rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2018-14-6-908-916rpcardio-1808Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯAnticoagulant Therapy in “Fragile” Elderly Patients: Current State of the ProblemАнтикоагулянтная терапия у «хрупких» пожилых пациентов: современное состояние проблемыВоробьеваН. М.VorobyevaN. M.

д.м.н., зав. лабораторией сердечно-сосудистого старения, Российский геронтологический научно-клинический центр

MD, PhD, Head of Laboratory of Cardiovascular Aging, Russian Gerontology Clinical Research Center

natalyavorobjeva@mail.ruТкачеваО. Н.TkachevaO. N.

д.м.н., профессор, директор Российского геронтологического научно-клинического центра

MD, PhD, Professor, Director of Russian Gerontology Clinical Research Center

Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation201805012019146908916Copyright © Vorobyeva N.M., Tkacheva O.N., 20192019Воробьева Н.М., Ткачева О.Н.Vorobyeva N.M., Tkacheva O.N.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/1808

The review focuses on the use of oral anticoagulants in fragile elderly patients. The issues of prevalence and diagnosis of senile asthenia syndrome or “fragility”, as well as its effects on the risks of thrombosis, bleeding and death, are discussed. The evidence base, which is quite limited, for the participation of fragile elderly patients in randomized controlled trials and real clinical practice trials with direct oral anticoagulants is presented. Nevertheless, one of the studies of real clinical practice showed that only therapy with rivaroxaban (out of three direct oral anticoagulants) compared with warfarin reduced the risk of stroke/systemic embolism and ischemic stroke alone in fragile elderly patients with atrial fibrillation after 2 years of observation.

Обзорная статья посвящена особенностям применения пероральных антикоагулянтов у «хрупких» пожилых пациентов. Рассмотрены вопросы распространенности и диагностики синдрома старческой астении или «хрупкости», а также его влияния на риски тромбоза, кровотечения и смерти. Приводится доказательная база по участию «хрупких» пожилых пациентов в рандомизированных контролируемых исследованиях и исследованиях реальной клинической практики с пероральными антикоагулянтами прямого действия, которая в целом достаточно ограничена. Тем не менее, одно из исследований реальной клинической практики продемонстрировало, что из трех пероральных антикоа- гулянтов прямого действия по сравнению с варфарином только терапия ривароксабаном снижала риск инсульта/системной эмболии и от- дельно ишемического инсульта у «хрупких» пожилых пациентов с фибрилляций предсердий через 2 года наблюдения.

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