References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/ms2025-561

medsovet-9750

Research Article

КАРДИОЛОГИЯ

CARDIOLOGY

Нагрузка фибрилляцией предсердий – фактор, влияющий на тактику применения прямых пероральных антикоагулянтов

Atrial fibrillation burden: A factor affecting direct oral anticoagulant use

https://orcid.org/0000-0002-8505-1848

Гиляревский

С. Р.

Gilyarevskiy

S. R.

Гиляревский Сергей Руджерович, д.м.н., профессор, ведущий научный сотрудник, Московский многопрофильный научно-клинический центр имени С.П. Боткина; профессор кафедры клинической фармакологии и терапии имени академика Б.Е. Вотчала, Российская медицинская академия непрерывного профессионального образования

Москва, 2-й Боткинский проезд, влад. 5,

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

Sergey R. Gilyarevskiy, Dr. Sci. (Med.), Professor, Leading Researcher, Botkin Moscow Multidisciplinary Scientific and Clinical Center; Professor of the Department of Clinical Pharmacology and Therapy named after Academician B.E. Votchal, Russian Medical Academy of Continuous Professional Education

5, 2nd Botkinskiy Proezd, Moscow, 125284,

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

sgilarevsky@rambler.ru

Московский многопрофильный научно-клинический центр имени С.П. Боткина; Российская медицинская академия непрерывного профессионального образованияРоссияBotkin Moscow Multidisciplinary Scientific and Clinical Center; Russian Medical Academy of Continuous Professional EducationRussian Federation

2025

22012026

0233439

2026

Гиляревский С.Р.

Gilyarevskiy S.R.

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/9750

В статье обсуждается проблема выбора тактики назначения антикоагулянтов в зависимости от нагрузки фибрилляцией предсердий (НФП), в первую очередь у пациентов с субклинической фибрилляцией предсердий (СКФП), т. е. фибрилляцией предсердий (ФП), которая зарегистрирована с помощью различных имплантированных в сердце или носимых устройств, но не на электрокардиограмме. Приводятся эпидемиологические данные, свидетельствующие об увеличении проблемы ФП как одного из основных факторов риска развития инсульта и/или эмболий в сосуды большого круга кровообращения (ЭСБКК). Рассматриваются различные трактовки термина «НФП», а также подробно представлены данные, касающиеся его клинического значения. Обсуждаются современные подходы к назначению прямых пероральных антикоагулянтов (ПОАК) у пациентов с СКФП в зависимости от расчетного риска развития инсульта и/или ЭСБКК, а также от наличия в анамнезе указаний на перенесенный инсульт или преходящее нарушение мозгового кровообращения (ПНМК). Обсуждаются результаты анализа данных об участниках рандомизированного клинического исследования по оценке эффективности применения ПОАК у пациентов с СКФП. Приводятся данные о прогностической роли НФП у пациентов с ФП, включая пациентов с сердечной недостаточностью и сниженной фракцией выброса левого желудочка. Рассматривается вопрос выбора ПОАК у пациентов с СКФП, а также важность применения в такой ситуации ПОАК с однократным суточным приемом. Обсуждается экономическая эффективность использования ПОАК для профилактики инсульта и/или ПНМК у пациентов с СКФП, которая во многом зависит от затрат на терапию.

This article discusses the issue of personalized approach for anticoagulants choice according to the atrial fibrillation burden (AFB), primarily in patients with subclinical atrial fibrillation (SCAF), i.e., atrial fibrillation (AF), which is identified using various cardiac implanted or wearable devices, but not on the electrocardiogram. There is some epidemiological evidence that the issue of AF as one of major risk factors for stroke and/or systemic embolism (SE) is becoming more prominent. Various interpretations of the term “AFB” are considered, and the data regarding its clinical significance are presented in detail. Current approaches to the prescription of direct oral anticoagulants (DOACs) in patients with SCAF according to the estimated risk of stroke/SE, and the known history of stroke or transient ischemic attack (TIA) are discussed. The results of the data analysis for subjects of the randomized clinical trial (RCT) evaluating the efficacy of DOAC use in patients with SCAF are considered. The data on the prognostic role of AFB in patients with AF including those with heart failure and reduced left ventricular ejection fraction are presented. The authors address the issue of DOAC choice in patients with SCAF, as well as the significance of once-daily DOACs in this situation. The cost-effectiveness of DOAC use for stroke and/or TIA prevention in patients with SCAF, which largely depends on the cost of therapy, is discussed.

субклиническая фибрилляция предсердийфакторы рискаинсульттромбоэмболические осложнениявыбор прямых пероральных антикоагулянтов

subclinical atrial fibrillationrisk factorsstrokethromboembolic complicationschoice of direct oral anticoagulants

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