Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Основные принципы антитромбоцитарной терапии с позиции новых рекомендаций
________________________________________________
Bubnova M.G., Mihin V.P. Basic principles of antiplatelet therapy from the perspective of new recommendations. Cardiosomatics. 2017; 8 (4): 26–35.
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Ключевые слова: ацетилсалициловая кислота, атеротромбоз, двойная антиагрегационная терапия, ингибиторы P2Y12.
________________________________________________
In the presented review, some of the main points of the new European recommendations on the use of double antiplatelet therapy (DAT) and triple antithrombotic therapy in patients with coronary heart disease (CHD) with different approaches to its treatment (conservative, invasive and surgical) are outlined. The positions of acetylsalicylic acid (ASA) are designated as the primary basis of a prophylactic antiplatelet strategy. Attention is paid to a new risk stratification for the calculation of the duration of DAT, recommendations for the proper choice of receptor inhibitors for adenosine diphosphate type P2Y12, for switching between oral inhibitors of P2Y12 and for the duration of DAT in different forms of CHD. The review discusses adherence to therapy with ASA and DAT.
Key words: acetylsalicylic acid, atherothrombosis, double antiplatelet therapy, P2Y12 inhibitors.
2. Munger MA, Hawkins DW. Atherothrombosis: epidemiology, pathophysiology, and prevention. J Am Pharm Assoc 2004; 44 (2 Suppl. 1): S5–S12.
3. Blatt DL, Steg PG, Ohman EM et al International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180–9.
4. Garg VP, Halperin JL. Novel Antiplatelet and Anticoagulant Agents in the Cardiac Care Unit. Cardiol Clin 2013; 31: 533–44.
5. Weiss HJ, Aledort LM Impaired platelet/connective-tissue reaction in man after aspirin ingestion. Lancet 1967; 2: 495–7.
6. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action of aspirin-like drug. Nature (New Biol) 1971; 231: 232–5.
7. Smith JH, Willis AL. Aspirin selectively inhibits prostaglandin production in human platelets. Nature (New Biol) 1971; 231: 235–7.
8. Patrono C, Ciabattoni G, Patrignani P et al. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation 1985; 72: 1177–84.
9. Cleland JGF. Fspirin. In D.L.Mann. Heart Failure 2004, Elsevier Inc.; p. 660–9.
10. Grosser N, Schröder H. Aspirin Protects Endothelial Cells From Oxidant Damage Via the Nitric Oxide-cGMP Pathway. Arterios Thromb Vasc Biol 2003; 23: 1345–8.
11. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315–81. DOI: 10.1093/eurheartj/ehw106
12. Ibanez B, James S, Agewall S et al. 2017 ESC Guidelines for themanagement of acutemyocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017; 00: 1–66. DOI: 10.1093/eurheartj/ ehx393
13. Roffi M, Patrono C, Collet J-P et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2015. DOI: 10.1093/eurheartj/ehv320.
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; 2i: 349–60.
15. Antiplatelet Trialists’Collaboration. Collaborative overview of randomized of antiplatelet therapy: I Prevention of death, myocardial infarction, and stroke by prolonged anti-platelet in various categories of patients. BMJ 1994; 308: 81–106.
16. Antithrombotic Trialists’Collaboration. Collaborative meta-analysis of randomised trials of antiplateletAntithrombotic Trialists’Collaboration. Collaborative meta-analysis of randomised trials of antiplatelettherapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86.
17. Deja MA, Kargul T, Domaradzki W et al. Effects of preoperative aspirin in coronary artery bypass grafting: a double-blind, placebo-controlled, randomized trial. J Thorac Cardiovasc Surg 2012; 144: 204–9.
18. Cao L, Young N, Liu H et al. Preoperative aspirin use and outcomes in cardiac surgery patients. Ann Surg 2012; 255: 399–404.
19. Бокерия Л.А., Аронов Д.М. и др. Российские клинические рекомендации. Коронарное шунтирование больных ишемической болезнью сердца: реабилитация и вторичная профилактика. CardioСоматика. 2016; 7 (3–4): 5–71. / Bokeriya L.A., Aronov D.M. et al. Russian clinical guidelines. Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. Cardiosomatics. 2016; 7 (3–4): 5–71. [in Russian]
20. Sousa-Uva M, Storey R, Huber K et al, on behalf of ESC Working Group on Cardiovascular Surgery and ESC Working Group on Thrombosis Expert position paper on the management of antiplatelet therapy in patients undergoing coronary artery bypass graft surgery. Eur Heart J 2014; 35: 1510–4. DOI: 10.1093/eurheartj/ehu158
21. Fabricius AM, Gerber W, Hanke M et al. Early angiographic control of perioperative ischemia after coronary artery bypass grafting. Eur J Cardiothorac Surg 2001; 19: 853–8.
