rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2021-04-13rpcardio-2441Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИAnticoagulation therapy in atrial fibrillation after intracranial hemorrhageАнтикоагулянтная терапия при фибрилляции предсердий у пациентов с внутричерепным кровоизлияниемhttps://orcid.org/0000-0002-7957-3770ГерасименкоА. С.GerasimenkoA. S.

Герасименко Анастасия Сергеевна – eLibrary SPIN 5800-2710

Волгоград

Anastasiya S. Gerasimenko - eLibrary SPIN 5800-2710

Volgograd

16any_61@mail.ruhttps://orcid.org/0000-0002-6565-2566ГорбатенкоВ. С.GorbatenkoV. S.

Горбатенко Владислав Сергеевич – eLibrary SPIN 6486-9110

Волгоград

Vladislav S. Gorbatenko - eLibrary SPIN 6486-9110

Volgograd

https://orcid.org/0000-0002-7311-4549ШаталоваО. В.ShatalovaO. V.

Шаталова Ольга Викторовна – eLibrary SPIN 3783-6286

Волгоград

Olga V. Shatalova - eLibrary SPIN 3783-6286

Volgograd

https://orcid.org/0000-0002-0258-4092ПетровВ. И.PetrovV. I.

Петров Владимир Иванович – eLibrary SPIN 2224-5311

Волгоград

Vladimir I. Petrov - eLibrary SPIN 2224-5311

Volgograd

Волгоградский государственный медицинский университетРоссияVolgograd State Medical UniversityRussian Federation202107052021172303309Copyright © Gerasimenko A.S., Gorbatenko V.S., Shatalova O.V., Petrov V.I., 20212021Герасименко А.С., Горбатенко В.С., Шаталова О.В., Петров В.И.Gerasimenko A.S., Gorbatenko V.S., Shatalova O.V., Petrov V.I.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/2441

Intracerebral hemorrhage (ICH) is severe and fatal complication of anticoagulant therapy with an incidence 0.3-0.7% per year. For patients with atrial fibrillation (AF) anticoagulants are administered for decreasing risk of stroke and systemic embolism. In this case the occurrence of intracranial bleeding is hard task for doctor. From the one side it is necessary to reverse the action of the drug for preventing the growth of hematoma. At the same time the discontinuation of therapy increases the risk of systemic embolism for patients with AF significantly. Clinical guidelines and studies have been reviewed about ICH during anticoagulant therapy. Nowadays there is no quality evidence about reversal of anticoagulant effects after ICH and optimal time of resumption of anticoagulant therapy. Firstly, we do not have large randomized controlled trials on this issue. The majority of clinical guidelines were based on retrospective studies and opinions of experts. Soon several randomized controlled trials will be finished and new data will be presented.

Внутричерепное кровоизлияние является наиболее тяжелым и жизнеугрожающим осложнением антикоагулянтной терапии, которое возникает у 0,3-0,7% пациентов в год. Наличие у человека фибрилляции предсердий требует назначения антикоагулянтов с целью профилактики системных тромбоэмболий, и развитие внутричерепного кровоизлияния у таких пациентов представляется весьма непростой клинической ситуацией для врача. С одной стороны, возникает необходимость реверсии действия препаратов для предотвращения увеличения объема гематомы. С другой стороны, прекращение антикоагулянтной терапии ведет к значительному повышению риска тромбоэмболических осложнений у пациентов с фибрилляцией предсердий. Авторами был выполнен обзор клинических рекомендаций и исследований, посвященных вопросам терапии пациентов с фибрилляцией предсердий, у которых на фоне приема антикоагулянтов возникло внутричерепное кровотечение. Было выявлено, что в настоящее время мы не располагаем достаточным количеством убедительных данных, касающихся вопросов реверсии действия антикоагулянтов при геморрагическом инсульте и оптимального времени возобновления антикоагулянтной терапии после перенесенного внутричерепного кровоизлияния. Связано это, в первую очередь, с отсутствием крупных рандомизированных проспективных исследований в этой области. Большинство имеющихся клинических рекомендаций основано на ретроспективных данных и мнении экспертов, но в скором времени ожидаются результаты нескольких клинических испытаний, которые предоставят дополнительную информацию в отношении терапии таких пациентов.

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