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Антитромботическая терапия у пациентов с кардиоэмболическим ишемическим инсультом
Антитромботическая терапия у пациентов с кардиоэмболическим ишемическим инсультом
Лагода О.В. Антитромботическая терапия у пациентов с кардиоэмболическим ишемическим инсультом. Consilium Medicum. Неврология и Ревматология (Прил.). 2016; 1: 33–36.
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Аннотация
В статье приведены современные представления о значении кардиальных заболеваний в патогенезе ишемического инсульта. Ведущими причинами кардиоэмболического инсульта являются неревматическая фибрилляция предсердий, постинфарктные изменения миокарда и ревматические пороки сердца. Представлены современные рекомендации по профилактике ишемического инсульта у пациентов с кардиальной патологией, приведены данные о подходах к терапии антикоагулянтами у этой категории больных.
Ключевые слова: кардиоэмболический инсульт, фибрилляция предсердий, оральные антикоагулянты.
Key words: cardioembolic stroke, atrial fibrillation, oral anticoagulation.
Ключевые слова: кардиоэмболический инсульт, фибрилляция предсердий, оральные антикоагулянты.
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Key words: cardioembolic stroke, atrial fibrillation, oral anticoagulation.
Полный текст
Список литературы
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13. Singer DE et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133 (Suppl. 6): 546S–592S.
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15. Camm AJ et al. 2012 focus edupdate of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719–27.
16. Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus warfarin in patients with atrial fibrillation [published correction appears in N Engl J Med 2010; 363: 1877]. N Engl J Med 2009; 361: 1139–51.
17. Patel MR, Mahaffey KW, Garg J et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883–91.
18. Granger CB, Alexander JH, McMurray JJ et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981–92.
19. Ruff CT, Giugliano RP, Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A metaanalysis of randomised trials. Lancet 2014; 383: 955–62.
20. Diener HC, Connolly SJ, Ezekowitz MD et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial [published correction appears in Lancet Neurol 2011; 10: 27]. Lancet Neurol 2010; 9: 1157–63.
21. Heidbuchel H, Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
22. Eikelboom JW, Connolly SJ, Brueckmann M. Dabigatran versus Warfarin in Patients with Mechanical Heart Valves. N Engl J Med. 2013; 369: 1206–14.
23. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Euro Heart J 2012; 33: 2719–47.
24. White HD, Gruber M, Feyzi J et al. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 2007; 167: 239–45.
25. Witt DM, Delate T, Clark NP et al. Outcomes and predictors of very stable INR control during chronic anticoagulation therapy. Blood 2007; 114: 952–6.
2. Bonita R, de Courten M, Dwyer T et al. Summary. Surveillance of Risk Factors for Noncommunicable Diseases: The WHO STEPwise Approach. Geneva, Switzerland: World Health Organization, 2001.
3. Suslina Z.A., Varakin Iu.Ia. Klinicheskoe rukovodstvo po rannei diagnostike, lecheniiu i profilaktike sosudistykh zabolevanii golovnogo mozga. M.: MEDpress-inform. 2015. [in Russian]
4. Hanna JP. Cardiac disease and embolic sources. In Brain ischemia: basic concepts and clinical. London etc.: Springer-Verlag, 1995.
5. Suslina Z.A., Tanashian M.M., Petrova E.A. i dr. Patogeneticheskie aspekty kardiogennykh ishemicheskikh insul'tov. Klin. meditsina. 2001; 79 (5): 15–9. [in Russian]
6. [in Russian]
7. Filatov A.G., Tarashvili E.G. Epidemiologiia i sotsial'naia znachimost' fibrilliatsii predserdii. Annaly aritmologii. 2012; 2: 5–13. [in Russian]
8. Suslina Z.A., Foniakin A.V., Petrova E.A. i dr. Znachenie kholterovskogo monitorirovaniia EKG u bol'nykh v ostrom periode ishemicheskogo insul'ta. Terapevt. arkhiv. 1997; 69 (4): 24–6. [in Russian]
9. Lloyd-Jones DM, Wang TJ, Leip EP et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004; 110: 1042–6.
10. Foniakin A.V. Sovremennaia kontseptsiia kardionevrologii. Annaly klinicheskoi i eksperimental'noi nevrologii. 2007; 1 (3): 45–8. [in Russian]
11. Heidbuchel H,Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
12. Furie KL, Goldstein LB, Albers GW et al. Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2012; 43 (12): 3442–53; http://dx.doi.org/10.1161/STR.0b013e318266722a
13. Singer DE et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133 (Suppl. 6): 546S–592S.
14. Hylek EM et al. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 1996; 335: 540–6.
15. Camm AJ et al. 2012 focus edupdate of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719–27.
16. Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus warfarin in patients with atrial fibrillation [published correction appears in N Engl J Med 2010; 363: 1877]. N Engl J Med 2009; 361: 1139–51.
