ЭФФЕКТИВНОСТЬ И БЕЗОПАСНОСТЬ ПРИМЕНЕНИЯ АЦЕТИЛСАЛИЦИЛОВОЙ КИСЛОТЫ В ПЕРВИЧНОЙ И ВТОРИЧНОЙ ПРОФИЛАКТИКЕ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ

Освещены вопросы, касающиеся применения ацетилсалициловой кислоты (АСК) в первичной и вторичной профилактике сердечно-сосудистых заболеваний. Обсуждаются дазагрегационные механизмы действия АСК. Представлены данные об эффективности и безопасности применения препаратов АСК с целью первичной и вторичной профилактики, полученные в рандомизированных контролируемых исследованиях. Обозначены основные группы пациентов, которые нуждаются в назначении АСК с профилактической целью согласно современным клиническим рекомендациям. Рассматривается баланс между пользой и риском, связанным с её приемом, и способы повышения безопасности антиагрегантной терапии, в том числе за счет использования кишечно-растворимых форм АСК.

1. Global strategy for prevention and control of non-communicable disease. Geneva: WHO; 2008.

2. Oganov R.G., Lepakhin V.K., Fitilev S.B. et al. Diagnosis and therapy of stable angina in Russian Federation (International Study ATP - angina treatment pattern). Kardiologiia 2003;43(5):9–15. Russian (Оганов Р .Г ., Лепахин В.К., Фитилев С.Б. и др. Особенности диагностики и терапии стабильной стенокардии в Российской Федерации (международное исследование ATP–Angina Treatment Pattern). Кардиология 2003; 5: 9–15).

3. Komarov A.L., Panchenko E.L. The value of antiplatelet therapy for prevention of atherosclerosis. Russkiy meditsinskiy zhurnal 2003; 11(19): 1102–1106. Russian (Комаров А.Л., Панченко Е.Л. Значение антитромботической терапии для профилактики атеросклероза. Русский Медицинский Журнал 2003; 11(19): 1102–1106).

4. Panchenko EP , Belenkov IuN. Characteristics and outcomes of atherothrombosis in ambulatory patients in Russian

5. Federation (according to materials of international register REACH). Kardiologiia. 2008;48(2):17–24. Russian (Панченко Е.П., Беленков Ю.Н. Характеристика и исходы атеротромбоза у амбулаторных больных в Российской Федерации (по материалам международного регистра REACH). Кардиология 2008; 2: 17–24).

6. National guidelines for diagnosis and correction of disorders of lipid metabolism in order to prevent and treat atherosclerosis. Kardiovaskulyarnaya Terapiya i Profilaktika 2007;6 (6) Prilozhenie 3: 1–32. Russian (Национальные рекомендации по диагностике и коррекции нарушений липидного обмена с целью профилактики и лечения атеросклероза. Кардиоваскулярная Терапия и Профилактика 2007;6 (6) Приложение 3: 1–32).

7. Harrington RA, Becker RC, Ezekowitz M. et al. Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (3) Suppl: 513S–548S.

8. Tran H., Anand S. Oral antiplatelet therapy in cerebrovascular disease, coronary artery disease, and peripheral arterial disease. JAMA 2004; 292 (15): 1867–1874.

9. Cleland JGF . Aspirin. In: Mann D.L., ed. Heart Failure: A Companion to Braunwald's Heart Disease. New York: Elsevier Science; 2004: 660–669.

10. Grosser N, Schröder H. Aspirin protects endothelial cells from oxidant damage via the nitric oxide-cGMP pathway. Arterioscler Thromb Vasc Biol 2003;23(8):1345–51.

11. McConnel H. Collaborative meta–analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J 2002; 324: 71–86.

12. Ridker PM, Manson JE, Gaziano JM, et al. Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial. Ann Intern Med 1991;114(10):835–839.

13. Juul-Moller S, Edvardsson N, Jahnmatz B et al. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Lancet 1992;340(8833):1421–1425.

14. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trail of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS–2. Lancet 1988; 2(8607): 349–360.

15. Baigent C, Collins R, Appleby P et al. ISIS-2 Collaborative Group. ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither . BMJ 1998; 316(7141): 1337–1343.

16. Hansson L., Zanchetti A., Carruthers S.G. et al. Effects of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: principal results of Hypertension Optimal Treatment (HOT) randomized trial. Lancet 1988; 351(9118): 1762—66.

17. Baigent C, Blackwell L, Collins R et al. Antithrombotic Trialists' (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomized trials. Lancet 2009; 373 (9678):1849–60.

18. Raju N, Sobieraj-Teague M, Hirsh J, et al. Effect of Aspirin on Mortality in the Primary Prevention of Cardiovascular Disease. The American Journal of Medicine 2011; 124(7): 621–629.

19. Okada S, Morimoto T , Ogawa H et al. Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes Trial Investigators. Diabetes Care 2011;34(6):1277–83.

20. Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; 337:1840.

