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Профилактика кардиоэмболического инсульта
Камчатнов П.Р., Осмаева З.Х., Чугунов А.В. Профилактика кардиоэмболического инсульта. Consilium Medicum. 2020; 22 (9): 102–105. DOI: 10.26442/20751753.2020.9.200509
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Kamchatnov P.R., Osmaeva Z.Kh., Chugunov A.V. Prevention of cardioembolic stroke. Consilium Medicum. 2020; 22 (9): 102–105. DOI: 10.26442/20751753.2020.9.200509
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Аннотация
Кардиоэмболический подтип ишемического инсульта (КЭИИ) – одна из наиболее тяжелых форм цереброваскулярной патологии. Трудности в значительной степени обусловлены объективной сложностью выявления нарушений сердечного ритма – наиболее частой причины КЭИИ, которые могут носить пароксизмальный характер. Современные методы длительной регистрации электрокардиограммы обеспечивают возможность их выявления и назначения адекватной терапии. В статье рассматриваются современные подходы к установлению причины КЭИИ и проведению профилактического лечения с применением антикоагулянтов.
Ключевые слова: ишемический инсульт, кардиоэмболический инсульт, антикоагулянты, антитромбоцитарные препараты, апиксабан, рандомизированное исследование, профилактика.
Ключевые слова: ишемический инсульт, кардиоэмболический инсульт, антикоагулянты, антитромбоцитарные препараты, апиксабан, рандомизированное исследование, профилактика.
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Cardioembolic subtype of ischemic stroke (CEIS) is one of the most severe forms of cerebrovascular pathology. The difficulties are largely due to the objective difficulty of detecting heart rhythm disorders – the most common cause of CEIS, which can be paroxysmal in nature. Modern methods of long-term ECG registration make it possible to detect and prescribe adequate therapy. The article discusses modern approaches to determining the cause of the CEIS and to conduct preventive treatment with the use of anticoagulants.
Key words: ischemic stroke, cardioembolic stroke, anticoagulants, antiplatelet drugs, apixaban, randomized trial, prevention.
Полный текст
Список литературы
1. Li L, Scott CA, Rothwell PM on behalf of the Oxford Vascular Study. Trends in Stroke Incidence in High-Income Countries in the 21st Century Population-Based Study and Systematic Review. Stroke 2020; 51: 34–9. DOI: 10.1161/ STROKEAHA.119.028484
2. A unified European action plan on stroke. Editorial. Lancet Neurol. Published online November 9, 2020. https://doi.org/10.1016/S1474-4422(20)30409-9
3. Arnett DK, Blumenthal S, Albert MA et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140: e596–e646. DOI: 10.1161/CIR.0000000000000678
4. Резник Е.В., Джиоева О.Н., Камчатнов П.Р., Никитин И.Г. Вторичная профилактика инсульта: взгляд терапевта и кардиолога. Неврология и ревматология. Consilium Medicum (Прил.). 2019; 1: 12–24.
[Reznik E.V., Dzhioeva O.N., Kamchatnov P.R., Nikitin I.G. Secondary prevention of stroke: the view of a therapist and cardiologist. Neurology and Rheumatology. Consilium Medicum (Suppl.). 2019; 1: 12–24 (in Russian).]
5. Парфенов В.А., Вербицкая С.В. Профилактика повторного некардиоэмболического ишемического инсульта на основе антитромбоцитарных средств. Атеротромбоз. 2016; 2:
97–8. DOI: 10.21518/2307-1109-2016-2-89-97
[Parfenov V.A., Verbitskaya S.V. Prevention of recurrent non-cardioembolic ischemic stroke based on antiplatelet agents. Atherothrombosis. 2016; 2: 97–8. DOI: 10.21518/2307-1109-2016-2-89-97 (in Russian).]
