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Современная антиагрегантная терапия у пациентов высокого сердечно-сосудистого риска
Современная антиагрегантная терапия у пациентов высокого сердечно-сосудистого риска
Напалков Д.А. Современная антиагрегантная терапия у пациентов высокого сердечно-сосудистого риска. Consilium Medicum. 2015; 17 (12): 36–39. DOI:10.26442/2075-1753_2015.12.36-39
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Аннотация
В данном обзоре литературы анализируются имеющаяся доказательная база и рекомендации по применению основных антиагрегантов, используемых в реальной клинической практике. Приводятся сведения о современных представлениях в отношении применения ацетилсалициловой кислоты для первичной профилактики сердечно-сосудистых событий. Обсуждается пошаговый подход к индивидуальной оценке пользы от применения ацетилсалициловой кислоты в первичной профилактике, предложенный Рабочей группой по тромбозам Европейского общества кардиологов.
Ключевые слова: ацетилсалициловая кислота, клопидогрел, тикагрелор, сердечно-сосудистая заболеваемость, первичная профилактика, вторичная профилактика, оценка риска, безопасность.
Ключевые слова: ацетилсалициловая кислота, клопидогрел, тикагрелор, сердечно-сосудистая заболеваемость, первичная профилактика, вторичная профилактика, оценка риска, безопасность.
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This literature review examines the available evidence base and recommendations for the use of basic antiplatelet agents used in clinical practice. Data on the current understanding on the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular events is reviewed. We discuss the step-wise approach to the individual assessment of benefits from the use of ASA in primary prevention, proposed by the Working Group on Thrombosis of the European Society of Cardiology.
Key words: aspirin, clopidogrel, ticagrelor, cardiovascular disease, primary prevention, secondary prevention, risk assessment, safety.
Key words: aspirin, clopidogrel, ticagrelor, cardiovascular disease, primary prevention, secondary prevention, risk assessment, safety.
Полный текст
Список литературы
1. Kolandaivelu K, Bhatt DL. Antiplatelet therapy in Coronary Heart Disease Prevention. Cardiol Clin 2011; 29: 71–85.
2. Patrono C, Garcia Rodriguez LA, Landolfi R et al. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005; 353 (22): 2373–83.
3. Patrono C, Rocca B. The furure of antiplatelet therapy in cardiovascular disease. Annu Rev Med 2010; 61: 49–61.
4. Sakhuja R, Yeh RW, Bhatt DL. Antiplatelet agents in acute coronary syndromes. Curr Probl Cardiol 2010; 35 (3): 123–70.
5. Campbell CL, Smyth S, Montalescot G et al. Aspirin dose for the prevention of cardiovascular disease: a systematic review. JAMA 2007; 297 (18): 2018–24.
6. Baigent C, Sudlow C, Collins R et al. Antithrombotic Triallists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71–86.
7. Baigent C, Blackwell L, Collins R et al. 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.
8. Grosser T, Fries S, Lawson JA et al. Drug resistance and pseudoresistance. An unintended consequence of enteric coating aspirin. Circulation 2013; 127: 377–85.
9. Halvorsen S, Andreotti F, ten Berg JM, et al. Aspirin Therapy in Primary Cardiovascular Disease Prevention: A Position paper of the European Society of Cardiology Working Group on Thrombosis. J Am Coll Cardiol 2014; 64: 319–27.
10. Hirata Y, Kataoka H, Shimura T et al. Incidence of gastrointestinal bleeding in patients with cardiovascular disease: buffered aspirin versus enteric-coated aspirin. Scand J Gastroent 2011; 46: 803–9.
11. Takada M, Fujimoto M, Hosomi K. Difference in risk of gastrointestinal complications between users of enteric-coated and buffered low-dose aspirin. Int J Clin Pharm Ther 2014; 52 (3): 181–91.
12. Michelson AD. Antiplatelet therapies for the treatment of cardiovascular disease. Nat Rev Drug Discov 2010; 9 (2): 154–69.
13. Bhatt DL, Topol EJ. Scientific and therapeutic advances in antiplatelet therapy. Nat Rev Drug Discov 2003; 2 (1): 15–28.
14. Kolandaivelu K, Bhatt DL. Overcoming «resistance» to antiplatelet therapy: targeting issue of nonadherence. Nat Rev Cardiol 2010; 7 (8): 461–7.
15. Von Beckerath N, Taubert D, Pogatsa-Murray G et al. Absorption, metabolization, and antiplatelet effects of 300-, 600- and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) trial. Circulation 2005; 112 (19): 2946–50.
16. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events.
17. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345 (7): 494–502.
18. Windecker S, Meier B. Latecoronary stent thrombosis. Circulation 2007; 116 (17): 1952–65.
19. Wiviott SD, Braunwald E, McCabe CH et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 116 (25): 2923–32.
20. Wallentin L, Becker RC, Budaj A et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361 (11): 1045–57.
2. Patrono C, Garcia Rodriguez LA, Landolfi R et al. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005; 353 (22): 2373–83.
3. Patrono C, Rocca B. The furure of antiplatelet therapy in cardiovascular disease. Annu Rev Med 2010; 61: 49–61.
4. Sakhuja R, Yeh RW, Bhatt DL. Antiplatelet agents in acute coronary syndromes. Curr Probl Cardiol 2010; 35 (3): 123–70.
5. Campbell CL, Smyth S, Montalescot G et al. Aspirin dose for the prevention of cardiovascular disease: a systematic review. JAMA 2007; 297 (18): 2018–24.
6. Baigent C, Sudlow C, Collins R et al. Antithrombotic Triallists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71–86.
7. Baigent C, Blackwell L, Collins R et al. 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.
8. Grosser T, Fries S, Lawson JA et al. Drug resistance and pseudoresistance. An unintended consequence of enteric coating aspirin. Circulation 2013; 127: 377–85.
9. Halvorsen S, Andreotti F, ten Berg JM, et al. Aspirin Therapy in Primary Cardiovascular Disease Prevention: A Position paper of the European Society of Cardiology Working Group on Thrombosis. J Am Coll Cardiol 2014; 64: 319–27.
10. Hirata Y, Kataoka H, Shimura T et al. Incidence of gastrointestinal bleeding in patients with cardiovascular disease: buffered aspirin versus enteric-coated aspirin. Scand J Gastroent 2011; 46: 803–9.
11. Takada M, Fujimoto M, Hosomi K. Difference in risk of gastrointestinal complications between users of enteric-coated and buffered low-dose aspirin. Int J Clin Pharm Ther 2014; 52 (3): 181–91.
12. Michelson AD. Antiplatelet therapies for the treatment of cardiovascular disease. Nat Rev Drug Discov 2010; 9 (2): 154–69.
13. Bhatt DL, Topol EJ. Scientific and therapeutic advances in antiplatelet therapy. Nat Rev Drug Discov 2003; 2 (1): 15–28.
14. Kolandaivelu K, Bhatt DL. Overcoming «resistance» to antiplatelet therapy: targeting issue of nonadherence. Nat Rev Cardiol 2010; 7 (8): 461–7.
15. Von Beckerath N, Taubert D, Pogatsa-Murray G et al. Absorption, metabolization, and antiplatelet effects of 300-, 600- and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) trial. Circulation 2005; 112 (19): 2946–50.
16. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events.
17. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345 (7): 494–502.
18. Windecker S, Meier B. Latecoronary stent thrombosis. Circulation 2007; 116 (17): 1952–65.
19. Wiviott SD, Braunwald E, McCabe CH et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 116 (25): 2923–32.
20. Wallentin L, Becker RC, Budaj A et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361 (11): 1045–57.
2. Patrono C, Garcia Rodriguez LA, Landolfi R et al. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005; 353 (22): 2373–83.
3. Patrono C, Rocca B. The furure of antiplatelet therapy in cardiovascular disease. Annu Rev Med 2010; 61: 49–61.
4. Sakhuja R, Yeh RW, Bhatt DL. Antiplatelet agents in acute coronary syndromes. Curr Probl Cardiol 2010; 35 (3): 123–70.
5. Campbell CL, Smyth S, Montalescot G et al. Aspirin dose for the prevention of cardiovascular disease: a systematic review. JAMA 2007; 297 (18): 2018–24.
6. Baigent C, Sudlow C, Collins R et al. Antithrombotic Triallists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71–86.
7. Baigent C, Blackwell L, Collins R et al. 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.
8. Grosser T, Fries S, Lawson JA et al. Drug resistance and pseudoresistance. An unintended consequence of enteric coating aspirin. Circulation 2013; 127: 377–85.
9. Halvorsen S, Andreotti F, ten Berg JM, et al. Aspirin Therapy in Primary Cardiovascular Disease Prevention: A Position paper of the European Society of Cardiology Working Group on Thrombosis. J Am Coll Cardiol 2014; 64: 319–27.
10. Hirata Y, Kataoka H, Shimura T et al. Incidence of gastrointestinal bleeding in patients with cardiovascular disease: buffered aspirin versus enteric-coated aspirin. Scand J Gastroent 2011; 46: 803–9.
