rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-3-337-343rpcardio-1279Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯTHE ADVANCED TACTICS OF THE MANAGEMENT OF PATIENTS WITH VENOUS THROMBOEMBOLISM: THE ROLE OF RIVAROXABAN AT VARIOUS STAGES OF TREATMENTУСОВЕРШЕНСТВОВАННАЯ ТАКТИКА ВЕДЕНИЯ БОЛЬНЫХ С ВЕНОЗНЫМИ ТРОМБОЭМБОЛИЯМИ: РОЛЬ ПРИМЕНЕНИЯ РИВАРОКСАБАНА НА РАЗНЫХ ЭТАПАХ ТЕРАПИИГиляревскийС. Р.GilyarevskiyS. R.

д.м.н., профессор кафедры клинической фармакологии и терапии РМАПО

sgilarevsky@rambler.ruРоссийская медицинская академия последипломного образования 123995, Москва, Баррикадная, 2/1РоссияMedical Academy of Postgraduate Education. Barricadnaya ul. 2/1, Moscow, 123995 RussiaRussian Federation201630062016123337343Copyright © Gilyarevskiy S.R., 20162016Гиляревский 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.rpcardio.online/jour/article/view/1279

Venous thromboembolism (VTE) is one of the most common cardiovascular disease, and can lead to death or the development of complications and disability. Modern approaches to the determination of the treatment strategy in patients with VTE are considered. The role of thrombolytic therapy is highlighted, as well as the choice of anticoagulants, including new oral anticoagulants (NOAC). EINSTEIN-PE is the only, specially planned and performed study of the NOAC in patients with pulmonary embolism that confirmed the validity of monotherapy tactics with rivaroxaban in patients with VTE. The results of this study are considered in detail.

Венозные тромбоэмболии (ВТЭ) являются одним из наиболее распространенных сердечно-сосудистых заболеваний и могут приводить к смертельному исходу или развитию осложнений и инвалидности. Рассматриваются современные подходы к определению тактики лечения больных с ВТЭ. Освещается роль тромболитической терапии, а также выбор антикоагулянтов, в том числе новых пероральных антикоагулянтов (НОАК). Подробно рассматриваются результаты исследования EINSTEIN-PE – единственного специально запланированного и проведенного исследования НОАК у пациентов с тромбоэмболией легочной артерии, подтвердившего обоснованность тактики монотерапии ривароксабаном. 

