Выбор антитромботической терапии у больных ишемической болезнью сердца и сахарным диабетом 2-го типа

В обзоре представлены распространенность сахарного диабета (СД) 2-го типа у больных ишемической болезнью сердца (ИБС), общность факторов риска возникновения, значительное ухудшение прогноза при их сочетании. Показаны патофизиологические механизмы дисфункции тромбоцитов и негативное изменение системы коагуляции у больных ИБС при наличии СД 2-го типа, что предопределяет активацию протромботического пути формирования гемостаза. Трудности оптимального выбора антитромботической терапии продемонстрированы как у больных СД 2-го типа без сердечно-сосудистых заболеваний в анамнезе, так и у больных ИБС в сочетании с СД 2-го типа. В обзоре обращается внимание на то, что данные рандомизированных клинических исследований (РКИ), выполненных у больных СД 2-го типа и острым коронарным синдромом или после коронарной реваскуляризации, нельзя экстраполировать на всю популяцию пациентов со стабильной ИБС. В настоящее время предпочтительным выбором антитромботической терапии у больных СД 2-го типа и стабильной ИБС является комбинация ривароксабана 2,5 мг 2 раза в сутки с ацетилсалициловой кислотой 100 мг / сут, обладающая максимальной клинической выгодой, по сравнению с другими стратегиями, представленными в РКИ.

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