rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2017-13-1-124-128rpcardio-1426Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИANTIPLATELET THERAPY OF ATRIAL FIBRILLATION: FOCUS ON THE ELDERLYАНТИАГРЕГАНТЫ В ТЕРАПИИ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ: ФОКУС НА ПОЖИЛЫХУшкаловаЕ. А.UshkalovaE. А.

Ушкалова Елена Андреевна – доктор медицинских наук, профессор кафедры общей и клинической фармакологии РУДН.

117198, Москва, ул. Миклухо-Маклая, 6

Elena A. Ushkalova – MD, PhD, Professor, Chair of General and Clinical Pharmacology.

Miklukho-Maklaya ul. 6, Moscow, 117198

eushk@yandex.ruЗыряновС. К.ZyryanovS. K.

Зырянов Сергей Кенсаринович – доктор медицинских наук, заведующий кафедрой общей и клинической фармакологии РУДН.

117198, Москва, ул. Миклухо-Маклая, 6

Sergei K. Zyryanov – MD, PhD, Professor, Head of Chair of General and Clinical Pharmacology.

Miklukho-Maklaya ul. 6, Moscow, 117198

ДумченкоЕ. В.DumchenkoE. V.

Думченко Екатерина Владимировна — аспирант кафедры общей и клинической фармакологии РУДН.

117198, Москва, ул. Миклухо-Маклая, 6

Ekaterina V. Dumchenko – MD, PhD Student, Chair of General and Clinical Pharmacology.

Miklukho-Maklaya ul. 6, Moscow, 117198

Российский университет дружбы народовРоссияPeople's Friendship University of RussiaRussian Federation201704032017131124128Copyright © Ushkalova E.А., Zyryanov S.K., Dumchenko E.V., 20172017Ушкалова Е.А., Зырянов С.К., Думченко Е.В.Ushkalova E.А., Zyryanov S.K., Dumchenko E.V.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/1426

Current guidelines for the management of atrial fibrillation (AF) recommend using anticoagulants as first-line drugs for stroke prevention, but in real medical practice antiplatelet drugs are often prescribed to elderly patients. Review of clinical and pharmacoepidemiological studies allows us to conclude that  risk associated with acetylsalicylic acid (ASA) use in patients ≥75 years can overweigh its potential benefit. Other antiplatelet drugs are poorly studied in patients with AF. Dual antiplatelet therapy (ASA + clopidogrel) can be prescribed to elderly patients with cardiovascular comorbidity who are deemed unsuitable candidates for anticoagulant therapy for reasons other  than  bleeding risk or those  who refuse to take oral anticoagulants. Combined therapy of antiplatelet drugs with warfarin or new oral anticoagulants results in no reduction in stroke rate compared with anticoagulant monotherapy but is associated with increased risk of bleeding and can’t be recommended.

В современных руководствах по лечению  фибрилляции предсердий (ФП) в качестве препаратов выбора для профилактики инсульта рекомендуют антикоагулянты, однако в реальной медицинской практике пожилым пациентам часто назначают антиагреганты. Обзор клинических и фармакоэпидемиологических исследований позволяет прийти к заключению, что риск, связанный с применением ацетилсалициловой кислоты (АСК) у пациентов в возрасте ≥75 лет, может превышать потенциальную пользу. Другие антиагреганты плохо изучены у больных ФП. Вопрос о назначении двойной антиагрегантной терапии  (АСК+клопидогрел) может быть рассмотрен у пациентов с сопутствующими сердечно-сосудистыми заболеваниями, которые не подходят для антикоагулянтной терапии по каким-либо другим причинам, помимо риска кровотечений, или у пациентов, отказывающихся принимать антикоагулянты. Комбинации антиагрегантов с варфарином или новыми пероральными антикоагулянтами не приводят к снижению  риска развития инсульта по сравнению с монотерапией антикоагулянтами, но ассоциируются с более  высоким  риском  кровотечений, поэтому не могут быть рекомендованы.

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