венозные тромбоэмболиитромбоэмболия легочной артерииновые пероральные антикоагулянтыривароксабанvenous thromboembolismpulmonary embolismnew oral anticoagulantsrivaroxabanReferencesHeit J.A. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008;28:370-2.Heit J.A. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008;28:370-2.Cohen A.T., Agnelli G., Anderson F.A., et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756-64.Cohen A.T., Agnelli G., Anderson F.A., et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756-64.Klok F.A., van Kralingen K.W., van Dijk A.P., et al. Quality of life in long-term survivors of acute pulmonary embolism. Chest 2010;138:1432-40.Klok F.A., van Kralingen K.W., van Dijk A.P., et al. Quality of life in long-term survivors of acute pulmonary embolism. Chest 2010;138:1432-40.Bonderman D., Wilkens H., Wakounig S., et al. Risk factors for chronic thromboembolic pulmonary hypertension. Eur Respir J 2009;33:325 -31.Bonderman D., Wilkens H., Wakounig S., et al. Risk factors for chronic thromboembolic pulmonary hypertension. Eur Respir J 2009;33:325 -31.Condliffe R., Kiely D.G., Gibbs J.S., et al. Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension. Eur Respir J 2009;33:332-338.Condliffe R., Kiely D.G., Gibbs J.S., et al. Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension. Eur Respir J 2009;33:332-338.Fanikos J., Piazza G., Zayaruzny M., Goldhaber S.Z. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost 2009;102:688-93.Fanikos J., Piazza G., Zayaruzny M., Goldhaber S.Z. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost 2009;102:688-93.Stein P.D., Henry J.W. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995;108:978-81.Stein P.D., Henry J.W. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 1995;108:978-81.Heit J.A. III, Silverstein M.D., Mohr D.N., et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population- based case-control study. Arch Intern Med 2000;160:809-815.Heit J.A. III, Silverstein M.D., Mohr D.N., et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population- based case-control study. Arch Intern Med 2000;160:809-815.Aujesky D., Obrosky D.S., Stone R.A., et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med 2006;166;2:169-75.Aujesky D., Obrosky D.S., Stone R.A., et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med 2006;166;2:169-75.Laporte S., Mismetti P., Décousus H., et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008;117:1711-6.Laporte S., Mismetti P., Décousus H., et al. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008;117:1711-6.Goldhaber S.Z., Visani L., De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353(9162):1386-9.Goldhaber S.Z., Visani L., De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999;353(9162):1386-9.Konstantinides S.V., Torbicki A., Agnelli G., et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69.Konstantinides S.V., Torbicki A., Agnelli G., et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014;35:3033-69.Otero R., Trujillo-Santos J., Cayuela A., et al. Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index? Eur Respir J 2007;30:1111-6.Otero R., Trujillo-Santos J., Cayuela A., et al. Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index? Eur Respir J 2007;30:1111-6.Kukla P., Bryniarski L., Długopolski R., et al. Acute pulmonary embolism registry in the Małopolska region - clinical course. Kardiol Pol 2009;67:735-41.Kukla P., Bryniarski L., Długopolski R., et al. Acute pulmonary embolism registry in the Małopolska region - clinical course. Kardiol Pol 2009;67:735-41.Meyer G., Vicaut E., Danays T., et al. Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism. N Engl J Med 2014;370:1402-11.Meyer G., Vicaut E., Danays T., et al. Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism. N Engl J Med 2014;370:1402-11.Elliott C.G. Fibrinolysis of pulmonary emboli - steer closer to Scylla. N Engl J Med 2014;370: 1457-8.Elliott C.G. Fibrinolysis of pulmonary emboli - steer closer to Scylla. N Engl J Med 2014;370: 1457-8.Kearon C., Akl E.A., Comerota A.J., et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141 Suppl:e419S-e494S.Kearon C., Akl E.A., Comerota A.J., et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141 Suppl:e419S-e494S.Bauersachs R., Berkowitz S.D., Brenner B., et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510.Bauersachs R., Berkowitz S.D., Brenner B., et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510.Büller H.R., Prins M.H., Lensin A.W., et al. Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med 2012;366:1287-97.Büller H.R., Prins M.H., Lensin A.W., et al. Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med 2012;366:1287-97.Büller H.R., Gallus A.S., Pillion G., et al. Enoxaparin followed by once-weekly idrabiotaparinux versus enoxaparin plus warfarin for patients with acute symptomatic pulmonary embolism: a randomised, double-blind, double-dummy, non-inferiority trial. Lancet 2012;379:123-9.Büller H.R., Gallus A.S., Pillion G., et al. Enoxaparin followed by once-weekly idrabiotaparinux versus enoxaparin plus warfarin for patients with acute symptomatic pulmonary embolism: a randomised, double-blind, double-dummy, non-inferiority trial. Lancet 2012;379:123-9.The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510.The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 2010;363:2499-510.Schulman S., Kearon C., Kakkar A.K., et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009;361:2342-52.Schulman S., Kearon C., Kakkar A.K., et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009;361:2342-52.Barritt D.W., Jordan S.C. Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial. Lancet 1960;1:1309-12.Barritt D.W., Jordan S.C. Anticoagulant drugs in the treatment of pulmonary embolism: a controlled trial. Lancet 1960;1:1309-12.The van Gogh Investigators. Idraparinux versus standard therapy for venous thromboembolic disease. N Engl J Med 2007;357:1094-104.The van Gogh Investigators. Idraparinux versus standard therapy for venous thromboembolic disease. N Engl J Med 2007;357:1094-104.Brandjes D.P.M., Heijboer H., Büller H.R., et al. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med 1992;327:1485-9.Brandjes D.P.M., Heijboer H., Büller H.R., et al. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med 1992;327:1485-9.Fiessinger J.N., Huisman M.V., Davidson B.L., et al. Ximelagatran vs low-molecular weight heparin and warfarin for the treatment of deep vein thrombosis: a randomized trial. JAMA 2005;293:681-9.Fiessinger J.N., Huisman M.V., Davidson B.L., et al. Ximelagatran vs low-molecular weight heparin and warfarin for the treatment of deep vein thrombosis: a randomized trial. JAMA 2005;293:681-9.Mueck W., Lensing A.W., Agnelli G., et al. Rivaroxaban: population pharmacokinetic analyses in patients treated for acute deep-vein thrombosis and exposure simulations in patients with atrial fibrillation treated for stroke prevention. Clin Pharmacokinet 2011;50:675-86.Mueck W., Lensing A.W., Agnelli G., et al. Rivaroxaban: population pharmacokinetic analyses in patients treated for acute deep-vein thrombosis and exposure simulations in patients with atrial fibrillation treated for stroke prevention. Clin Pharmacokinet 2011;50:675-86.Agnelli G., Gallus A., Goldhaber S.Z., et al. Treatment of proximal deep-vein thrombosis with the oral direct factor Xa inhibitor rivaroxaban (BAY 59-7939): the ODIXa-DVT (Oral Direct Factor Xa Inhibitor BAY 59-7939 in Patients with Acute Symptomatic Deep-Vein Thrombosis) study. Circulation 2007;116:180-7.Agnelli G., Gallus A., Goldhaber S.Z., et al. Treatment of proximal deep-vein thrombosis with the oral direct factor Xa inhibitor rivaroxaban (BAY 59-7939): the ODIXa-DVT (Oral Direct Factor Xa Inhibitor BAY 59-7939 in Patients with Acute Symptomatic Deep-Vein Thrombosis) study. Circulation 2007;116:180-7.van Es J., Douma R.A., Kamphuisen P.W., et al. Clot resolution after 3 weeks of anticoagulant treatment for pulmonary embolism: comparison of computed tomography and perfusion scintigraphy. J Thromb Haemost 2013;11:679-85.van Es J., Douma R.A., Kamphuisen P.W., et al. Clot resolution after 3 weeks of anticoagulant treatment for pulmonary embolism: comparison of computed tomography and perfusion scintigraphy. J Thromb Haemost 2013;11:679-85.Prandoni P., Prins M.H., Cohen A.T., et al. Use of prestudy heparin did not influence the efficacy and safety of rivaroxaban in patients treated for symptomatic venous thromboembolism in the EINSTEIN DVT and EINSTEIN-PE studies. Acad Emerg Med 2015;22:142-9.Prandoni P., Prins M.H., Cohen A.T., et al. Use of prestudy heparin did not influence the efficacy and safety of rivaroxaban in patients treated for symptomatic venous thromboembolism in the EINSTEIN DVT and EINSTEIN-PE studies. Acad Emerg Med 2015;22:142-9.Bayer Pharma AG. Xarelto (rivaroxaban) Summary of Product Characteristics. 2014. Available at: http://www.ema.europa.eu/docs/en_GB/ document_library/EPAR_-_Product_Information/ human/000944/WC500057108.pdf. Accessed November 17, 2014.Bayer Pharma AG. Xarelto (rivaroxaban) Summary of Product Characteristics. 2014. Available at: http://www.ema.europa.eu/docs/en_GB/ document_library/EPAR_-_Product_Information/ human/000944/WC500057108.pdf. Accessed November 17, 2014.Janssen Pharmaceuticals Inc. Xarelto (rivaroxaban) Prescribing Information. 2014. Available at: http://www.xareltohcp.com/sites/default/files/ pdf/xarelto_0.pdf. Accessed November 17, 2014.Janssen Pharmaceuticals Inc. Xarelto (rivaroxaban) Prescribing Information. 2014. Available at: http://www.xareltohcp.com/sites/default/files/ pdf/xarelto_0.pdf. Accessed November 17, 2014.Weitz J.I., Connolly S.J., Patel I., et al. Randomised, parallel-group, multicentre, multinational phase 2 study comparing edoxaban, an oral factor Xa inhibitor, with warfarin for stroke prevention in patients with atrial fibrillation. Thromb Haemost 2010;104:633- 41.Weitz J.I., Connolly S.J., Patel I., et al. Randomised, parallel-group, multicentre, multinational phase 2 study comparing edoxaban, an oral factor Xa inhibitor, with warfarin for stroke prevention in patients with atrial fibrillation. Thromb Haemost 2010;104:633- 41.

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