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Препараты ацетилсалициловой кислоты у больных с бессимптомным атеросклерозом: риск или польза?
Препараты ацетилсалициловой кислоты у больных с бессимптомным атеросклерозом: риск или польза?
Минушкина Л.О. Препараты ацетилсалициловой кислоты у больных с бессимптомным атеросклерозом: риск или польза? Consilium Medicum. 2015; 17 (10): 57–60. DOI:10.26442/2075-1753_2015.10.57-60
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Аннотация
В настоящем обзоре представлены данные о проблемах назначения ацетилсалициловой кислоты (АСК) в широкой клинической практике. Показано, что это наиболее часто рекомендуемый специалистами антитромбоцитарный препарат, при назначении которого важное значение имеет соотношение эффективности и риска осложнений. Описаны проблемы, связанные с оценкой риска и выбором терапии для больного с субклиническим атеросклерозом. Описаны известные ассоциации разных маркеров атеросклероза с риском коронарных и церебральных осложнений, данные метаанализов эффективности антитромбоцитарной терапии. Рассмотрены вопросы, касающиеся возможностей профилактики поражений желудочно-кишечного тракта. Наиболее значимым для безопасного использования является применение минимально эффективных доз АСК. Сочетание АСК с небольшими дозами антацидов может сделать ее применение более безопасным, не влияя существенно на эффективность лекарства.
Ключевые слова: первичная профилактика, субклинический атеросклероз, ацетилсалициловая кислота.
Ключевые слова: первичная профилактика, субклинический атеросклероз, ацетилсалициловая кислота.
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This review presents the problems of acetylsalicylic acid (ASA) application in general clinical practice. We showed that this was the most commonly used antiplatelet drug and it was very important to take the correlation of efficiency and risk of complications into account during the appointment of this drug. We described the problems associated with risk assessment and treatment selection in patient with subclinical atherosclerosis. We showed main associations between the different atherosclerosis markers and risk of coronary and cerebral complications; the results of meta-analysis concerning the efficiency of antiplatelet therapy. We discussed the possibilities for the prevention of the gastrointestinal tract damage. The application of the lowest effective quantity of ASA was the most important act for safe usage. The combination of ASA and small antacid doses could make its application more safety without significantly affecting the drugs efficiency.
Key words: primary prevention, subclinical atherosclerosis, acetylsalicylic acid.
Key words: primary prevention, subclinical atherosclerosis, acetylsalicylic acid.
Полный текст
Список литературы
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19. Яковенко Э.П., Краснолобова Л.П., Яковенко А.В. и др. Влияние препаратов АСК на морфофункциональное состояние слизистой оболочки желудка у кардиологических пациентов пожилого возраста. Сердце. 2013; 71 (3): 145–50. / Yakovenko E.P., Krasnolobova L.P., Yakovenko A.V. i dr. Vliyanie preparatov ASK na morfofunktsional'noe sostoyanie slizistoy obolochki zheludka u kardiologicheskikh patsientov pozhilogo vozrasta. Serdtse. 2013; 71 (3): 145–50. [in Russian]
2. Zanchetti A, Hansson L, Dahlöf B. Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. J Hypertens 2002; 20 (11): 2301–7.
3. Gallino A, Aboyans V, Diehm C et al. European Society of Cardiology Working Group on Peripheral Circulation. Non-coronary atherosclerosis. Eur Heart J 2014; 35 (17): 1112–9.
4. Fowkes FG, Housley E, Cawood EH et al. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial claudication: ultrasound study in men at high and low risk for disease in the general population. Int J Epidemiol 1991; 20: 384–92.
5. Nambi V, Chambless L, He M et al. Common carotid artery intima-media thickness is as good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J 2012; 33 (2): 183–90.
6. O’Leary DH, Polak JF, Kronmal RA et al. Carotid-artery intima media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. New Engl J Med 1999; 340: 14–22.
7. Bots ML, Hoes AW, Koudstaal PJ et al. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 96: 1432–7.
8. Patel J, Al Rifai M, Blaha MJ et al. Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease: Results Fr om Multiethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2015; 8 (6): e003186.
9. Gielen S, De Backer G, Piepoli M, Wood D ESC Textbook of Preventive Cardiology. Oxford University Press, 2015; p. 351.
10. Vandvik PO, Lincoff AM, Gore JM et al. Primary and Secondary Prevention of Cardiovascular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest, 2012; 141 (Suppl. 2): e637S–e668S.
11. Baigent C, Blackwell L, Collins R et al. Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative metaanalysis of individual participant data from randomised trials. Lancet 2009; 373 (9678): 1849–60.