6. Rosales JS, Alet MJ, Pujol Lereis VA, Ameriso SF. Fall in the Proportion of Atherothrombotic Strokes During the Last Decade. J Stroke Cerebrovasc Dis 2020; 29 (12): 105257. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105257
7. Клочихина О.А., Стаховская Л.В., Полунина Е.А. и др. Эпидемиология и прогноз уровня заболеваемости и смертности от инсульта в разных возрастных группах по данным территориально-популяционного регистра. Журн. неврологии и психиатрии им. С.С. Корсакова. 2019; 119 (8): 5–12. DOI: 10.17116/jnevro20191190825
[Klochihina O.A., Stakhovskaya L.V., Polunina Е.А. et al. Epidemiology and prognosis of the level of morbidity and mortality from stroke in different age groups according to the territorial-population register. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2019; 119 (8): 5–12 (in Russian).]
8. Svennberg E, Engdahl J, Al-Khalili F et al. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation 2015; 131: 2176–84. DOI: 10.1161/CIRCULATIONAHA.114.014343
9. Healey J, Alings M, Ha A et al. Subclinical Atrial Fibrillation in Older Patients. Circulation 2017; 136: 1276–83. DOI: 10.1161/CIRCULATIONAHA.117.028845
10. Tayal A, Tian M, Kelly K et al. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology 2008; 71: 1696–701. DOI: 10.1212/01.wnl.0000325059.86313.31
11. Jowett S, Bryan S, Mant J et al. Cost effectiveness of warfarin versus aspirin in patients older than 75 years with atrial fibrillation. Stroke 2011; 42 (6): 1717–21. DOI: 10.1161/STROKEAHA.110.600767
12. Niska R, Han B. Anticoagulation for Patients with Atrial Fibrillation in Ambulatory Care Settings. Am Board Fam Med 2009; 22: 299–306. DOI: 10.3122/jabfm.2009.03.080218
13. Giralt-Steinhauer E, Cuadrado-Godia E, Ois Á et al. Comparison between CHADS2 and CHA2DS2-VASc score in a stroke cohort with atrial fibrillation. Eur J Neurol 2013; 20 (4): 623–8. DOI: 10.1111/j.1468-1331.2012.03807.x
14. Mercaldi CJ, Ciarametaro M, Hahn B et al. Cost Efficiency of Anticoagulation With Warfarin to Prevent Stroke in Medicare Beneficiaries With Nonvalvular Atrial Fibrillation. Stroke 2011; 42 (1): 112–8. DOI: 10.1161/STROKEAHA.110.592907
15. Connolly SJ, Eikelboom J, Joyne C et al. Apixaban in Patients with Atrial Fibrillation. N Engl J Med 2011; 364: 806–17. N Engl J Med 2011; 364 (9): 806–17. DOI: 10.1056/NEJMoa1007432
16. Benz AP, Eikelboom JW, Yusuf S et al. Long-Term Treatment with Apixaban in Patients with Atrial Fibrillation: Outcomes during the Open-Label Extension following AVERROES. Thromb Haemost 2020. DOI: 10.1055/s-0040-1717115
17. Hart RG, Diener HC, Coutts S et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429–38. DOI: 10.1016/S1474-4422(13)70310-7
18. Chimowitz M, Lynn M, Howlett-Smith H et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352: 1305–16. DOI: 10.1056/NEJMoa043033
19. Amarenco P, Davis S, Jones E et al. Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques. Stroke 2014; 45: 1248–57. DOI: 10.1161/STROKEAHA.113.004251
20. Kamel H, Longstreth WT Jr, Tirschwell D et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke (ARCADIA) randomized trial: Rationale and Methods. Int J Stroke 2019; 14 (2): 207–14. DOI: 10.1177/1747493018799981
21. De Bruijn R, Heeringa J, Wolters F et al. Association between atrial fibrillation and dementia in the general population. JAMA Neurol 2015; 72: 1288–94. DOI: 10.1001/jamaneurol.2015.2161
22. Wehling M, Collins R, Gil VM et al. Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016). Drugs Aging 2017; 34 (7): 499–507. DOI: 10.1007/s40266-017-0466-6
23. Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2018; 35: 61–71. DOI: 10.1007/s40266-017-0514-2
24. Приказ Минздрава России №1н «Об утверждении перечня лекарственных препаратов для медицинского применения для обеспечения в течение одного года в амбулаторных условиях…» от 09.01.2020.
