Комплексный подход к лечению пациентов с неклапанной фибрилляцией предсердий. Место ривароксабана
Комплексный подход к лечению пациентов с неклапанной фибрилляцией предсердий. Место ривароксабана
Морозова Т.Е., Конышко Н.А. Комплексный подход к лечению пациентов с неклапанной фибрилляцией предсердий. Место ривароксабана. Consilium Medicum. 2019; 21 (5): 51–56. DOI: 10.26442/20751753.2019.5.190436
________________________________________________
Morozova T.E., Konyshko N.A. Complex approach to the treatment of patients with non-valvular atrial fibrillation. Place rivaroxaban. Consilium Medicum. 2019; 21 (5): 51–56. DOI: 10.26442/20751753.2019.5.190436
Комплексный подход к лечению пациентов с неклапанной фибрилляцией предсердий. Место ривароксабана
Морозова Т.Е., Конышко Н.А. Комплексный подход к лечению пациентов с неклапанной фибрилляцией предсердий. Место ривароксабана. Consilium Medicum. 2019; 21 (5): 51–56. DOI: 10.26442/20751753.2019.5.190436
________________________________________________
Morozova T.E., Konyshko N.A. Complex approach to the treatment of patients with non-valvular atrial fibrillation. Place rivaroxaban. Consilium Medicum. 2019; 21 (5): 51–56. DOI: 10.26442/20751753.2019.5.190436
Фибрилляция предсердий (ФП) – наиболее распространенное нарушение ритма сердца, взаимосвязанное со старением. Диагностика ФП требует документирования эпизода с регистрацией типичного рисунка электрокардиограммы. Профилактика инсульта имеет первостепенное значение у пациентов с ФП. Неклапанная ФП увеличивает риск инсульта в 3–5 раз, особенно у пожилых пациентов, создавая значительную нагрузку на систему здравоохранения, отрицательно влияет на качество жизни пациентов. Основные принципы ведения пациентов с ФП: контроль частоты и/или ритма для обеспечения стабильной гемодинамики и облегчения симптомов; оценка и коррекция факторов, способствующих развитию, поддержанию и рецидивированию ФП; оценка риска тромбоэмболических осложнений (инсульта) и назначение антикоагулянтной терапии. Использование оральных антикоагулянтов показано у всех пациентов с неклапанной ФП, кроме пациентов с низким риском инсульта на основании шкалы CHA2DS2-VASc или при наличии абсолютных противопоказаний к приему антикоагулянтной терапии. В настоящее время имеются данные научных исследований, иллюстрирующие относительные преимущества представителей нового подкласса пероральных антикоагулянтов, например высокоселективного прямого ингибитора фактора Ха – ривароксабана (Ксарелто), обладающего рядом клинических и практических преимуществ по сравнению со стандартной терапией при лечении пожилых пациентов с неклапанной ФП.
Ключевые слова: неклапанная фибрилляция предсердий, новые оральные антикоагулянты, ривароксабан.
________________________________________________
Atrial fibrillation (AF) is the most common heart rhythm disorder associated with aging. Diagnosis of AF requires documentation of the typical electrocardiogram pattern registration. Diagnosis of AF before complications is a recognized priority in the prevention of cardioembolic stroke. Non-valvular atrial fibrillation increases the risk of stroke by three to five times, especially in elderly patients, creating a significant load on the health care system, negatively affects the quality of life of patients. The basic principles of the supervision of patients with AF: emergency control of the frequency and/or rhythm to ensure stable hemodynamics and symptom relief; assessment and correction of factors contributing to the development, maintenance and recurrence of AF; assessment of the thromboembolic complications risk (stroke) and the anticoagulant therapy appointment. The use of oral anticoagulants is indicated in all patients with non-valvular AF, except for patients with low risk of stroke on the basis of the CHA2DS2-VASc scale or in the presence of absolute contraindications to anticoagulant therapy. Currently, there are research data illustrating the relative advantages of representatives of the new subclass of oral anticoagulants, for example, highly selective direct inhibitor of factor XA – rivaroxaban (Xarelto), which has a number of clinical and practical advantages over standard therapy in the treatment of elderly patients with non-valvular AF.
Key words: non-valvular atrial fibrillation, new oral anticoagulants, rivaroxaban.
