rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2020-04-10rpcardio-2177Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯThe Current Status of Direct Oral Anticoagulants in Cancer-Related Venous Thromboembolism TreatmentАктуальный статус прямых оральных антикоагулянтов при лечении венозных тромбоэмболических осложнений у онкологических больныхЛобастовК. В.LobastovК. V.

Лобастов Кирилл Викторович – кандидат медицинских наук, доцент, кафедра общей хирургии и лучевой диагностики

117997 Москва, ул. Островитянова, 1

Kirill V. Lobastov – MD, PhD, Associate Professor, Chair of General Surgery and Radiology

Ostrovitianova ul. 1, Moscow, 117997

lobastov_kv@mail.ruСчастливцевИ. В.SchastlivtsevI. V.

Счастливцев Илья Вениаминович – кандидат медицинских наук, доцент, кафедра общей хирургии и лучевой диагностики

117997 Москва, ул. Островитянова, 1

Ilya V. Schastlivtsev – MD, PhD, Associate Professor, Chair of General Surgery and Radiology

Ostrovitianova ul. 1, Moscow, 117997

Российский Национальный Исследовательский Медицинский Университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202001052020162286295Copyright © Lobastov К.V., Schastlivtsev I.V., 20202020Лобастов К.В., Счастливцев И.В.Lobastov К.V., Schastlivtsev I.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/2177

This article is a review of epidemiology, pathogenesis and treatment of venous thromboembolism (VTE) in cancer patients. In accordance with actual guidelines, the duration of anticoagulant therapy of cancer-related venous thrombosis should be at least 6 months. The use of vitamin K antagonists (VKA) is associated with an increased risk of VTE recurrence and bleeding, so low molecular weight heparin (LMWH), in particular dalteparin, has been the "gold standard" until recently. Compared to VKA, prolonged use of LMWH can reduce the incidence of VTE recurrence without affecting the risk of bleeding or death. The main disadvantage of LMWH is low compliance, leading to premature discontinuation of treatment or switching to alternative anticoagulants. Direct oral anticoagulants (DOACs) have changed the situation. Compared to VKA, they demonstrated higher efficacy with a similar (or improved for individual DOACs) safety in patients with cancer-related VTE. Recently, the results of studies comparing the use of DOACs with dalteparin in cancer patients have been published: SELECT-D (rivaroxaban), HOKUSAI-VTE Cancer (edoxaban), ADAM VTE (apixaban), CARAVAGGIO (apixaban). Rivaroxaban showed higher efficacy than dalteparin with a similar risk of major bleeding, but an increased risk of clinically relevant non-major (CRNM) bleeding. Edoxaban had the same efficacy as dalteparin but increased risk of major but not CRNM bleeding. Apixaban showed similar efficacy and safety as dalteparin in the CARAVAGGIO study, but did not provide higher safety in the ADAM VTE study. It was noted that gastrointestinal and urogenital bleeding dominated in the structure of hemorrhagic complications of DOACs. The results of published trials are reflected in the current guidelines of the specialized societies. DOACs (particularly, rivaroxaban and edoxaban) are recommended for the VTE treatment in cancer patients.

Статья представляет собой обзор, посвященный вопросам эпидемиологии, патогенеза и лечения венозных тромбоэмболических осложнений (ВТЭО) у онкологических больных. В соответствии с современными рекомендациями антикоагулянтная терапия онко-ассоциированного венозного тромбоза должна продолжаться не менее 6 мес. Использование антагонистов витамина К (АВК) ассоциируется с повышенным риском рецидива ВТЭО и кровотечения, поэтому «золотым стандартом» до последнего времени являлись низкомолекулярные гепарины (НМГ), в частности, далтепарин. В сравнении с АВК длительное использование НМГ позволяет уменьшить риск рецидива ВТЭО без влияния на опасность геморрагических осложнений и летального исхода. Главным недостатком НМГ считается низкая комплаентность, приводящая к преждевременному завершению лечения или переходу на альтернативные препараты. Появление прямых оральных антикоагулянтов (ПОАК) изменило ситуацию. В сравнении с АВК они обладают более высокой эффективностью при сопоставимом (или улучшенном для отдельных препаратов) профиле безопасности при лечении онко-ассоциированных ВТЭО. Недавно были опубликованы результаты исследо-ваний, сравнивающих результаты применения ПОАК и далтепарина у онкологических пациентов: SELECT-D (ривароксабан), HOKUSAI-VTE Cancer (эдоксабан), ADAM VTE (апиксабан), CARAVAGGIO (апиксабан). Ривароксабан продемонстрировал бóльшую эффективность при сопоставимом риске больших кровотечений и увеличенной частоте не больших, но клинически значимых (НБКЗ) кровотечений. Эдоксабан оказался не менее эффективным, но увеличивал частоту развития больших (но не НБКЗ) кровотечений. Апиксабан продемонстрировал не меньшую эффективность и сопоставимую безопасность в исследовании CARAVAGGIO, но не смог доказать бóльшую безопасность в исследовании ADAM VTE. Было отмечено, что в структуре геморрагических осложнений при использовании ПОАК доминировали желудочно-кишечные и урогенитальные кровотечения. Результаты опубликованных исследований нашли отражение в современных рекомендациях специализированных сообществ. ПОАК (в частности, ривароксабан и эдоксабан) рекомендуются к применению для лечения ВТЭО у онкологических пациентов.

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