[Order of the Ministry of health of the Russian Federation №1n "On approval of the list of medicines for medical use to provide for one year in outpatient conditions..." dated 09.01.2020 (in Russian).]
2. A unified European action plan on stroke. Editorial. Lancet Neurol. Published online November 9, 2020. https://doi.org/10.1016/S1474-4422(20)30409-9
3. Arnett DK, Blumenthal S, Albert MA et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140: e596–e646. DOI: 10.1161/CIR.0000000000000678
4. Резник Е.В., Джиоева О.Н., Камчатнов П.Р., Никитин И.Г. Вторичная профилактика инсульта: взгляд терапевта и кардиолога. Неврология и ревматология. Consilium Medicum (Прил.). 2019; 1: 12–24.
[Reznik E.V., Dzhioeva O.N., Kamchatnov P.R., Nikitin I.G. Secondary prevention of stroke: the view of a therapist and cardiologist. Neurology and Rheumatology. Consilium Medicum (Suppl.). 2019; 1: 12–24 (in Russian).]
5. Парфенов В.А., Вербицкая С.В. Профилактика повторного некардиоэмболического ишемического инсульта на основе антитромбоцитарных средств. Атеротромбоз. 2016; 2:
97–8. DOI: 10.21518/2307-1109-2016-2-89-97
[Parfenov V.A., Verbitskaya S.V. Prevention of recurrent non-cardioembolic ischemic stroke based on antiplatelet agents. Atherothrombosis. 2016; 2: 97–8. DOI: 10.21518/2307-1109-2016-2-89-97 (in Russian).]
6. Rosales JS, Alet MJ, Pujol Lereis VA, Ameriso SF. Fall in the Proportion of Atherothrombotic Strokes During the Last Decade. J Stroke Cerebrovasc Dis 2020; 29 (12): 105257. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105257
7. Клочихина О.А., Стаховская Л.В., Полунина Е.А. и др. Эпидемиология и прогноз уровня заболеваемости и смертности от инсульта в разных возрастных группах по данным территориально-популяционного регистра. Журн. неврологии и психиатрии им. С.С. Корсакова. 2019; 119 (8): 5–12. DOI: 10.17116/jnevro20191190825
[Klochihina O.A., Stakhovskaya L.V., Polunina Е.А. et al. Epidemiology and prognosis of the level of morbidity and mortality from stroke in different age groups according to the territorial-population register. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2019; 119 (8): 5–12 (in Russian).]
8. Svennberg E, Engdahl J, Al-Khalili F et al. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation 2015; 131: 2176–84. DOI: 10.1161/CIRCULATIONAHA.114.014343
9. Healey J, Alings M, Ha A et al. Subclinical Atrial Fibrillation in Older Patients. Circulation 2017; 136: 1276–83. DOI: 10.1161/CIRCULATIONAHA.117.028845
10. Tayal A, Tian M, Kelly K et al. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology 2008; 71: 1696–701. DOI: 10.1212/01.wnl.0000325059.86313.31
11. Jowett S, Bryan S, Mant J et al. Cost effectiveness of warfarin versus aspirin in patients older than 75 years with atrial fibrillation. Stroke 2011; 42 (6): 1717–21. DOI: 10.1161/STROKEAHA.110.600767
12. Niska R, Han B. Anticoagulation for Patients with Atrial Fibrillation in Ambulatory Care Settings. Am Board Fam Med 2009; 22: 299–306. DOI: 10.3122/jabfm.2009.03.080218
13. Giralt-Steinhauer E, Cuadrado-Godia E, Ois Á et al. Comparison between CHADS2 and CHA2DS2-VASc score in a stroke cohort with atrial fibrillation. Eur J Neurol 2013; 20 (4): 623–8. DOI: 10.1111/j.1468-1331.2012.03807.x
14. Mercaldi CJ, Ciarametaro M, Hahn B et al. Cost Efficiency of Anticoagulation With Warfarin to Prevent Stroke in Medicare Beneficiaries With Nonvalvular Atrial Fibrillation. Stroke 2011; 42 (1): 112–8. DOI: 10.1161/STROKEAHA.110.592907