17. Patel MR, Mahaffey KW, Garg J et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883–91.
18. Granger CB, Alexander JH, McMurray JJ et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981–92.
19. Ruff CT, Giugliano RP, Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A metaanalysis of randomised trials. Lancet 2014; 383: 955–62.
20. Diener HC, Connolly SJ, Ezekowitz MD et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial [published correction appears in Lancet Neurol 2011; 10: 27]. Lancet Neurol 2010; 9: 1157–63.
21. Heidbuchel H, Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
22. Eikelboom JW, Connolly SJ, Brueckmann M. Dabigatran versus Warfarin in Patients with Mechanical Heart Valves. N Engl J Med. 2013; 369: 1206–14.
23. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Euro Heart J 2012; 33: 2719–47.
24. White HD, Gruber M, Feyzi J et al. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 2007; 167: 239–45.
25. Witt DM, Delate T, Clark NP et al. Outcomes and predictors of very stable INR control during chronic anticoagulation therapy. Blood 2007; 114: 952–6.
2. Bonita R, de Courten M, Dwyer T et al. Summary. Surveillance of Risk Factors for Noncommunicable Diseases: The WHO STEPwise Approach. Geneva, Switzerland: World Health Organization, 2001.
3. Суслина З.А., Варакин Ю.Я. Клиническое руководство по ранней диагностике, лечению и профилактике сосудистых заболеваний головного мозга. М.: МЕДпресс-информ. 2015. / Suslina Z.A., Varakin Iu.Ia. Klinicheskoe rukovodstvo po rannei diagnostike, lecheniiu i profilaktike sosudistykh zabolevanii golovnogo mozga. M.: MEDpress-inform. 2015. [in Russian]
4. Hanna JP. Cardiac disease and embolic sources. In Brain ischemia: basic concepts and clinical. London etc.: Springer-Verlag, 1995.
5. Суслина З.А., Танашян М.М., Петрова Е.А. и др. Патогенетические аспекты кардиогенных ишемических инсультов. Клин. медицина. 2001; 79 (5): 15–9. / Suslina Z.A., Tanashian M.M., Petrova E.A. i dr. Patogeneticheskie aspekty kardiogennykh ishemicheskikh insul'tov. Klin. meditsina. 2001; 79 (5): 15–9. [in Russian]
6. Гераскина Л.А. Кардиоэмболический инсульт: многообразие причин и современные подходы к профилактике. Неврология, нейропсихиатрия, психосоматика. 2013; 4: 60–5; doi: 10.14412/2074-2711-2013-2457. [in Russian]
7. Филатов А.Г., Тарашвили Э.Г. Эпидемиология и социальная значимость фибрилляции предсердий. Анналы аритмологии. 2012; 2: 5–13. / Filatov A.G., Tarashvili E.G. Epidemiologiia i sotsial'naia znachimost' fibrilliatsii predserdii. Annaly aritmologii. 2012; 2: 5–13. [in Russian]
8. Суслина З.А., Фонякин А.В., Петрова Е.А. и др. Значение холтеровского мониторирования ЭКГ у больных в остром периоде ишемического инсульта. Терапевт. архив. 1997; 69 (4): 24–6. / Suslina Z.A., Foniakin A.V., Petrova E.A. i dr. Znachenie kholterovskogo monitorirovaniia EKG u bol'nykh v ostrom periode ishemicheskogo insul'ta. Terapevt. arkhiv. 1997; 69 (4): 24–6. [in Russian]
9. Lloyd-Jones DM, Wang TJ, Leip EP et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004; 110: 1042–6.
10. Фонякин А.В. Современная концепция кардионеврологии. Анналы клинической и экспериментальной неврологии. 2007; 1 (3): 45–8. / Foniakin A.V. Sovremennaia kontseptsiia kardionevrologii. Annaly klinicheskoi i eksperimental'noi nevrologii. 2007; 1 (3): 45–8. [in Russian]
11. Heidbuchel H,Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
12. Furie KL, Goldstein LB, Albers GW et al. Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2012; 43 (12): 3442–53; http://dx.doi.org/10.1161/STR.0b013e318266722a
13. Singer DE et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133 (Suppl. 6): 546S–592S.
14. Hylek EM et al. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 1996; 335: 540–6.
15. Camm AJ et al. 2012 focus edupdate of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719–27.
16. Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus warfarin in patients with atrial fibrillation [published correction appears in N Engl J Med 2010; 363: 1877]. N Engl J Med 2009; 361: 1139–51.
17. Patel MR, Mahaffey KW, Garg J et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883–91.
18. Granger CB, Alexander JH, McMurray JJ et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981–92.
19. Ruff CT, Giugliano RP, Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A metaanalysis of randomised trials. Lancet 2014; 383: 955–62.
