Рекомендации по применению прямых пероральных антикоагулянтов у пациентов с фибрилляцией предсердий (по материалам Европейской Ассоциации по изучению ритма сердца, 2018 г.)

Прямые пероральные антикоагулянты (ППОАК) все более широко применяются в клинической практике. Остается много нерешенных вопросов о том, как оптимально использовать ППОАК в конкретной клинической ситуации. Европейская ассоциация по изучению ритма сердца в апреле2018 г. представила обновленные рекомендации по применению ППОАК у пациентов с фибрилляцией предсердий. Группа авторов рассмотрели ряд конкретных клинических вариантов, для которых были сформулированы практические советы на основе имеющихся доказательств, полученных в рандомизированных клинических исследованиях (РКИ); определены показания к применению ППОАК; практическая старт-программа и последующая схема ведения пациентов, принимающих ППОАК; рассматриваются фармакокинетика и лекарственное взаимодействие ППОАК; возможность применения их у пациентов с хронической почечной недостаточностью или прогрессирующим заболеванием печени и многие другие вопросы.    

1. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. European Heart Journal. 2018;39(16):1330–93. DOI: 10.1093/eurheartj/ehy136

2. Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2013;15(5):625–51. DOI: 10.1093/europace/eut083

3. Heidbuchel H, Verhamme P, Alings M, Antz M, Diener H-C, Hacke W et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015;17(10):1467–507. DOI: 10.1093/europace/euv309

4. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL et al. Edoxaban versus warfarin in patients with atrial fibrillation. The New England Journal of Medicine. 2013;369(22):2093–104. DOI: 10.1056/NEJMoa1310907

5. Stangier J, Stahle H, Rathgen K, Fuhr R. Pharmacokinetics and Pharmacodynamics of the Direct Oral Thrombin Inhibitor Dabigatran in Healthy Elderly Subjects: Clinical Pharmacokinetics. 2008;47(1):47–59. DOI: 10.2165/00003088-200847010-00005

6. Reinecke H, Engelbertz C, Schabitz W-R. Preventing Stroke in Patients With Chronic Kidney Disease and Atrial Fibrillation: Benefit and Risks of Old and New Oral Anticoagulants. Stroke. 2013;44(10):2935–41. DOI: 10.1161/STROKEAHA.113.001701

7. Efird LM, Mishkin DS, Berlowitz DR, Ash AS, Hylek EM, Ozonoff A et al. Stratifying the Risks of Oral Anticoagulation in Patients With Liver Disease. Circulation: Cardiovascular Quality and Outcomes. 2014;7(3):461–7. DOI: 10.1161/CIRCOUTCOMES.113.000817

8. Kubitza D, Roth A, Becka M, Alatrach A, Halabi A, Hinrichsen H et al. Effect of hepatic impairment on the pharmacokinetics and pharmacodynamics of a single dose of rivaroxaban, an oral, direct Factor Xa inhibitor: Rivaroxaban pharmacokinetics and pharmacodynamics in hepatic impairment. British Journal of Clinical Pharmacology. 2013;76(1):89–98. DOI: 10.1111/bcp.12054

9. Hum J, Shatzel JJ, Jou JH, Deloughery TG. The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis. European Journal of Haematology. 2017;98(4):393–7. DOI: 10.1111/ejh.12844

10. Caldeira D, Barra M, Santos AT, de Abreu D, Pinto FJ, Ferreira JJ et al. Risk of drug-induced liver injury with the new oral anticoagulants: systematic review and meta-analysis. Heart. 2014;100(7):550–6. DOI: 10.1136/heartjnl-2013-305288

11. Pollack CV, Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA et al. Idarucizumab for Dabigatran Reversal – Full Cohort Analysis. New England Journal of Medicine. 2017;377(5):431–41. DOI: 10.1056/NEJMoa1707278

12. Ansell JE, Bakhru SH, Laulicht BE, Steiner SS, Grosso M, Brown K et al. Use of PER977 to Reverse the Anticoagulant Effect of Edoxaban. New England Journal of Medicine. 2014;371(22):2141–2. DOI: 10.1056/NEJMc1411800