1. Colilla S, Crow A, Petkun W et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013; 112 (8): 1142–7.
2. Benedetti G, Neccia M, Agati L. Direct oral anticoagulants use in elderly patients with non valvular atrial fibrillation: state of evidence. Minerva Cardioangiologica 2018; 66 (3): 301–13. DOI: 10.23736/S0026-4725.17.04553-4
3. Рекомендации Европейского общества кардиологов (ESC) по лечению пациентов с фибрилляцией предсердий ,разработанные совместно С EACTS рабочей группой по лечению пациентов с фибрилляцией предсердий Европейского общества кардиологов (EОК), Европейской ассоциацией ритма сердца (EHRA), Европейской организацией по изучению инсульта (ESO). Рос. кардиол. журн. 2017; 7 (147): 7–86.
[Rekomendatsii Evropeiskogo obshchestva kardiologov (ESC) po lecheniiu patsientov s fibrilliatsiei predserdii ,razrabotannye sovmestno S EACTS rabochei gruppoi po lecheniiu patsientov s fibrilliatsiei predserdii Evropeiskogo obshchestva kardiologov (EOK), Evropeiskoi assotsiatsiei ritma serdtsa (EHRA), Evropeiskoi organizatsiei po izucheniiu insul'ta (ESO). Ros. kardiol. zhurn. 2017; 7 (147): 7–86 (in Russian).]
4. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO). Eur Heart J 2016; 37: 2893–962. DOI: 10.1093/eurheartj/ehw210
5. Jahangir A, Lee V, Friedman PA et al. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation 2007; 115: 3050–6.
6. Gillis AM, Rose MS. Temporal patterns of paroxysmal atrial fibrillation following DDDR pacemaker implantation. Am J Cardiol 2000; 85: 1445–50.
7. Charitos EI, Purerfellner H, Glotzer TV, Ziegler PD. Clinical classifications of atrial fibrillation poorly reflect its temporal persistence: insights from 1,195 patients continuously monitored with implantable devices. J Am Coll Cardiol 2014; 63: 2840–8.
8. Banerjee A, Taillandier S, Olesen JB et al. Pattern of atrial fibrillation and risk of outcomes: the Loire Valley Atrial Fibrillation Project. Int J Cardiol 2013; 167: 2682–7.
9. Lee G, Sanders P, Kalman JM. Catheter ablation of atrial arrhythmias: state of the art. Lancet 2012; 380: 1509–19.
10. Davis RC, Hobbs FD, Kenkre JE. Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace 2012; 14: 1553–9.
11. Hobbs FD, Fitzmaurice DA, Mant J et al. A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Health Technol Assess 2005; 9: iii–iv, ix–x, 1–74.
12. Aronsson M, Svennberg E, Rosenqvist M et al. Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording. Europace 2015; 17: 1023–9.
13. Levin LA, Husberg M, Sobocinski PD et al. A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace 2015; 17: 207–14.
14. Heidbuchel H, Verhamme P, Alings M et al. Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. Eur Heart J 2017; 38 (27): 2137–49.
15. Patel MR, Mahaffey KW, Garg J et al for the ROCKET-AF Investigators. Rivaroxaban versus warfarin in nonvalvularatrial fibrillation. N Engl J Med 2011; 365: 883–91.
16. Kirchhof P, Breithardt G, Aliot E et al. Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference. Europace 2013; 15: 1540–56.
17. Nikolaidou T, Channer KS. Chronic atrial fibrillation: a systematic review of medical heart rate control management. Postgrad Med J 2009; 85: 303–12.
18. Tamariz LJ, Bass EB. Pharmacological rate control of atrial fibrillation. Cardiol Clin 2004; 22: 35–45.
19. Segal JB, McNamara RL, Miller MR et al. The evidence regarding the drugs used for ventricular rate control. In J Fam Practice 2000; 49: 47–59.
20. Инструкция по применению лекарственного препарата для медицинского применения Ксарелто® 15/20 мг ЛП-001457. https://grls.rosminzdrav.ru/Grls_View_v2.aspx? routingGuid=082b82c0‑6225‑481a-a575‑befc31da5d49&t=
[Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Ksarelto® 15/20 mg LP-001457. https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=082b82c0‑ 6225‑481a-a575‑befc31da5d49&t= (in Russian).]
21. Kirchhof P et al. Global Prospective Safety Analysis of Rivaroxaban. J Am Coll Cardiol 2018; 72 (2): 141–53.
22. Fox KA et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J 2011; 32 (19): 2387–94.
23. Лукьянов М.М. и др. Диагностика, лечение, сочетанная сердечно-сосудистая патология и сопутствующие заболевания у больных с диагнозом «фибрилляция предсердий» в условиях реальной амбулаторно-поликлинической практики (по данным РЕгистра КардиоВАскулярных ЗАболеваний РЕКВАЗА). Рациональная фармакотерапия в кардиологии. 2014; 10 (4): 366–77.
