Anticoagulant Therapy in Difficult Patients with Atrial Fibrillation: When the Risks of Embolism and Bleeding Are Comparable
https://doi.org/10.20996/1819-6446-2018-14-5-785-789
Abstract
This article affects the problems of using NOAC in the most defenseless groups of patients with atrial fibrillation: those who have high bleeding and high thromboembolic risk and elderly. The focus is on comparison of effectiveness and safety of NOACs based on randomized clinical trials (RCT) and real-world data (RWD). The possible reasons for the different interpretation of the data of the RCT and the RWD are shown. Use of NOAC in reduced doses prescribing according to RCT and RWD are shown. Our own 13-month observation of patients 75 years and older with very high thromboembolic risk (CHA2DS2-VASc – 4,5 points) on rivaroxaban therapy are presented. Good efficacy and safety of full and reduced doses of rivaroxaban were demonstrated: only 2 episodes of small bleedings and no large bleedings (ISTH criteria) were detected as well as no thromboembolic events. Thus, even difficult patients with AF and comorbidity may be safely and effectively treated with NOACs taking into consideration integrated approach and correction of modifiable risk factors.
About the Authors
D. A. Napalkov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Dmitry A. Napalkov – MD, PhD, Professor, Chair of Faculty Therapy №1, Medical Faculty.
Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435.
A. A. Sokolova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Anastasiya A. Sokolova – MD, PhD, Assistant, Chair of Faculty Therapy №1, Medical Faculty.
Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435.
M. A. Gabitova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Mariia A. Gabitova – MD, Post-Graduate Student, Chair of Faculty Therapy №1, Medical Faculty.
Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435.
L. N. Uddin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Luisa N. Uddin – MD, Post-Graduate Student, Chair of Faculty Therapy №1, Medical Faculty.
Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435.
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Review
For citations:
Napalkov D.A., Sokolova A.A., Gabitova M.A., Uddin L.N. Anticoagulant Therapy in Difficult Patients with Atrial Fibrillation: When the Risks of Embolism and Bleeding Are Comparable. Rational Pharmacotherapy in Cardiology. 2018;14(5):785-789. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-5-785-789
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