avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2020-10-5-348-356avk-1088Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESСовременные подходы к проведению оптимальной антитромботической терапии при стабильной ишемической болезни сердцаModern Approaches to Optimal Antithrombotic Therapy for Stable Ischemic Heart DiseaseРойтбергГ. Е.RoytbergG. E.

Кафедра терапии, общей врачебной практики и ядерной медицины факультета дополнительного профессионального образования

Москва

School of Continuing Medical Education

Moscow

https://orcid.org/0000-0002-4076-2849СластниковаИ. Д.SlastnikovaI. D.

Ирина Дмитриевна Сластникова - кафедра терапии, общей врачебной практики и ядерной медицины факультета дополнительного профессионального образования

Москва

School of Continuing Medical Education

Moscow

slastid@mail.ruФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Минздрава РоссииРоссияPirogov Russian National Research Medical University (RNRMU)Russian Federation202008102020105348356Copyright © Ройтберг Г.Е., Сластникова И.Д., 20202020Ройтберг Г.Е., Сластникова И.Д.Roytberg G.E., Slastnikova I.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1088

В статье освещены практические аспекты применения антитромботической терапии у больных стабильной (хронической) ИБС. Рассмотрены вопросы верификации ИБС с применением современных функциональных и анатомических ме тодов исследования. Больные с хронической ИБС представляют неоднородную группу с различными клиническими вариантами. Приведена информация по основным факторам риска ишемических и геморрагических осложнений, определяющим выбор оптимальных схем антитромботической терапии. Представлены современные взгляды на применение аспирина и клопидогреля в режиме монотерапии при стабильной ИБС. Приведены данные наиболее крупных международных исследований CHARISMA и PEGASUS-TIMI 54 по применению двойной антитромбоцитарной терапии у больных хронической ИБС, нашедших отражение в современных рекомендациях, подчеркнуты особенности новых антиагрегантов (прасугрела и тикагрелола). На основании результатов исследования COMPASS рассмотрены показания к назначению малых доз ривароксабана в сочетании с аспирином для вторичной профилактики сердечно-сосудистых осложнений у больных со стабильными проявлениями атеросклероза, имеющими низкий риск кровотечений. Применение антитромботической терапии связано с увеличением риска кровотечений и, прежде всего, с повышением риска желудочно-кишечных кровотечений. Представлена информация по использованию препаратов для профилактики желудочно-кишечных кровотечений.

Антитромботическая терапия позволяет снизить риск осложнений, связанных с атеротромбозом, однако для улучшения прогноза при стабильной ИБС необходимо комплексное вмешательство, включающее воздействие на факторы риска и назначение препаратов разных групп с доказанной эффективностью. Оптимальная медикаментозная терапия, включающая антитромботические препараты, является основой ведения больных стабильной ИБС, позволяя успешно предотвращать большинство неблагоприятных исходов.

The article highlights the practical aspects of the use of antithrombotic therapy in patients with stable (chronic) coronary artery disease (САD). The САD verification using modern functional and anatomical diagnostic methods are considered. Patients with stable САD represent a heterogeneous group, having various clinical scenarios. Information is provided on the main risk factors for ischemic and hemorrhagic complications that determine the choice of optimal antithrombotic therapy regimens. Modern views on the monotherapy and clopidogrel in САD are presented. The data of the largest international studies CHARISMA and PEGASUS-TIMI 54 on the use of double antiplatelet therapy in patients with stable IHD reflected in modern guidelines are highlighted. Features of new antiplatelet agents (prasugrel and ticagrelol) are described. Based on the results of the COMPASS study, indications for the administration of small doses of rivaroxaban in combination with aspirin for the secondary prevention of cardiovascular complications in patients with stable manifestations of atherosclerosis with a low risk of bleeding are considered. The use of antithrombotic therapy is associated with an increased risk of bleeding and particularly with gastrointestinal bleeding. The information on the use of drugs for the prevention of gastrointestinal bleeding is provided.

Antithrombotic therapy can reduce the risk of complications associated with atherothrombosis, however, to improve prognosis a multipurpose intervention is required, including correction of risk factors and the use of drugs from different groups with proven effectiveness. Optimal medical therapy, including antithrombotic drugs, is vital for patients with САD and can successfully prevent adverse outcomes.

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