[Luk'ianov M.M. i dr. Diagnostika, lechenie, sochetannaia serdechno-sosudistaia patologiia i soputstvuiushchie zabolevaniia u bol'nykh s diagnozom "fibrilliatsiia predserdii' v usloviiakh real'noi ambulatorno-poliklinicheskoi praktiki (po dannym REgistra KardioVAskuliarnykh ZAbolevanii REKVAZA). Ratsional'naia farmakoterapiia v kardiologii. 2014; 10 (4): 366–77 (in Russian).]
24. Gómez-Outes A et al. Causes of Death in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol 2016; 68: 2508–21.
25. Van Diepen S et al. Efficacy and safety of rivaroxaban in patients with heart failure and nonvalvular atrial fibrillation: insights from ROCKET AF. Circ Heart Fail 2013; 6 (4): 740–7.
26. Bansilal S et al. Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Once-daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial). Am Heart J 2015; 170: 675–82.e8
27. Mak K-H. Coronary and mortality risk of novel oral antithrombotic agents: a meta-analysis of large randomised trials. BMJ Open 2012; 2: e001592
28. Chatterjee S, Sharma A, Uchino K et al. Rivaroxaban and risk of myocardial infarction: insights from a meta-analysis and trial sequential analysis of randomized clinical trials. Coron Artery Dis 2013; 24 (8): 628–35.
29. Jingyi Liu, Makoto Nishida, Hiroyasu Inuietall. Rivaroxaban Suppresses the Progression of Ischemic Cardiomyopathy in a Murine Model of Diet-Induced Myocardial Infarction. J Atherosclerosis Thrombosis 2019; 14.
30. Pop C, Matei C, Petris A. Anticoagulation in Acute Coronary Syndrome: Review of Major Therapeutic Advances. Am J Ther 2019; 26 (2): e184–e197.
31. Majeed A, Ågren A., Holmström M et al. Management of rivaroxaban- or apixaban-associated major bleeding with prothrombin complex concentrates: a cohort study. Blood 2017; 130: 1706–12. DOI: https://doi.org/10.1182
32. Инструкция по применению лекарственного препарата для медицинского применения Ксарелто® 2,5 мг. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=844b686e-f176-4cca-bfe6-b6c1b49ed495&t=
[Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Ksarelto® 2,5 mg. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=844b686e-f176-4cca-bfe6-b6c1b49ed495&am... Russian).]
________________________________________________
1. Colilla S, Crow A, Petkun W et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013; 112 (8): 1142–7.
2. Benedetti G, Neccia M, Agati L. Direct oral anticoagulants use in elderly patients with non valvular atrial fibrillation: state of evidence. Minerva Cardioangiologica 2018; 66 (3): 301–13. DOI: 10.23736/S0026-4725.17.04553-4
3. Rekomendatsii Evropeiskogo obshchestva kardiologov (ESC) po lecheniiu patsientov s fibrilliatsiei predserdii ,razrabotannye sovmestno S EACTS rabochei gruppoi po lecheniiu patsientov s fibrilliatsiei predserdii Evropeiskogo obshchestva kardiologov (EOK), Evropeiskoi assotsiatsiei ritma serdtsa (EHRA), Evropeiskoi organizatsiei po izucheniiu insul'ta (ESO). Ros. kardiol. zhurn. 2017; 7 (147): 7–86 (in Russian).
4. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO). Eur Heart J 2016; 37: 2893–962. DOI: 10.1093/eurheartj/ehw210
5. Jahangir A, Lee V, Friedman PA et al. Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation 2007; 115: 3050–6.
6. Gillis AM, Rose MS. Temporal patterns of paroxysmal atrial fibrillation following DDDR pacemaker implantation. Am J Cardiol 2000; 85: 1445–50.
7. Charitos EI, Purerfellner H, Glotzer TV, Ziegler PD. Clinical classifications of atrial fibrillation poorly reflect its temporal persistence: insights from 1,195 patients continuously monitored with implantable devices. J Am Coll Cardiol 2014; 63: 2840–8.
8. Banerjee A, Taillandier S, Olesen JB et al. Pattern of atrial fibrillation and risk of outcomes: the Loire Valley Atrial Fibrillation Project. Int J Cardiol 2013; 167: 2682–7.
