Гендерные особенности и современная оценка тромбоэмболических осложнений при фибрилляции предсердий (обзор литературы)

В статье рассматривается эволюция подходов к оценке риска тромбоэмболических осложнений (ТЭО) у пациентов с фибрилляцией предсердий с акцентом на роль гендерного фактора в шкале CHA₂DS₂-VASc, долгое время являющейся стандартом стратификации риска инсульта. Проведённый анализ исторических аспектов разных стратегий оценки риска ТЭО, начиная с рекомендаций 2001 г., когда не существовало единой оценки риска, до современных международных руководств 2024 г. доказывает, что целесообразно включение женского пола как независимого фактора риска инсульта. Современные данные свидетельствуют о нивелировании значимости гендерной принадлежности с течением времени в частоте возникновения инсультов среди пациентов с фибрилляцией предсердий и предлагают рассматривать женский пол лишь как модификатор риска инсульта, зависящий от возраста. Результаты исследований, проведённых в разных странах (Финляндия, Дания, Великобритания), подтверждают снижение влияния женского пола как самостоятельного фактора риска на частоту инсульта, определяя целесообразность перехода к упрощённой шкале CHA₂DS₂-VA (без учёта гендерной принадлежности). Авторы акцентируют внимание на важности индивидуальной эпизодической переоценки риска ТЭО, в особенности у пациентов с сопутствующей патологией, а также подчеркивают необходимость соблюдения настороженности при внедрении изменений в отечественную практику, учитывая специфику российской медицины и имеющиеся различия с системами здравоохранения других стран.

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