22. Puskas JD, Williams WH, Mahoney EM et al. Off-pumpvs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA J Am Med Assoc 2004; 291: 1841–9.
23. Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75: S715–S20.
24. Kulik A, Ruel M, Jneid H et al, on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association. Circulation 2015; 131 (10): 927–64. DOI: 10.1161/CIR.000000 0000000182
25. Bednar F, Tencer T, Plasil P et al. Evaluation of aspirin’s effect on platelet function early after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2012; 26: 575–80. DOI: 10.1053/j.jvca.2011.12.004
26. Mangano DT. Aspirin and mortality from coronary bypass surgery. N Eng J Med 2002; 347: 1309–17.
27. Mehta RH, Sheng S, O’Brien SM et al. Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes 2009; 2: 583–90.
28. Sharma GV, Khuri SF, Josa M et al. The effect of antiplatelet therapy on saphenous vein coronary artery bypass graft patency. Circulation 1983; 68: II218–21.
29. Рафальский В.В., Крикова А.В., Павлюченкова Н.А. Низкодозовый аспирин: разнообразие лекарственных форм. Кардиоваск. профилактика и терапия. 2017; 16 (4): 68–75. / Rafal'skii V.V., Krikova A.V., Pavliuchenkova N.A. Nizkodozovyi aspirin: raznoobrazie lekarstvennykh form. Kardiovask. profilaktika i terapiia. 2017; 16 (4): 68–75. [in Russian]
30. Рафальский В.В., Крикова А.В. Клиническая фармакология ацетилсалициловой кислоты и особенно лекарственных форм – ключ к эффективному и безопасному применению для профилактики тромбозов. Мед. совет. 2016; 5: 26–33. / Rafal'skii V.V., Krikova A.V. Klinicheskaia farmakologiia atsetilsalitsilovoi kisloty i osobenno lekarstvennykh form – kliuch k effektivnomu i bezopasnomu primeneniiu dlia profilaktiki trombozov. Med. sovet. 2016; 5: 26–33. [in Russian]
31. Garcia Rodriguez LA, Hernandez-Diaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol 2001; 52: 563–71.
32. Nakatani D, Sakata Y, Suna S et al, Osaka Acute Coronary Insufficiency Study (OACIS) Investigators. Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction. Circ J 2013; 77 (2): 439–46.
33. Stone GW, Maehara A, Lansky AJ et al, PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364 (3): 226–35.
34. Population Division. Department of Economic and Social Affairs. United Nations. Revision of World Population Prospects. https://esa.un.org/unpd/wpp/
35. Schomig A, Neumann FJ, Kastrati A et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334: 1084–9.
36. Valgimigli M, Bueno H, Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J 2017; 0: 1–48. DOI: 10.1093/eurheartj/ehx419
37. Yeh RW, Secemsky EA, Kereiakes DJ et al, DAPT Study Investigators. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 2016; 315: 1735–49.
38. Costa F, van Klaveren D, James S et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 2017; 389: 1025–34.
39. Eagle KA, Kline-Rogers E, Goodman SG et al. Adherence to evidence based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med 2004; 117: 73–81. DOI: 10.1016/j.amjmed.2003.12.041
40. Sud A, Kline-Rogers EM, Eagle KA et al. Adherence to medications by patients after acute coronary syndromes. Ann Pharmacother 2005; 39: 1792–7. DOI: 10.1345/aph.1G249
41. Kulkarni SP, Alexander KP, Lytle B et al. Long-term adherence with cardiovascular drug regimens. Am Heart J 2006; 151: 185–91.
42. Herlitz J, Tуth PP, Naesdal J. Low-dose aspirin therapy for cardiovascular prevention: quantification and consequences of poor compliance or discontinuation. Am J Cardiovasc Drugs 2010; 10: 125–41. DOI: 10.2165/11318440-000000000-00000
43. Sundström J, Hedberg J, Thuresson M et al. Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events. A Swedish Nationwide, Population-Based Cohort Study. Circulation 2017; 136: 1183–92. DOI: 10.1161/CIRCULATIONAHA.117.028321
44. Mehran R, Baber U, Steg PG et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 2013. http: //dx.doi.org/10.1016/S0140–6736 (13)61720-1
45. Бубнова М.Г., Холмогорова Г.Т., Худяков М.Б. и др. Как больные с сердечно-сосудистыми заболеваниями понимают некоторые медицинские термины? Профилактическая мед. 2016; 2: 36–42. / Bubnova M.G., Kholmogorova G.T., Khudiakov M.B. i dr. Kak bol'nye s serdechno-sosudistymi zabolevaniiami ponimaiut nekotorye meditsinskie terminy? Profilakticheskaia med. 2016; 2: 36–42. [in Russian]
46. Бубнова М.Г. Понимание некоторых медицинских терминов мужчинами и женщинами с сердечно-сосудистыми заболеваниями. Проблемы женского здоровья. 2016; 3: 5–11. / Bubnova M.G. Ponimanie nekotorykh meditsinskikh terminov muzhchinami i zhenshchinami s serdechno-sosudistymi zabolevaniiami. Problemy zhenskogo zdorov'ia. 2016; 3: 5–11. [in Russian]