21. Graham I, Atar D, Borch-Johnsen R et al. European Atherosclerosis Society (EAS). European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14 Suppl 2: S1–113.

22. Becker R.C., Meade T .W., Berger P .B. et al. The Primary and Secondary Prevention of Coronary Artery Disease. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 776S–814S.

23. Patrono C., Baigent C., Hirsh J., Roth G. Antiplatelet Drugs. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:199–233.

24. Mancia G., De Backer G., Dominiczak A. et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25 (6):1105—1187.

25. Calonge N, Petitti DB, DeWitt TG, et al. Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2009;150:396–404.

26. Patrono C., Coller B., FitzGerald GA Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy . Chest 2004;126(3 Suppl):234S– 264S.

27. National guidelines for cardiovascular prevention. Kardiovaskulyarnaya Terapiya i Profilaktika 2011; 10 (6) suppl 2: 1–35. Russian (Национальные рекомендации по кардиоваскулярной профилактике. Кардиоваскулярная Терапия и Профилактика 2011; 10 (6) Приложение 2: 1–42).

28. Collet J.P ., Montalescot G., Blanchet B. et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation 2004; 110: 2361–7.

29. Moyer P . Repeat Ischemic Stroke More Likely With Interruption of Aspirin Prophylaxis. 30th International Stroke Conference. February 2–4, 2005; New Orleans, Louisiana. Abstract P87.

30. Rodríguez LA, Cea-Soriano L, Martín-Merino E, Johansson S. Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care. BMJ 2011; 343:d4094.

31. Ferrari E, Benhamou M, Cerboni P , Marcel B. Coronary syndromes following aspirin withdrawal. A special risk for late stent thrombosis. J Am Coll Cardiol 2005; 45(3): 456–9.

32. Taylor D.W., Barnett H.J., Haynes R.B. et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: randomized controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet 1999;353:2179–84.

33. Lanza FL. A guideline for the treatment and prevention of NSAID — induced ulcer . Members of the AdHoc Committee on Practice Parameters of the American College of Gastroenterology . Am J Gastroenterol 1998;93(11):2037–46.

34. Lanas A. Cyclo-oxygenase-1/cyclo-oxygenase-2 non selective non-steroidal anti-inflammatory drugs: epidemiology of gastrointerstinal events. Dig Liver Dis 2002; 33 (Suppl 2): S29–S34.

35. Patrono C. Aspirin as an antiplatelet drug. N Engl J Med 1994; 330: 1287–94.

36. Weil J, Colin-Jones D, Langman M et. al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310: 827–30.

37. García Rodríguez LA, Cattaruzzi C, Troncon MG, Agostinis L. Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal and anti–inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Intern Med 1998; 158: 33–9.

38. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010;122(24):2619–2633.

39. Scheiman JM. Strategies to reduce the GI risks of antiplatelet therapy. Rev Cardiovasc Med 2005; 6 Suppl 4:23–31.

40. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 28 2008;118(18):1894–1909.

41. Chan FK, Ching JY , Hung LC et. al. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005; 352: 238–44.

42. Edgar B, Bogentoft C, Lagerstrom PO. Comparison of two enteric-coated acetylsalicylic acid preparations by monitoring steady-state levels of salicylic acid and its metabolites in plasma and urine. Biopharm Drug Dispos 1984; 5(3): 251–60.

43. Kelly J P , Kaufman DW, Jurgelon JM et al. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 1996; 348: 1413–141.

44. Dietz R, Rauch B. Leitlinie zur Diagnose und Behandlung der chronischen koronaren Herzerkrankung der Deutschen Gesellschaft Kardiologie — Herz- und Kreislaufforschung (DGK). Z Kardiol 2003; 92: 501–521.

45. Kubler W, Darius H. Primγre Prγvention der koronaren Herzkrankheit mit Aspirin. Z Kardiol 2005; 93: 66–73.

46. Martsevich S.Yu., Tolpygina S.N., Boychenko E. S. et al. Comparison of antiplatelet efficacy of original and generic enterosoluble acetylsalicylic acid in patients with high cardiovascular risk. Simple blind crossed randomized controlled study (IKAR). Rational Pharmacother Card 2010;6(6):796–802. Russian (Марцевич С.Ю., Толпыгина С.Н., Бойченко Е.С. и др. Сравнительное изучение дезагрегантной эффективности оригинального и воспроизведенного препарата ацетилсалициловой кислоты в кишечно-растворимой форме у пациентов высокого риска сердечно-сосудистых осложнений. Простое слепое перекрестное рандомизированное контролируемое исследование (ИКАР). РФК 2010;6(6):796–802).

47. National guidelines for the efficacy and safety of drug therapy for primary and secondary prifilaktike cardiovascular disease. Rational Pharmacother Card 2010;7(5) suppl: 1–72. Russian (Национальные рекомендации по эффективности и безопасности лекарственной терапии при первичной и вторичной профилактике сердечно-сосудистых заболеваний. РФК 2011; 7(5) приложение: 1–72).