11. Takada M, Fujimoto M, Hosomi K. Difference in risk of gastrointestinal complications between users of enteric-coated and buffered low-dose aspirin. Int J Clin Pharm Ther 2014; 52 (3): 181–91.
12. Michelson AD. Antiplatelet therapies for the treatment of cardiovascular disease. Nat Rev Drug Discov 2010; 9 (2): 154–69.
13. Bhatt DL, Topol EJ. Scientific and therapeutic advances in antiplatelet therapy. Nat Rev Drug Discov 2003; 2 (1): 15–28.
14. Kolandaivelu K, Bhatt DL. Overcoming «resistance» to antiplatelet therapy: targeting issue of nonadherence. Nat Rev Cardiol 2010; 7 (8): 461–7.
15. Von Beckerath N, Taubert D, Pogatsa-Murray G et al. Absorption, metabolization, and antiplatelet effects of 300-, 600- and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) trial. Circulation 2005; 112 (19): 2946–50.
16. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events.
17. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345 (7): 494–502.
18. Windecker S, Meier B. Latecoronary stent thrombosis. Circulation 2007; 116 (17): 1952–65.
19. Wiviott SD, Braunwald E, McCabe CH et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 116 (25): 2923–32.
20. Wallentin L, Becker RC, Budaj A et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361 (11): 1045–57.
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2. Patrono C, Garcia Rodriguez LA, Landolfi R et al. Low-dose aspirin for the prevention of atherothrombosis. N Engl J Med 2005; 353 (22): 2373–83.
3. Patrono C, Rocca B. The furure of antiplatelet therapy in cardiovascular disease. Annu Rev Med 2010; 61: 49–61.
4. Sakhuja R, Yeh RW, Bhatt DL. Antiplatelet agents in acute coronary syndromes. Curr Probl Cardiol 2010; 35 (3): 123–70.
5. Campbell CL, Smyth S, Montalescot G et al. Aspirin dose for the prevention of cardiovascular disease: a systematic review. JAMA 2007; 297 (18): 2018–24.
6. Baigent C, Sudlow C, Collins R et al. Antithrombotic Triallists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324 (7329): 71–86.
7. Baigent C, Blackwell L, Collins R et al. 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.
8. Grosser T, Fries S, Lawson JA et al. Drug resistance and pseudoresistance. An unintended consequence of enteric coating aspirin. Circulation 2013; 127: 377–85.
9. Halvorsen S, Andreotti F, ten Berg JM, et al. Aspirin Therapy in Primary Cardiovascular Disease Prevention: A Position paper of the European Society of Cardiology Working Group on Thrombosis. J Am Coll Cardiol 2014; 64: 319–27.
10. Hirata Y, Kataoka H, Shimura T et al. Incidence of gastrointestinal bleeding in patients with cardiovascular disease: buffered aspirin versus enteric-coated aspirin. Scand J Gastroent 2011; 46: 803–9.
11. Takada M, Fujimoto M, Hosomi K. Difference in risk of gastrointestinal complications between users of enteric-coated and buffered low-dose aspirin. Int J Clin Pharm Ther 2014; 52 (3): 181–91.
12. Michelson AD. Antiplatelet therapies for the treatment of cardiovascular disease. Nat Rev Drug Discov 2010; 9 (2): 154–69.
13. Bhatt DL, Topol EJ. Scientific and therapeutic advances in antiplatelet therapy. Nat Rev Drug Discov 2003; 2 (1): 15–28.
14. Kolandaivelu K, Bhatt DL. Overcoming «resistance» to antiplatelet therapy: targeting issue of nonadherence. Nat Rev Cardiol 2010; 7 (8): 461–7.
15. Von Beckerath N, Taubert D, Pogatsa-Murray G et al. Absorption, metabolization, and antiplatelet effects of 300-, 600- and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) trial. Circulation 2005; 112 (19): 2946–50.
16. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events.
17. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345 (7): 494–502.
18. Windecker S, Meier B. Latecoronary stent thrombosis. Circulation 2007; 116 (17): 1952–65.
19. Wiviott SD, Braunwald E, McCabe CH et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 116 (25): 2923–32.
20. Wallentin L, Becker RC, Budaj A et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361 (11): 1045–57.
Авторы
Д.А.Напалков
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
dminap@mail.ru
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
dminap@mail.ru
________________________________________________
D.A.Napalkov
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
dminap@mail.ru
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
dminap@mail.ru
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