15. Connolly SJ, Eikelboom J, Joyne C et al. Apixaban in Patients with Atrial Fibrillation. N Engl J Med 2011; 364: 806–17. N Engl J Med 2011; 364 (9): 806–17. DOI: 10.1056/NEJMoa1007432
16. Benz AP, Eikelboom JW, Yusuf S et al. Long-Term Treatment with Apixaban in Patients with Atrial Fibrillation: Outcomes during the Open-Label Extension following AVERROES. Thromb Haemost 2020. DOI: 10.1055/s-0040-1717115
17. Hart RG, Diener HC, Coutts S et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429–38. DOI: 10.1016/S1474-4422(13)70310-7
18. Chimowitz M, Lynn M, Howlett-Smith H et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352: 1305–16. DOI: 10.1056/NEJMoa043033
19. Amarenco P, Davis S, Jones E et al. Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques. Stroke 2014; 45: 1248–57. DOI: 10.1161/STROKEAHA.113.004251
20. Kamel H, Longstreth WT Jr, Tirschwell D et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke (ARCADIA) randomized trial: Rationale and Methods. Int J Stroke 2019; 14 (2): 207–14. DOI: 10.1177/1747493018799981
21. De Bruijn R, Heeringa J, Wolters F et al. Association between atrial fibrillation and dementia in the general population. JAMA Neurol 2015; 72: 1288–94. DOI: 10.1001/jamaneurol.2015.2161
22. Wehling M, Collins R, Gil VM et al. Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016). Drugs Aging 2017; 34 (7): 499–507. DOI: 10.1007/s40266-017-0466-6
23. Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2018; 35: 61–71. DOI: 10.1007/s40266-017-0514-2
24. Приказ Минздрава России №1н «Об утверждении перечня лекарственных препаратов для медицинского применения для обеспечения в течение одного года в амбулаторных условиях…» от 09.01.2020.
[Order of the Ministry of health of the Russian Federation №1n "On approval of the list of medicines for medical use to provide for one year in outpatient conditions..." dated 09.01.2020 (in Russian).]
________________________________________________
1. Li L, Scott CA, Rothwell PM on behalf of the Oxford Vascular Study. Trends in Stroke Incidence in High-Income Countries in the 21st Century Population-Based Study and Systematic Review. Stroke 2020; 51: 34–9. DOI: 10.1161/ STROKEAHA.119.028484
2. A unified European action plan on stroke. Editorial. Lancet Neurol. Published online November 9, 2020. https://doi.org/10.1016/S1474-4422(20)30409-9
3. Arnett DK, Blumenthal S, Albert MA et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140: e596–e646. DOI: 10.1161/CIR.0000000000000678
4. Reznik E.V., Dzhioeva O.N., Kamchatnov P.R., Nikitin I.G. Secondary prevention of stroke: the view of a therapist and cardiologist. Neurology and Rheumatology. Consilium Medicum (Suppl.). 2019; 1: 12–24 (in Russian).
5. Parfenov V.A., Verbitskaya S.V. Prevention of recurrent non-cardioembolic ischemic stroke based on antiplatelet agents. Atherothrombosis. 2016; 2: 97–8. DOI: 10.21518/2307-1109-2016-2-89-97 (in Russian).
6. Rosales JS, Alet MJ, Pujol Lereis VA, Ameriso SF. Fall in the Proportion of Atherothrombotic Strokes During the Last Decade. J Stroke Cerebrovasc Dis 2020; 29 (12): 105257. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105257
7. Klochihina O.A., Stakhovskaya L.V., Polunina Е.А. et al. Epidemiology and prognosis of the level of morbidity and mortality from stroke in different age groups according to the territorial-population register. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2019; 119 (8): 5–12 (in Russian).
