ПРОФИЛАКТИКА ИНСУЛЬТА ПРИ НЕКЛАПАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ. О ЧЕМ ГОВОРЯТ РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ ROCKET AF

И. С. Явелов

doi:10.21518/2079-701X-2017-12-154-160

ПРОФИЛАКТИКА ИНСУЛЬТА ПРИ НЕКЛАПАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ. О ЧЕМ ГОВОРЯТ РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ ROCKET AF

И. С. Явелов

https://doi.org/10.21518/2079-701X-2017-12-154-160

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Аннотация

Длительное (неопределенно долгое) применение пероральных антикоагулянтов – наиболее действенный способ медикаментозного предупреждения кардиоэмболических осложнений при фибрилляции предсердий (ФП). Этот подход превосходит по эффективности антиагреганты (как монотерапию ацетилсалициловой кислотой, так и ее сочетание с клопидогрелом). В этом сообщении будут представлены факты, определившие представления о месте одного из пероральных антикоагулянтов прямого действия – ривароксабана – в профилактике кардиоэмболических осложнений у больных с неклапанной ФП. Речь идет о рандомизированном контролируемом исследовании ROCKET AF, результаты которого стали основанием для одобрения ривароксабана к широкому применению при неклапанной ФП.

Ключевые слова

неклапанная фибрилляция предсердий, инсульт, исследование ROCKET AF, ривароксабан

Об авторе

И. С. Явелов

Государственный научно-исследовательский центр профилактической медицины Минздрава России
Россия

д.м.н., в.н.с. отдела клинической кардиологии и молекулярной генетики

Список литературы

1. You JJ, Singer DE, Howard PA et al. Antithrombotic Therapy for Atrial Fibrillation. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(Suppl): e531S-e575S.

2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37: 2893-2962.

3. 2014 AHA/ACC/HRS Guidelines for theManagement of Patients With Atrial Fibrillation. JACC, 2014, 64: 2246-2280.

4. Hart RG, Benavente O, McBride R, Pearce LA.Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis. Ann Intern Med, 1999, 131: 492-501.

5. Hart RG, Pearce LA, Aguilar MI. Meta-analysis:Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Ann Intern Med, 2007, 146: 857-867.

6. Connolly SJ, Eikelboom J, Joyner C et al, for theAVERROES Steering Committee and Investigators. Apixaban in patients with atrial fibrillation. N Engl J Med, 2011, 364: 806-817.

7. The ACTIVE Writing Group on behalf of theACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet, 2006, 367: 1903-1912.

8. Hohnloser SH, Pajitnev D, Pogue J et al, for theACTIVE W Investigators. Incidence of Stroke in Paroxysmal Versus Sustained Atrial Fibrillation in Patients Taking Oral Anticoagulation or Combined Antiplatelet Therapy. An ACTIVE W Substudy. JACC, 2007, 50: 2156-2161.

9. Heidbuche H, Verhamme P, Alings M et al.European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace, 2013, 15: 625-651.

10. Granger CB, Alexander JH, McMurray JJ et al, for the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med, 2011, 365: 981-992.

11. Connolly SJ, Connolly SJ, Ezekowitz MD et al, for the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med, 2009, 361: 1139-1351.

12. Patel MR, Mahaffey KW, Garg J et al, for theROCKET-AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med, 2011, 365: 883-891.

13. Breithardt G, Baumgartner H, Berkowitz SD et al, for the ROCKET AF Steering Committee & Investigators. Characteristics and Outcomes of Patients with Atrial Fibrillation and Significant Valvular Lesions: Experience from the ROCKET AF Trial. JACC, 2013, 61(supplement): E339.

14. Breithardt G, Berkowitz SD, Baumgartner H et al, for the ROCKET AF Steering Committee & Investigators. Outcomes of Patients with Atrial Fibrillation and Significant Valvular Lesions: Comparison of the Effects of Rivaroxaban and Warfarin in the ROCKET AT Trial. JACC, 2013, 61(supplement): E339.

15. Patel MR, Hellkamp AS, Lokhnygina Y et al.Outcomes of Discontinuing Rivaroxaban Compared With Warfarin in Patients With Nonvalvular Atrial Fibrillation. Analysis From the ROCKET AF Trial (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation). JACC, 2013, 61: 651-658.

16. Sherwood MW, Nessel CC, Hellkamp AS et al.Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin ROCKET AF Trial. JACC, 2015, 66: 2271-2281.

17. Mahaffey KW, Stevens SR, White HD et al, for the ROCKET AF Investigators. Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial. Eur Heart J, 2014, 35: 233-241.

18. Hankey GJ, Patel MR, Stevens SR et al, for the ROCKET AF Steering Committee and Investigators. Rivaroxaban compared with war-farin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol, 2012, 11: 315-322.

19. Fox KAA, Piccini JP, Wojdyla D et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J, 2011, 32: 2387-2394.

20. Lindner SM, Fordyce CB, Hellkamp AS et al, on behalf of the ROCKET AF Steering Committee and Investigators. Treatment Consistency Across Levels of Baseline Renal Function With Rivaroxaban or Warfarin. A ROCKET AF (Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) Analysis. Circulation, 2017, 135: 1001-1003.

21. Fordyce CB, Hellkamp AS, Lokhnygina Y on behalf of the ROCKET AF Steering Committee and Investigators. On-Treatment Outcomes in Patients With Worsening Renal Function With Rivaroxaban Compared With Warfarin. Insights From ROCKET AF. Circulation, 2016, 134: 37-47.

22. Jones WS, Hellkamp AS, Halperin J et al. Efficacy and safety of rivaroxaban compared with warfarin in patients with peripheral artery disease and non-valvular atrial fibrillation: insights from ROCKET AF. Eur Heart J, 2014, 35: 242-249.

23. Piccini JP, Hellkamp AS, Washam JB et al. Polypharmacy and the Efficacy and Safety of Rivaroxaban versus Warfarin in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation. Circulation, 2016, 133: 352-360.

Для цитирования:

Явелов И.С. ПРОФИЛАКТИКА ИНСУЛЬТА ПРИ НЕКЛАПАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ. О ЧЕМ ГОВОРЯТ РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ ROCKET AF. Медицинский Совет. 2017;(12):154-160. https://doi.org/10.21518/2079-701X-2017-12-154-160

For citation:

Yavelov I.S. STROKE PREVENTION IN NON-VALVULAR ATRIAL FIBRILLATION. WHAT ROCKET AF STUDY RESULTS SAY. Medical Council. 2017;(12):154-160. (In Russ.) https://doi.org/10.21518/2079-701X-2017-12-154-160