12. Conrad MF, Boulom V, Mukhopadhyay S et al. Progression of asymptomatic carotid stenosis despite optimal medical therapy. J Vasc Surg 2013; 58 (1): 128–35.
13. Schoenefeld E, Donas K, Radicke A et al. Perioperative use of aspirin for patients undergoing carotid endarterectomy. Vasa 2012; 41 (4): 282–7.
14. Weil J, Colin-Jones D, Langman M et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310 (6983): 827–30.
15. Henry P, Vermillet A, Boval B. 24-hour time-dependent aspirin efficacy in patients with stable coronary artery disease. Thromb Haemost 2011; 105 (2): 336–44.
16. Nonsteroidal anti-inflammatory drugs: add an anti-ulcer drug for patients at high risk only. Always lim it the dose and duration of treatment with NSAIDs. Prescrire Int 2011; 20 (119): 216–9.
17. Miyamoto M, Haruma K, Okamoto T. Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan. J Gastroenterol Hepatol 2012; 27 (2): 372–7.
18. Barkagan Z.S., Kotovshchikova E.F. Sravnitel'nyy analiz osnovnykh i pobochnykh effektov razlichnykh form atsetilsalitsilovoy kisloty. Klin. farmakologiya i terapiya. 2004; 13 (3): 40–3. [in Russian]
19. Yakovenko E.P., Krasnolobova L.P., Yakovenko A.V. i dr. Vliyanie preparatov ASK na morfofunktsional'noe sostoyanie slizistoy obolochki zheludka u kardiologicheskikh patsientov pozhilogo vozrasta. Serdtse. 2013; 71 (3): 145–50. [in Russian]
2. Zanchetti A, Hansson L, Dahlöf B. Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. J Hypertens 2002; 20 (11): 2301–7.
3. Gallino A, Aboyans V, Diehm C et al. European Society of Cardiology Working Group on Peripheral Circulation. Non-coronary atherosclerosis. Eur Heart J 2014; 35 (17): 1112–9.
4. Fowkes FG, Housley E, Cawood EH et al. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial claudication: ultrasound study in men at high and low risk for disease in the general population. Int J Epidemiol 1991; 20: 384–92.
5. Nambi V, Chambless L, He M et al. Common carotid artery intima-media thickness is as good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J 2012; 33 (2): 183–90.
6. O’Leary DH, Polak JF, Kronmal RA et al. Carotid-artery intima media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. New Engl J Med 1999; 340: 14–22.
7. Bots ML, Hoes AW, Koudstaal PJ et al. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 96: 1432–7.
8. Patel J, Al Rifai M, Blaha MJ et al. Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease: Results Fr om Multiethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2015; 8 (6): e003186.
9. Gielen S, De Backer G, Piepoli M, Wood D ESC Textbook of Preventive Cardiology. Oxford University Press, 2015; p. 351.
10. Vandvik PO, Lincoff AM, Gore JM et al. Primary and Secondary Prevention of Cardiovascular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest, 2012; 141 (Suppl. 2): e637S–e668S.
11. Baigent C, Blackwell L, Collins R et al. Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative metaanalysis of individual participant data from randomised trials. Lancet 2009; 373 (9678): 1849–60.
12. Conrad MF, Boulom V, Mukhopadhyay S et al. Progression of asymptomatic carotid stenosis despite optimal medical therapy. J Vasc Surg 2013; 58 (1): 128–35.
13. Schoenefeld E, Donas K, Radicke A et al. Perioperative use of aspirin for patients undergoing carotid endarterectomy. Vasa 2012; 41 (4): 282–7.
14. Weil J, Colin-Jones D, Langman M et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310 (6983): 827–30.
15. Henry P, Vermillet A, Boval B. 24-hour time-dependent aspirin efficacy in patients with stable coronary artery disease. Thromb Haemost 2011; 105 (2): 336–44.
16. Nonsteroidal anti-inflammatory drugs: add an anti-ulcer drug for patients at high risk only. Always lim it the dose and duration of treatment with NSAIDs. Prescrire Int 2011; 20 (119): 216–9.
17. Miyamoto M, Haruma K, Okamoto T. Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan. J Gastroenterol Hepatol 2012; 27 (2): 372–7.
