rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2021-10-01rpcardio-2590Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИGastrointestinal Bleeding: a Cardiologist's Point of ViewЖелудочно-кишечные кровотечения с точки зрения кардиологаhttps://orcid.org/0000-0002-3010-755XАверковО. В.AverkovO. V.

Аверков Олег Валерьевич

Москва, eLibrary SPIN 9284-7173

Oleg V. Averkov

Moscow, eLibrary SPIN 9284-7173

oleg.averkov@gmail.comhttps://orcid.org/0000-0002-4189-1116МищенкоЛ. Н.MishchenkoL. N.

Мищенко Лидия Никитична

Москва

Мищенко Лидия Никитична

Москва

Городская Клиническая Больница № 15 им. О.М. ФилатоваРоссияMoscow City Clinical Hospital №15 n.a. O. M. FilatovaRussian Federation202103112021175771778Copyright © Averkov O.V., Mishchenko L.N., 20212021Аверков О.В., Мищенко Л.Н.Averkov O.V., Mishchenko L.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/2590

Oral anticoagulant therapy is widely used in different patients for the prevention and treatment of thromboembolic events: in atrial fibrillation, deep vein thrombosis/pulmonary embolism, acute coronary syndrome, in the early postoperative period after orthopedic surgery. Nowadays it is possible to use vitamin K antagonists (warfarin) as well as direct oral anticoagulants (DOAC): dabigatran, rivaroxaban, apixaban and edoxaban. The mai complication of any anticoagulant therapy is bleeding (gastrointestinal, intracranial, etc.), which seriously limits its usage. In this review the incidence of gastrointestinal bleeding (GIB) associated with oral anticoagulants intake was analyzed according to the results of both large randomized and postregistration trials. Furthermore, the effect of age on the risk of GIB development is discussed, and also aspects of the pathophysiology of gastrointestinal mucosa lesions in patients taking DOAC are considered.

Пероральная антикоагулянтная терапия широко используется у различных пациентов для профилактики и лечения тромбоэмболических состояний: при фибрилляции предсердий, тромбозе глубоких вен/тромбоэмболии лёгочной артерии, остром коронарном синдроме, в послеоперационном периоде у больных, перенесших ортопедические хирургические вмешательства. В настоящее время с целью длительной антикоагуляции возможно применение как антагонистов витамина К (варфарина), так и прямых оральных антикоагулянтов (ПОАК): дабигатрана, ривароксабана, апиксабана и эдоксабана. Основным осложнением любой антикоагулянтной терапии являются кровотечения (желудочно-кишечные, внутричерепные и др.), что серьёзно ограничивает её применение. В настоящем обзоре на основе результатов как крупных рандомизированных, так и пострегистрационных исследований проведён анализ встречаемости желудочно-кишечных кровотечений (ЖКК) на фоне приёма различных пероральных антикоагулянтов. Кроме этого, обсуждается влияние возраста на риск развития ЖКК, а также рассматриваются аспекты патофизиологии поражения слизистой желудочно-кишечного тракта при приёме ПОАК.

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