13. Tomaselli GF, Mahaffey KW, Cuker A, Dobesh PP, Doherty JU, Eikelboom JW et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants. Journal of the American College of Cardiology. 2017;70(24):3042– 67. DOI: 10.1016/j.jacc.2017.09.1085

14. Getta B, Muller N, Motum P, Hsu D, Zebeljan D, Rosenfeld D. Intermittent haemodialysis and continuous veno-venous dialysis are effective in mitigating major bleeding due to dabigatran. British Journal of Haematology. 2015;169(4):603–4. DOI: 10.1111/bjh.13236

15. Wang X, Tirucherai G, Marbury TC, Wang J, Chang M, Zhang D et al. Pharmacokinetics, pharmacodynamics, and safety of apixaban in subjects with end-stage renal disease on hemodialysis. The Journal of Clinical Pharmacology. 2016;56(5):628–36. DOI: 10.1002/jcph.628

16. Healey JS, Eikelboom J, Douketis J, Wallentin L, Oldgren J, Yang S et al. Periprocedural Bleeding and Thromboembolic Events With Dabigatran Compared With Warfarin: Results From the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) Randomized Trial. Circulation. 2012;126(3):343–8. DOI: 10.1161/CIRCULATIONAHA.111.090464

17. Beyer-Westendorf J, Gelbricht V, Forster K, Ebertz F, Kohler C, Werth S et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. European Heart Journal. 2014;35(28):1888–96. DOI: 10.1093/eurheartj/eht557

18. National Confidential Enquiry into Patient Outcome and Death. Classification of Intervention. [Интернет] Available at: https://www.ncepod.org.uk/classification.html

19. Albaladejo P, Bonhomme F, Blais N, Collet J-P, Faraoni D, Fontana P et al. Management of direct oral anticoagulants in patients undergoing elective surgeries and invasive procedures: Updated guidelines from the French Working Group on Perioperative Hemostasis (GIHP) – September 2015. Anaesthesia Critical Care & Pain Medicine. 2017;36(1):73–6. DOI: 10.1016/j.accpm.2016.09.002

20. Calkins H, Hindricks G, Cappato R, Kim Y-H, Saad EB, Aguinaga L et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. Journal of Interventional Cardiac Electrophysiology. 2017;50(1):1–55. DOI: 10.1007/s10840-017-0277-z

21. Di Biase L, Burkhardt JD, Santangeli P, Mohanty P, Sanchez JE, Horton R et al. Periprocedural Stroke and Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation With Different Anticoagulation Management: Results From the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) Randomized Trial. Circulation. 2014;129(25):2638–44. DOI: 10.1161/CIRCULATIONAHA.113.006426

22. Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ et al. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. European Heart Journal. 2015;36(28):1805–11. DOI: 10.1093/eurheartj/ehv177

23. Sticherling C, Marin F, Birnie D, Boriani G, Calkins H, Dan G-A et al. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). EP Europace. 2015;17(8):1197–214. DOI: 10.1093/europace/euv190

24. Valgimigli M, Bueno H, Byrne RA, Collet J-P, Costa F, Jeppsson A et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2018;39(3):213–60. DOI: 10.1093/eurheartj/ehx419

25. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018;39(2):119–77. DOI: 10.1093/eurheartj/ehx393

26. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210

27. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. PMID: 1866765

28. Tricco AC, Thomas SM, Veroniki AA, Hamid JS, Cogo E, Strifler L et al. Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017;318(17):1687. DOI: 10.1001/jama.2017.15006

29. Martin K, Beyer-Westendorf J, Davidson BL, Huisman MV, Sandset PM, Moll S. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. Journal of Thrombosis and Haemostasis. 2016;14(6):1308–13. DOI: 10.1111/jth.13323

30. Zamorano JL, Lancellotti P, Rodriguez Munoz D, Aboyans V, Asteggiano R, Galderisi M et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). European Heart Journal. 2016;37(36):2768–801. DOI: 10.1093/eurheartj/ehw211