8. Svennberg E, Engdahl J, Al-Khalili F et al. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation 2015; 131: 2176–84. DOI: 10.1161/CIRCULATIONAHA.114.014343
9. Healey J, Alings M, Ha A et al. Subclinical Atrial Fibrillation in Older Patients. Circulation 2017; 136: 1276–83. DOI: 10.1161/CIRCULATIONAHA.117.028845
10. Tayal A, Tian M, Kelly K et al. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology 2008; 71: 1696–701. DOI: 10.1212/01.wnl.0000325059.86313.31
11. Jowett S, Bryan S, Mant J et al. Cost effectiveness of warfarin versus aspirin in patients older than 75 years with atrial fibrillation. Stroke 2011; 42 (6): 1717–21. DOI: 10.1161/STROKEAHA.110.600767
12. Niska R, Han B. Anticoagulation for Patients with Atrial Fibrillation in Ambulatory Care Settings. Am Board Fam Med 2009; 22: 299–306. DOI: 10.3122/jabfm.2009.03.080218
13. Giralt-Steinhauer E, Cuadrado-Godia E, Ois Á et al. Comparison between CHADS2 and CHA2DS2-VASc score in a stroke cohort with atrial fibrillation. Eur J Neurol 2013; 20 (4): 623–8. DOI: 10.1111/j.1468-1331.2012.03807.x
14. Mercaldi CJ, Ciarametaro M, Hahn B et al. Cost Efficiency of Anticoagulation With Warfarin to Prevent Stroke in Medicare Beneficiaries With Nonvalvular Atrial Fibrillation. Stroke 2011; 42 (1): 112–8. DOI: 10.1161/STROKEAHA.110.592907
15. Connolly SJ, Eikelboom J, Joyne C et al. Apixaban in Patients with Atrial Fibrillation. N Engl J Med 2011; 364: 806–17. N Engl J Med 2011; 364 (9): 806–17. DOI: 10.1056/NEJMoa1007432
16. Benz AP, Eikelboom JW, Yusuf S et al. Long-Term Treatment with Apixaban in Patients with Atrial Fibrillation: Outcomes during the Open-Label Extension following AVERROES. Thromb Haemost 2020. DOI: 10.1055/s-0040-1717115
17. Hart RG, Diener HC, Coutts S et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429–38. DOI: 10.1016/S1474-4422(13)70310-7
18. Chimowitz M, Lynn M, Howlett-Smith H et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005; 352: 1305–16. DOI: 10.1056/NEJMoa043033
19. Amarenco P, Davis S, Jones E et al. Clopidogrel plus aspirin versus warfarin in patients with stroke and aortic arch plaques. Stroke 2014; 45: 1248–57. DOI: 10.1161/STROKEAHA.113.004251
20. Kamel H, Longstreth WT Jr, Tirschwell D et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke (ARCADIA) randomized trial: Rationale and Methods. Int J Stroke 2019; 14 (2): 207–14. DOI: 10.1177/1747493018799981
21. De Bruijn R, Heeringa J, Wolters F et al. Association between atrial fibrillation and dementia in the general population. JAMA Neurol 2015; 72: 1288–94. DOI: 10.1001/jamaneurol.2015.2161
22. Wehling M, Collins R, Gil VM et al. Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016). Drugs Aging 2017; 34 (7): 499–507. DOI: 10.1007/s40266-017-0466-6
23. Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging 2018; 35: 61–71. DOI: 10.1007/s40266-017-0514-2
24. Order of the Ministry of health of the Russian Federation №1n "On approval of the list of medicines for medical use to provide for one year in outpatient conditions..." dated 09.01.2020 (in Russian).
Авторы
П.Р. Камчатнов*1, З.Х. Осмаева2, А.В. Чугунов1
1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Чеченский государственный университет», Грозный, Россия
*pavkam7@gmail.com
1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Чеченский государственный университет», Грозный, Россия
*pavkam7@gmail.com
________________________________________________
Pavel R. Kamchatnov*1, Zareta Kh. Osmaeva2, Aleksandr V. Chugunov1
1 Pirogov Russian National Research Medical University, Moscow, Russia;
2 Chechen State University, Grozny, Russia
*pavkam7@gmail.com
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