rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLCrpcardio-2038Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТRivaroxaban-Associated Hepatotoxicity: a Clinical Case and Literature ReviewРивароксабан-ассоциированная гепатотоксичность: клинический случай и обзор литературыТатарскийБ. А.TatarskyB. A.

д.м.н., профессор, г.н.с., научно-исследовательская лаборатория клинической аритмологии,

197341, Санкт-Петербург, ул. Аккуратова, 2

MD, PhD, Professor, Chief Researcher, Clinical Arrhythmology Research Laboratory, 

Akkuratova ul. 2, St. Petersburg, 197341

btat@mail.ruКазенноваН. В.KazennovaN. V.

к.м.н., н.с., научно-исследовательская лаборатория клинической аритмологии, 

197341, Санкт-Петербург, ул. Аккуратова, 2

MD, PhD, Researcher, Clinical Arrhythmology Research Laboratory, 

Akkuratova ul. 2, St. Petersburg, 197341

НапалковД. А.NapalkovD. A.

д.м.н., профессор, кафедра факультетской терапии №1, 

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Professor, Chair of Faculty Therapy №1,

Trubetskaya ul. 8-2, Moscow, 119991

Северо-Западный федеральный медицинский исследовательский центр им. В.А. АлмазоваРоссияAlmazov National Research Medical CenterRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation201905112019155675680Copyright © Tatarsky B.A., Kazennova N.V., Napalkov D.A., 20192019Татарский Б.А., Казеннова Н.В., Напалков Д.А.Tatarsky B.A., Kazennova N.V., 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/2038

Direct oral anticoagulants (not vitamin K antagonists), unlike standard oral anticoagulants (e.g. warfarin), have a predictable manifestation of the anticoagulant effect and the possibility of using a fixed dose without the need for constant monitoring of the anticoagulant effect. The rapid onset and cessation of the effect of direct oral anticoagulants, the relatively low likelihood of interaction with food and other drugs compared to warfarin, have expanded the possibilities of anticoagulant therapy.

Direct oral anticoagulants, particularly rivaroxaban, are widely used for deep vein thrombosis/pulmonary embolism prevention and treatment, and for stroke prevention in patients with atrial fibrillation. Awareness of side effects is mostly associated with bleeding risks while other problems with the use of this medication attract less physicians’ attention. These side effects mainly include liver damage and some other rare side effects. This article describes a clinical case of rivaroxaban-associated drug-induced liver injury in patient with first diagnosed atrial fibrillation and normal baseline liver enzymes. A literature review focused on this problem is also presented. 

Прямые пероральные антикоагулянты (пероральные антикоагулянты, не являющиеся антагонистами витамина K) в отличие от стандартных пероральных антикоагулянтов (например, варфарин) обладают предсказуемым проявлением антикоагулянтного действия и возможностью применения в фиксированной дозе без необходимости постоянного контроля антикоагулянтного эффекта. Быстрое начало и прекращение действия прямых пероральных антикоагулянтов, относительно низкая вероятность взаимодействия с пищевыми продуктами и другими лекарственными препаратами по сравнению с варфарином, расширили возможности антикоагулянтной терапии. Прямые пероральные антикоагулянты, в частности, ривароксабан (ингибитор Xa фактора), широко используются при различных показаниях, включающих венозную профилактику тромбоза глубоких вен/лечение после ортопедических операций по замене коленного/тазобедренного сустава и профилактике инсульта у пациентов с фибрилляцией предсердий (ФП). Вследствие механизма действия ривароксабана, настороженность в отношении побочных эффектов, как правило, сфокусирована на вероятности возникновения кровотечений. При этом развитие других побочных эффектов препарата получило меньше внимания, или остается нераспознанными. Эти побочные эффекты, в основном, включают повреждение печени и ряд других редких побочных реакций. В статье представлен случай ривароксабан-ассоциированного повреждения печени у пациента с впервые диагностированной ФП и нормальным исходно уровнем печеночных ферментов, а также представлен обзор литературы, посвященной этой проблеме.

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