rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2025-3212HXLSOYrpcardio-3212Research ArticleREVIEWSОБЗОРЫPleiotropic properties of direct oral anticoagulants — new therapeutic horizonsПлейотропные свойства прямых оральных антикоагулянтов — новые горизонты терапииhttps://orcid.org/0000-0002-5972-6418ДавтянП. А.DavtianP. A.

Давтян Паруйр Артакович 

Уфа 

Paruir A. Davtian 

Ufa 

i@pdavtjan.ruhttps://orcid.org/0000-0003-2386-6707ЗагидуллинН. Ш.ZagidullinN. S.

Загидуллин Науфаль Шамилевич 

Уфа 

Naufal S. Zagidullin

Ufa

znaufal@mail.ruФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава РоссииРоссияBashkir State Medical UniversityRussian Federation202525102025214396403Copyright © Davtian P.A., Zagidullin N.S., 20252025Давтян П.А., Загидуллин Н.Ш.Davtian P.A., Zagidullin N.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/3212

Direct oral anticoagulants (DOACs), including factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) and the direct thrombin inhibitor dabigatran, are widely used for the prevention and treatment of thrombotic complications, particularly in patients undergoing major joint replacement, with atrial fibrillation (AF), as well as part of dual antithrombotic therapy (anticoagulant + antiplatelet) in patients after acute coronary syndrome and percutaneous coronary interventions, especially in the context of concomitant AF and an increased risk of systemic embolism. In recent years, there has been growing interest in studying the pleiotropic effects of DOACs that extend beyond their primary anticoagulant action on the hemostatic system. Accumulating experimental and clinical data suggest that these agents possess additional pharmacological properties — namely, anti-inflammatory, antiarrhythmic, and neuroprotective effects. The proposed molecular and cellular mechanisms include the reduction of proinflammatory cytokine levels, modulation of endothelial function, attenuation of oxidative stress, as well as favorable effects on myocardial remodeling processes and neurovascular protection. Such pleiotropic effects may play a significant pathophysiological role in slowing the progression of cardiovascular and cerebrovascular diseases, contributing to the reduction of complications and improvement of clinical outcomes. Understanding the pleiotropic properties of DOACs provides a foundation for their broader clinical application as part of integrated treatment strategies for cardiovascular, inflammatory, and cerebrovascular diseases. This review summarizes current data on the pleiotropic actions of oral anticoagulants and discusses their potential contribution to enhancing the effectiveness and individualization of pharmacotherapy in clinical cardiology.

Прямые оральные антикоагулянты (ПОАК), включая ингибиторы фактора Xa (ривароксабан, апиксабан, эдоксабан) и прямой ингибитор тромбина (дабигатран), широко применяются для профилактики и лечения тромботических осложнений, в частности при эндопротезировании крупных суставов, неклапанной фибрилляции предсердий (ФП), а также в составе двойной антитромботической терапии (антикоагулянт + антиагрегант) у пациентов после острого коронарного синдрома и чрескожных коронарных вмешательств, особенно в контексте сопутствующей ФП и повышенного риска системной эмболии. В последние годы значительно усиливается интерес к исследованию плейотропных эффектов ПОАК, выходящих за пределы их основного антикоагулянтного действия. Накапливающиеся экспериментальные и клинические данные свидетельствуют о наличии у этих препаратов дополнительных фармакологических свойств — в частности, противовоспалительного, антиаритмического и нейропротективного действия. Предложенные молекулярные и клеточные механизмы включают снижение уровня провоспалительных цитокинов, модуляцию функций эндотелия, уменьшение выраженности оксидативного стресса, а также положительное влияние на процессы ремоделирования миокарда и нейроваскулярную защиту. Подобные плейотропные эффекты могут играть важную патофизиологическую роль в замедлении прогрессирования сердечно-сосудистых и цереброваскулярных заболеваний, способствуя уменьшению частоты осложнений и улучшая клинические исходы пациентов. Понимание плейотропных свойств ПОАК формирует предпосылки для их более широкого клинического применения в составе комплексной терапии сердечно-сосудистых, воспалительных и цереброваскулярных заболеваний. В настоящем обзоре рассматриваются современные данные о плейотропных свойствах ПОАК и обсуждается их потенциальный вклад в повышение эффективности и индивидуализацию фармакотерапии в клинической кардиологии.

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