rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2020-11-12rpcardio-2361Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИModern Antiplatelet Therapy for Percutaneous Coronary Intervention. How to Make the Right Choice?Современная антитромбоцитарная терапия при чрескожном коронарном вмешательстве. Как сделать правильный выбор?УскачТ. М.UskachT. M.

Ускач Татьяна Марковна - доктор медицинских наук, ведущий научный сотрудник, НМИЦ кардиологии; профессор, кафедра кардиологии, РМАНПО121552, Москва, ул. 3-я Черепковская, 15а; 125993, Москва, ул. Баррикадная, 2/1 стр. 1.

Tatiana M. Uskach - MD PhD, Leading Researcher, National Medical Research Center of Cardiology; Professor, Chair of Cardiology, Russian Medical Academy of Continuous Professional Education.3-ya Cherepkovskaya ul. 15a, Moscow, 121552; Barrikadnaya ul. 2/1 build. 1, Moscow, 125993.

tuskach@mail.ruТерещенкоА. С.TereshchenkoA. S.

Терещенко Андрей Сергеевич - кандидат медицинских наук, научный сотрудник, НМИЦ кардиологии.121552, Москва, ул. 3-я Черепковская, 15а.

Andrey S. Tereshchenko - PhD, Researcher, National Medical Research Center of Cardiology.3-ya Cherepkovskaya ul. 15a, Moscow, 121552.

Научный медицинский исследовательский центр кардиологии; Российская медицинская академия непрерывного профессионального образованияРоссияNational Medical Research Center of Cardiology; Russian Medical Academy of Continuous Professional EducationRussian FederationНаучный медицинский исследовательский центр кардиологииРоссияNational Medical Research Center of CardiologyRussian Federation20203012202016610171023Copyright © Uskach T.M., Tereshchenko A.S., 20202020Ускач Т.М., Терещенко А.С.Uskach T.M., Tereshchenko A.S.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/2361

Dual antiplatelet therapy is the most important step in acute coronary syndrome (ACS) treatment. The new generation of inhibitors of P2Y12 platelet receptors (prasugrel and ticagrelor) provide more pronounced platelet inhibition than clopidogrel. The drugs differ in pharmacodynamics and platelet reactivity tests due to different mechanisms of binding to P2Y12 receptors. The antiplatelet effect of prasugrel and ticagrelor provides clinical benefit and better prognosis in patients with various forms of ACS. In patients with ST-segment elevation ACS prasugrel and ticagrelor are preferred over clopi-dogrel due to their higher efficacy and better clinical outcomes, and currently have preferential positions in guidelines compared to clopidogrel. The comparison of prasugrel versus ticagrelor (ISAR-REACT 5 trial) demonstrated superiority of prasugrel over ticagrelor in patients with ST-segment elevation ACS, for whom an invasive evaluation is planned and in early invasive treatment non-ST-segment elevation ACS. The choice of a drug for dual antiplatelet therapy in various clinical situations remains controversial. The latest ESC guidelines on non-ST elevation ACS (2020) [1] demonstrate the possible preference for prasugrel in patients with ACS without ST-segment elevation undergoing percutaneous coronary intervention. Current article demonstrates the results of recent clinical studies and the real clinical data regarding antiplatelet therapy in patients with coronary interventions. The indications for the use of P2Y12 platelet inhibitors in certain groups of patients are outlined. Treatment selection of the most effective and safe drugs in patients with ACS is highlighted according to the updated European guidelines.

Двойная антитромбоцитарная терапия является важнейшей составляющей лечения пациентов с острым коронарным синдромом (ОКС). Новые, более мощные ингибиторы P2Y12 рецепторов тромбоцитов (прасугрел и тикагрелор) по сравнению с клопидогрелом снижают частоту тромботических событий у пациентов с ОКС. В связи с различными механизмами связывания с рецепторами P2Y12 препараты отличаются по фармакодинамике и показателям реактивности тромбоцитов. Эффективное действие прасугрела и тикагрелора на агрегацию тромбоцитов находит свое отражение в преимуществах препаратов по влиянию на прогноз у пациентов с различными формами ОКС. В тактике лечения пациентов с ОКС и подъемом сегмента ST прасугрел и тикагрелор являются предпочтительными по сравнению с клопидогрелом в связи с большей эффективностью и лучшими клиническими исходами и имеют в настоящее время преимущественные позиции в рекомендациях по сравнению с клопидогрелом. Исследование прямого сравнения двух новых ингибиторов P2Y12 рецепторов тромбоцитов (ISAR-REACT 5) продемонстрировало преимущество прасугрела перед тикагрелором при планируемом первичном чрескожном коронарном вмешательстве у пациентов с ОКС с подъемом сегмента ST и при раннем инвазивном лечении ОКС без подъема сегмента ST. Актуальным является вопрос выбора препарата в двойной антиагрегантной терапии в различных клинических ситуациях. В последних Европейских рекомендациях по ведению пациентов с ОКС без подъема ST (2020) [1] указано на возможность предпочтительного назначения прасугрела у пациентов с ОКС без подъема сегмента ST, подвергнутых чрескожному коронарному вмешательству. В статье представлены результаты клинических исследований и данные реальной клинической практики, касающиеся антитромбоцитарной терапии у пациентов с вмешательствами на коронарных артериях. Изложены особенности показаний к применению ингибиторов P2Y12 рецепторов тромбоцитов у отдельных групп пациентов. Освещены актуальные вопросы выбора наиболее эффективных и безопасных препаратов у пациентов с ОКС в свете последних рекомендаций.

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