________________________________________________
1. Organização Mundial da Saúde (OMS). [citado 2012 abril 10]. Disponível em: http://www.who.int.
2. Munger MA, Hawkins DW. Atherothrombosis: epidemiology, pathophysiology, and prevention. J Am Pharm Assoc 2004; 44 (2 Suppl. 1): S5–S12.
3. Blatt DL, Steg PG, Ohman EM et al International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180–9.
4. Garg VP, Halperin JL. Novel Antiplatelet and Anticoagulant Agents in the Cardiac Care Unit. Cardiol Clin 2013; 31: 533–44.
5. Weiss HJ, Aledort LM Impaired platelet/connective-tissue reaction in man after aspirin ingestion. Lancet 1967; 2: 495–7.
6. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action of aspirin-like drug. Nature (New Biol) 1971; 231: 232–5.
7. Smith JH, Willis AL. Aspirin selectively inhibits prostaglandin production in human platelets. Nature (New Biol) 1971; 231: 235–7.
8. Patrono C, Ciabattoni G, Patrignani P et al. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation 1985; 72: 1177–84.
9. Cleland JGF. Fspirin. In D.L.Mann. Heart Failure 2004, Elsevier Inc.; p. 660–9.
10. Grosser N, Schröder H. Aspirin Protects Endothelial Cells From Oxidant Damage Via the Nitric Oxide-cGMP Pathway. Arterios Thromb Vasc Biol 2003; 23: 1345–8.
11. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315–81. DOI: 10.1093/eurheartj/ehw106
12. Ibanez B, James S, Agewall S et al. 2017 ESC Guidelines for themanagement of acutemyocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017; 00: 1–66. DOI: 10.1093/eurheartj/ ehx393
13. Roffi M, Patrono C, Collet J-P et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2015. DOI: 10.1093/eurheartj/ehv320.
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; 2i: 349–60.
15. Antiplatelet Trialists’Collaboration. Collaborative overview of randomized of antiplatelet therapy: I Prevention of death, myocardial infarction, and stroke by prolonged anti-platelet in various categories of patients. BMJ 1994; 308: 81–106.
16. Antithrombotic Trialists’Collaboration. Collaborative meta-analysis of randomised trials of antiplateletAntithrombotic Trialists’Collaboration. Collaborative meta-analysis of randomised trials of antiplatelettherapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86.
17. Deja MA, Kargul T, Domaradzki W et al. Effects of preoperative aspirin in coronary artery bypass grafting: a double-blind, placebo-controlled, randomized trial. J Thorac Cardiovasc Surg 2012; 144: 204–9.
18. Cao L, Young N, Liu H et al. Preoperative aspirin use and outcomes in cardiac surgery patients. Ann Surg 2012; 255: 399–404.
19. Bokeriya L.A., Aronov D.M. et al. Russian clinical guidelines. Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. Cardiosomatics. 2016; 7 (3–4): 5–71. [in Russian]
20. Sousa-Uva M, Storey R, Huber K et al, on behalf of ESC Working Group on Cardiovascular Surgery and ESC Working Group on Thrombosis Expert position paper on the management of antiplatelet therapy in patients undergoing coronary artery bypass graft surgery. Eur Heart J 2014; 35: 1510–4. DOI: 10.1093/eurheartj/ehu158
21. Fabricius AM, Gerber W, Hanke M et al. Early angiographic control of perioperative ischemia after coronary artery bypass grafting. Eur J Cardiothorac Surg 2001; 19: 853–8.
22. Puskas JD, Williams WH, Mahoney EM et al. Off-pumpvs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA J Am Med Assoc 2004; 291: 1841–9.
23. Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75: S715–S20.