20. Diener HC, Connolly SJ, Ezekowitz MD et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial [published correction appears in Lancet Neurol 2011; 10: 27]. Lancet Neurol 2010; 9: 1157–63.
21. Heidbuchel H, Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
22. Eikelboom JW, Connolly SJ, Brueckmann M. Dabigatran versus Warfarin in Patients with Mechanical Heart Valves. N Engl J Med. 2013; 369: 1206–14.
23. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Euro Heart J 2012; 33: 2719–47.
24. White HD, Gruber M, Feyzi J et al. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 2007; 167: 239–45.
25. Witt DM, Delate T, Clark NP et al. Outcomes and predictors of very stable INR control during chronic anticoagulation therapy. Blood 2007; 114: 952–6.
________________________________________________
2. Bonita R, de Courten M, Dwyer T et al. Summary. Surveillance of Risk Factors for Noncommunicable Diseases: The WHO STEPwise Approach. Geneva, Switzerland: World Health Organization, 2001.
3. Suslina Z.A., Varakin Iu.Ia. Klinicheskoe rukovodstvo po rannei diagnostike, lecheniiu i profilaktike sosudistykh zabolevanii golovnogo mozga. M.: MEDpress-inform. 2015. [in Russian]
4. Hanna JP. Cardiac disease and embolic sources. In Brain ischemia: basic concepts and clinical. London etc.: Springer-Verlag, 1995.
5. Suslina Z.A., Tanashian M.M., Petrova E.A. i dr. Patogeneticheskie aspekty kardiogennykh ishemicheskikh insul'tov. Klin. meditsina. 2001; 79 (5): 15–9. [in Russian]
6. [in Russian]
7. Filatov A.G., Tarashvili E.G. Epidemiologiia i sotsial'naia znachimost' fibrilliatsii predserdii. Annaly aritmologii. 2012; 2: 5–13. [in Russian]
8. Suslina Z.A., Foniakin A.V., Petrova E.A. i dr. Znachenie kholterovskogo monitorirovaniia EKG u bol'nykh v ostrom periode ishemicheskogo insul'ta. Terapevt. arkhiv. 1997; 69 (4): 24–6. [in Russian]
9. Lloyd-Jones DM, Wang TJ, Leip EP et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004; 110: 1042–6.
10. Foniakin A.V. Sovremennaia kontseptsiia kardionevrologii. Annaly klinicheskoi i eksperimental'noi nevrologii. 2007; 1 (3): 45–8. [in Russian]
11. Heidbuchel H,Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
12. Furie KL, Goldstein LB, Albers GW et al. Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2012; 43 (12): 3442–53; http://dx.doi.org/10.1161/STR.0b013e318266722a
13. Singer DE et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133 (Suppl. 6): 546S–592S.
14. Hylek EM et al. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 1996; 335: 540–6.
15. Camm AJ et al. 2012 focus edupdate of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719–27.
16. Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus warfarin in patients with atrial fibrillation [published correction appears in N Engl J Med 2010; 363: 1877]. N Engl J Med 2009; 361: 1139–51.
17. Patel MR, Mahaffey KW, Garg J et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365: 883–91.
18. Granger CB, Alexander JH, McMurray JJ et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981–92.
19. Ruff CT, Giugliano RP, Braunwald E et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A metaanalysis of randomised trials. Lancet 2014; 383: 955–62.
20. Diener HC, Connolly SJ, Ezekowitz MD et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial [published correction appears in Lancet Neurol 2011; 10: 27]. Lancet Neurol 2010; 9: 1157–63.
21. Heidbuchel H, Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013; 15: 625–51.
22. Eikelboom JW, Connolly SJ, Brueckmann M. Dabigatran versus Warfarin in Patients with Mechanical Heart Valves. N Engl J Med. 2013; 369: 1206–14.
23. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Euro Heart J 2012; 33: 2719–47.
24. White HD, Gruber M, Feyzi J et al. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 2007; 167: 239–45.
25. Witt DM, Delate T, Clark NP et al. Outcomes and predictors of very stable INR control during chronic anticoagulation therapy. Blood 2007; 114: 952–6.
Авторы
О.В.Лагода*
ФГБНУ Научный центр неврологии. 125367, Россия, Москва, Волоколамское ш., д. 80
*angionev@gmail.com
Research Center of Neurology. 125367, Russian Federation, Moscow, Volokolamskoe sh., d. 80
*angionev@gmail.com
ФГБНУ Научный центр неврологии. 125367, Россия, Москва, Волоколамское ш., д. 80
*angionev@gmail.com
________________________________________________
Research Center of Neurology. 125367, Russian Federation, Moscow, Volokolamskoe sh., d. 80
*angionev@gmail.com
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