9. Lee G, Sanders P, Kalman JM. Catheter ablation of atrial arrhythmias: state of the art. Lancet 2012; 380: 1509–19.
10. Davis RC, Hobbs FD, Kenkre JE. Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace 2012; 14: 1553–9.
11. Hobbs FD, Fitzmaurice DA, Mant J et al. A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Health Technol Assess 2005; 9: iii–iv, ix–x, 1–74.
12. Aronsson M, Svennberg E, Rosenqvist M et al. Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording. Europace 2015; 17: 1023–9.
13. Levin LA, Husberg M, Sobocinski PD et al. A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace 2015; 17: 207–14.
14. Heidbuchel H, Verhamme P, Alings M et al. Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. Eur Heart J 2017; 38 (27): 2137–49.
15. Patel MR, Mahaffey KW, Garg J et al for the ROCKET-AF Investigators. Rivaroxaban versus warfarin in nonvalvularatrial fibrillation. N Engl J Med 2011; 365: 883–91.
16. Kirchhof P, Breithardt G, Aliot E et al. Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference. Europace 2013; 15: 1540–56.
17. Nikolaidou T, Channer KS. Chronic atrial fibrillation: a systematic review of medical heart rate control management. Postgrad Med J 2009; 85: 303–12.
18. Tamariz LJ, Bass EB. Pharmacological rate control of atrial fibrillation. Cardiol Clin 2004; 22: 35–45.
19. Segal JB, McNamara RL, Miller MR et al. The evidence regarding the drugs used for ventricular rate control. In J Fam Practice 2000; 49: 47–59.
20. Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Ksarelto® 15/20 mg LP-001457. https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=082b82c0‑ 6225‑481a-a575‑befc31da5d49&t= (in Russian).
21. Kirchhof P et al. Global Prospective Safety Analysis of Rivaroxaban. J Am Coll Cardiol 2018; 72 (2): 141–53.
22. Fox KA et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J 2011; 32 (19): 2387–94.
23. Luk'ianov M.M. i dr. Diagnostika, lechenie, sochetannaia serdechno-sosudistaia patologiia i soputstvuiushchie zabolevaniia u bol'nykh s diagnozom "fibrilliatsiia predserdii' v usloviiakh real'noi ambulatorno-poliklinicheskoi praktiki (po dannym REgistra KardioVAskuliarnykh ZAbolevanii REKVAZA). Ratsional'naia farmakoterapiia v kardiologii. 2014; 10 (4): 366–77 (in Russian).
24. Gómez-Outes A et al. Causes of Death in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol 2016; 68: 2508–21.
25. Van Diepen S et al. Efficacy and safety of rivaroxaban in patients with heart failure and nonvalvular atrial fibrillation: insights from ROCKET AF. Circ Heart Fail 2013; 6 (4): 740–7.
26. Bansilal S et al. Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Once-daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial). Am Heart J 2015; 170: 675–82.e8
27. Mak K-H. Coronary and mortality risk of novel oral antithrombotic agents: a meta-analysis of large randomised trials. BMJ Open 2012; 2: e001592
28. Chatterjee S, Sharma A, Uchino K et al. Rivaroxaban and risk of myocardial infarction: insights from a meta-analysis and trial sequential analysis of randomized clinical trials. Coron Artery Dis 2013; 24 (8): 628–35.
29. Jingyi Liu, Makoto Nishida, Hiroyasu Inuietall. Rivaroxaban Suppresses the Progression of Ischemic Cardiomyopathy in a Murine Model of Diet-Induced Myocardial Infarction. J Atherosclerosis Thrombosis 2019; 14.
30. Pop C, Matei C, Petris A. Anticoagulation in Acute Coronary Syndrome: Review of Major Therapeutic Advances. Am J Ther 2019; 26 (2): e184–e197.
31. Majeed A, Ågren A., Holmström M et al. Management of rivaroxaban- or apixaban-associated major bleeding with prothrombin complex concentrates: a cohort study. Blood 2017; 130: 1706–12. DOI: https://doi.org/10.1182
32. Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Ksarelto® 2,5 mg. http://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=844b686e-f176-4cca-bfe6-b6c1b49ed495&am... Russian).
Авторы
Т.Е. Морозова*, Н.А. Конышко
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*temorozova@gmail.com
________________________________________________
Tatiana E. Morozova*, Natalia A. Konyshko
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*temorozova@gmail.com