chazov St., Moscow, 121552, Russia;

lizapanchenko@mail.ruНациональный медицинский исследовательский центр кардиологии имени академика Е.И. ЧазоваРоссияNational Medical Research Centre of Cardiology named after Academician E.I. ChazovRussian Federation20252405202506158165Copyright © Панченко Е.П., 20252025Панченко Е.П.Panchenko E.P.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/9116

Статья посвящена безопасности как критерию выбора антикоагулянта. Апиксабан всесторонне изучен у пациентов с фибрилляцией предсердий (ФП) как в рандомизированных, так и в исследованиях реальной клинической практики (РКП). Исследование ARISTOTLE показало, что апиксабан не только достоверно снижает риск ишемического инсульта (ИИ) и тромбоэмболии (ТЭ), внутричерепных кровотечений, риск больших кровотечений, но и не увеличивает риск кровотечений из желудочно-кишечного тракта (ЖКТ). Безопасность апиксабана способствует тому, что он является единственным прямым оральным антикоагулянтом (ПОАК), который достоверно снижает смертность от всех причин по данным рандомизированных клинических исследований. Результаты исследования ARISTOTLE подтверждены в исследованиях РКП, в которых показано, что апиксабан обладает безопасностью в отношении развития геморрагических осложнений и при этом эффективен. Апиксабан всесторонне изучен и с успехом применяется во время проведения кардиоверсии (КВ), аблации, при чрескожном коронарном вмешательстве (ЧКВ). Все ПОАК в рекомендациях Европейского общества кардиологов 2024 г. по ФП поставлены в одинаковые позиции, но задача врача выбрать среди них наиболее безопасный. Есть все основания полагать (по данным РКИ и исследований РКП), что апиксабан является эффективным и наиболее безопасным из 3 имеющихся в нашей стране ПОАК. В соответствии с клиническими рекомендациями ЕОК 2024 г., врачи при назначении ПОАК не должны исключать пациентов с ФП, имеющих наиболее высокий риск кровотечения, т. к. они часто имеют высокий риск инсульта. Задача врача состоит в том, чтобы выбрать среди ПОАК самый безопасный, что, несомненно, будет способствовать повышению приверженности к лечению и позволит достигнуть наибольших успехов в профилактике ИИ и ТЭ.

The article is devoted to the safety as a criterion for choosing an anticoagulant. Apixaban has been extensively studied in patients with atrial fibrillation (AF) in both randomized and real-world data (RWD) trials. The ARISTOTLE trial showed that apixaban not only significantly reduces the risk of ischemic stroke (IS) and thromboembolism (TE), intracranial bleeding, major bleeding, but also keeps down the risk of gastrointestinal (GI) bleeding. The safety of apixaban lies in the fact that it is the only direct oral anticoagulant (DOAC) that significantly reduces all-cause death based on the results of randomized clinical trials. The results of the ARISTOTLE trial have been confirmed in RWD trials showing that apixaban is safe with regards to bleeding complications and, at the same time, effective. Apixaban has been studied extensively and is used successfully in the settings of cardioversion (CV), ablation, and percutaneous coronary intervention (PCI). The 2024 European Society of Cardiology guidelines on AF puts all DOACs in the same positions, but the doctor’s task is to choose the safest among them. There is every reason to believe (based on RCTs and RWD trials findings) that apixaban is effective and the safest of 3 DOACs available in our country. According to the 2024 ESC clinical guidelines, when prescribing DOACs physicians should not exclude patients with AF who have the highest risk of bleeding, as they are often at high risk of stroke. The role of a physician is to choose the safest among DOACs, which will certainly help to improve adherence to treatment and to achieve the greatest success in preventing IS and TE.

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