24. Kulik A, Ruel M, Jneid H et al, on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia Secondary prevention after coronary artery bypass graft surgery: A scientific statement from the American Heart Association. Circulation 2015; 131 (10): 927–64. DOI: 10.1161/CIR.000000 0000000182
25. Bednar F, Tencer T, Plasil P et al. Evaluation of aspirin’s effect on platelet function early after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2012; 26: 575–80. DOI: 10.1053/j.jvca.2011.12.004
26. Mangano DT. Aspirin and mortality from coronary bypass surgery. N Eng J Med 2002; 347: 1309–17.
27. Mehta RH, Sheng S, O’Brien SM et al. Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes 2009; 2: 583–90.
28. Sharma GV, Khuri SF, Josa M et al. The effect of antiplatelet therapy on saphenous vein coronary artery bypass graft patency. Circulation 1983; 68: II218–21.
29. Rafal'skii V.V., Krikova A.V., Pavliuchenkova N.A. Nizkodozovyi aspirin: raznoobrazie lekarstvennykh form. Kardiovask. profilaktika i terapiia. 2017; 16 (4): 68–75. [in Russian]
30. Rafal'skii V.V., Krikova A.V. Klinicheskaia farmakologiia atsetilsalitsilovoi kisloty i osobenno lekarstvennykh form – kliuch k effektivnomu i bezopasnomu primeneniiu dlia profilaktiki trombozov. Med. sovet. 2016; 5: 26–33. [in Russian]
31. Garcia Rodriguez LA, Hernandez-Diaz S, de Abajo FJ. Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies. Br J Clin Pharmacol 2001; 52: 563–71.
32. Nakatani D, Sakata Y, Suna S et al, Osaka Acute Coronary Insufficiency Study (OACIS) Investigators. Incidence, predictors, and subsequent mortality risk of recurrent myocardial infarction in patients following discharge for acute myocardial infarction. Circ J 2013; 77 (2): 439–46.
33. Stone GW, Maehara A, Lansky AJ et al, PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364 (3): 226–35.
34. Population Division. Department of Economic and Social Affairs. United Nations. Revision of World Population Prospects. https://esa.un.org/unpd/wpp/
35. Schomig A, Neumann FJ, Kastrati A et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334: 1084–9.
36. Valgimigli M, Bueno H, Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J 2017; 0: 1–48. DOI: 10.1093/eurheartj/ehx419
37. Yeh RW, Secemsky EA, Kereiakes DJ et al, DAPT Study Investigators. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 2016; 315: 1735–49.
38. Costa F, van Klaveren D, James S et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 2017; 389: 1025–34.
39. Eagle KA, Kline-Rogers E, Goodman SG et al. Adherence to evidence based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med 2004; 117: 73–81. DOI: 10.1016/j.amjmed.2003.12.041
40. Sud A, Kline-Rogers EM, Eagle KA et al. Adherence to medications by patients after acute coronary syndromes. Ann Pharmacother 2005; 39: 1792–7. DOI: 10.1345/aph.1G249
41. Kulkarni SP, Alexander KP, Lytle B et al. Long-term adherence with cardiovascular drug regimens. Am Heart J 2006; 151: 185–91.
42. Herlitz J, Tуth PP, Naesdal J. Low-dose aspirin therapy for cardiovascular prevention: quantification and consequences of poor compliance or discontinuation. Am J Cardiovasc Drugs 2010; 10: 125–41. DOI: 10.2165/11318440-000000000-00000
43. Sundström J, Hedberg J, Thuresson M et al. Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events. A Swedish Nationwide, Population-Based Cohort Study. Circulation 2017; 136: 1183–92. DOI: 10.1161/CIRCULATIONAHA.117.028321
44. Mehran R, Baber U, Steg PG et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 2013. http: //dx.doi.org/10.1016/S0140–6736 (13)61720-1
45. Bubnova M.G., Kholmogorova G.T., Khudiakov M.B. i dr. Kak bol'nye s serdechno-sosudistymi zabolevaniiami ponimaiut nekotorye meditsinskie terminy? Profilakticheskaia med. 2016; 2: 36–42. [in Russian]
46. Bubnova M.G. Ponimanie nekotorykh meditsinskikh terminov muzhchinami i zhenshchinami s serdechno-sosudistymi zabolevaniiami. Problemy zhenskogo zdorov'ia. 2016; 3: 5–11. [in Russian]
1 ФГБУ «Национальный медицинский исследовательский центр профилактической медицины» Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3;
2 ФГБОУ ВО «Курский государственный медицинский университет» Минздрава России. 305041, Россия, Курск, ул. Карла Маркса, д. 3
*mbubnova@gnicpm.ru
________________________________________________
M.G.Bubnova*1, V.P.Mihin2
1 National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3;
2 Kursk State Medical University of the Ministry of Health of the Russian Federation. 305041, Russian Federation, Kursk, ul. Karla Marksa, d. 3
*mbubnova@gnicpm.ru