rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-5-595-602rpcardio-1342Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯFeatures of Modern Anticoagulant Therapy in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney DiseaseВозможности современной антикоагулянтной терапии у пациентов с неклапанной этиологией фибрилляции предсердий и хронической болезнью почекДаабульИ. С.DaabulI. S.

аспирант кафедры факультетской терапии №1 лечебного факультета Первого МГМУ им. И.М. Сеченова

MD, PhD Student of Chair of Faculty Therapy #1, I.M. Sechenov First Moscow State Medical University

СоколоваА. А.SokolovaA. A.

к.м.н., заместитель директора по образовательной деятельности Института персонализированной медицины Первого МГМУ им. И.М. Сеченова

MD, PhD, Deputy Director for Educational Activities, Institute of Personalized Medicine, I.M. Sechenov First Moscow State Medical University

НапалковД. А.NapalkovD. A.

д.м.н., профессор кафедры факультетской терапии №1 лечебного факультета Первого МГМУ им. И.М. Сеченова

MD, PhD, Professor of Chair of Faculty Therapy #1, I.M. Sechenov First Moscow State Medical University

dminap@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова Россия, 119991, Москва, ул. Трубецкая, 8 стр. 2РоссияI.M. Sechenov First Moscow State Medical University. Trubetskaya ul. 8-2, Moscow, 119991 RussiaRussian Federation201607112016125595602Copyright © Daabul I.S., Sokolova A.A., Napalkov D.A., 20162016Даабуль И.С., Соколова А.А., Напалков Д.А.Daabul I.S., Sokolova A.A., Napalkov D.A.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/1342

Prevalence of atrial fibrillation (AF) in population is very high and continues to grow. According to the existing statistics its prevalence reaches about 2% so it is twice more, than it was considered in the last decade. Prevalence of AF among patients with chronic kidney disease (CKD) varies from 11 to 22% (according to other data – from 15 to 20%) and increases with age, considerably surpassing that in the general population among all age groups. Vast majority of patients with AF need in treatment with anticoagulants to prevent an ischemic stroke and systemic thromboembolisms. However, in case of combination AF and CKD, in addition to increase in frequency of strokes and the thromboembolic events, also the frequency of major bleedings significantly increases that considerably complicates the choice of adequate anticoagulant therapy in such situation. Many years the vitamin K antagonists were the only representatives of a class of anticoagulants for long-term therapy in patients with AF. Their well-known deficiencies (a narrow therapeutic window, need of frequent laboratory control, numerous drug-drug and dietary interactions, unpredictability of a pharmacodynamics and pharmacokinetics at certain patients) promoted search of new medicines, more convenient in use. Direct oral anticoagulants were easier to use, and by results of the main studies didn't yield or exceeded warfarin concerning balance of efficiency and safety. However, they were not specially studied in patients with the reduced kidney function. Features of modern anticoagulant therapy in patients with the nonvalvular AF and CKD are considered in the review. The possibility of the safest use of anticoagulants for patients with decreased creatinine clearance is analyzed.

Распространенность фибрилляции предсердий (ФП) в популяции весьма велика и продолжает расти. По существующей в настоящее время статистике ее распространенность достигает примерно 2%, что вдвое больше, чем считалось в последнее десятилетие. Распространенность ФП у пациентов с хронической болезнью почек (ХБП) составляет от 11 до 22% (по другим данным – 15-20%) и увеличивается с возрастом, значительно превосходя таковую в общей популяции среди всех возрастных групп. Абсолютное большинство пациентов с ФП нуждаются в проведении терапии антикоагулянтами для профилактики ишемического инсульта и системных тромбоэмболий. Однако при сочетании ФП с ХБП, помимо увеличения частоты инсультов и тромбоэмболических осложнений, значимо увеличивается и частота серьезных кровотечений, что существенно затрудняет подбор адекватной антикоагулянтной терапии в такой ситуации. Много лет антагонисты витамина К были единственными представителями класса антикоагулянтов для долгосрочной терапии при ФП. Их общеизвестные недостатки (узкое терапевтическое окно, необходимость частого лабораторного контроля, многочисленные межлекарственные и диетические взаимодействия, непредсказуемость фармакодинамики и фармакокинетики у отдельных пациентов) способствовали поиску новых, более удобных в использовании препаратов. Прямые пероральные антикоагулянты оказались проще в применении, а по результатам основных исследований не уступали или превосходили варфарин в отношении баланса эффективности и безопасности. Однако у пациентов со сниженной функцией почек они специально не изучались. В настоящем обзоре литературы рассматриваются особенности современной антикоагулянтной терапии у пациентов с фибрилляцией предсердий неклапанной этиологии и ХБП. Анализируется возможность максимально безопасного применения антикоагулянтной терапии у пациентов со снижением клиренса креатинина.

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