18. Баркаган З.С., Котовщикова Е.Ф. Сравнительный анализ основных и побочных эффектов различных форм ацетилсалициловой кислоты. Клин. фармакология и терапия. 2004; 13 (3): 40–3. / Barkagan Z.S., Kotovshchikova E.F. Sravnitel'nyy analiz osnovnykh i pobochnykh effektov razlichnykh form atsetilsalitsilovoy kisloty. Klin. farmakologiya i terapiya. 2004; 13 (3): 40–3. [in Russian]
19. Яковенко Э.П., Краснолобова Л.П., Яковенко А.В. и др. Влияние препаратов АСК на морфофункциональное состояние слизистой оболочки желудка у кардиологических пациентов пожилого возраста. Сердце. 2013; 71 (3): 145–50. / Yakovenko E.P., Krasnolobova L.P., Yakovenko A.V. i dr. Vliyanie preparatov ASK na morfofunktsional'noe sostoyanie slizistoy obolochki zheludka u kardiologicheskikh patsientov pozhilogo vozrasta. Serdtse. 2013; 71 (3): 145–50. [in Russian]
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2. Zanchetti A, Hansson L, Dahlöf B. Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. J Hypertens 2002; 20 (11): 2301–7.
3. Gallino A, Aboyans V, Diehm C et al. European Society of Cardiology Working Group on Peripheral Circulation. Non-coronary atherosclerosis. Eur Heart J 2014; 35 (17): 1112–9.
4. Fowkes FG, Housley E, Cawood EH et al. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial claudication: ultrasound study in men at high and low risk for disease in the general population. Int J Epidemiol 1991; 20: 384–92.
5. Nambi V, Chambless L, He M et al. Common carotid artery intima-media thickness is as good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J 2012; 33 (2): 183–90.
6. O’Leary DH, Polak JF, Kronmal RA et al. Carotid-artery intima media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. New Engl J Med 1999; 340: 14–22.
7. Bots ML, Hoes AW, Koudstaal PJ et al. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 96: 1432–7.
8. Patel J, Al Rifai M, Blaha MJ et al. Coronary Artery Calcium Improves Risk Assessment in Adults With a Family History of Premature Coronary Heart Disease: Results Fr om Multiethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2015; 8 (6): e003186.
9. Gielen S, De Backer G, Piepoli M, Wood D ESC Textbook of Preventive Cardiology. Oxford University Press, 2015; p. 351.
10. Vandvik PO, Lincoff AM, Gore JM et al. Primary and Secondary Prevention of Cardiovascular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest, 2012; 141 (Suppl. 2): e637S–e668S.
11. Baigent C, Blackwell L, Collins R et al. Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative metaanalysis of individual participant data from randomised trials. Lancet 2009; 373 (9678): 1849–60.
12. Conrad MF, Boulom V, Mukhopadhyay S et al. Progression of asymptomatic carotid stenosis despite optimal medical therapy. J Vasc Surg 2013; 58 (1): 128–35.
13. Schoenefeld E, Donas K, Radicke A et al. Perioperative use of aspirin for patients undergoing carotid endarterectomy. Vasa 2012; 41 (4): 282–7.
14. Weil J, Colin-Jones D, Langman M et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310 (6983): 827–30.
15. Henry P, Vermillet A, Boval B. 24-hour time-dependent aspirin efficacy in patients with stable coronary artery disease. Thromb Haemost 2011; 105 (2): 336–44.
16. Nonsteroidal anti-inflammatory drugs: add an anti-ulcer drug for patients at high risk only. Always lim it the dose and duration of treatment with NSAIDs. Prescrire Int 2011; 20 (119): 216–9.
17. Miyamoto M, Haruma K, Okamoto T. Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan. J Gastroenterol Hepatol 2012; 27 (2): 372–7.
18. Barkagan Z.S., Kotovshchikova E.F. Sravnitel'nyy analiz osnovnykh i pobochnykh effektov razlichnykh form atsetilsalitsilovoy kisloty. Klin. farmakologiya i terapiya. 2004; 13 (3): 40–3. [in Russian]
19. Yakovenko E.P., Krasnolobova L.P., Yakovenko A.V. i dr. Vliyanie preparatov ASK na morfofunktsional'noe sostoyanie slizistoy obolochki zheludka u kardiologicheskikh patsientov pozhilogo vozrasta. Serdtse. 2013; 71 (3): 145–50. [in Russian]
Авторы
Л.О.Минушкина
ФГБУ ДПО Учебно-научный медицинский центр Управления делами Президента РФ. 121359, Россия, Москва, ул.Маршала Тимошенко, д.21
minushkina@mail.ru
ФГБУ ДПО Учебно-научный медицинский центр Управления делами Президента РФ. 121359, Россия, Москва, ул.Маршала Тимошенко, д.21
minushkina@mail.ru
________________________________________________
L.O.Minushkina
Teaching and Research Medical Center Office of the President of the Russian Federation. 121359, Russian Federation, Moscow, ul. Marshala Timoshenko, d. 21
minushkina@mail.ru
Teaching and Research Medical Center Office of the President of the Russian Federation. 121359, Russian Federation, Moscow, ul. Marshala Timoshenko, d. 21
minushkina@mail.ru
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