Антитромботическая терапия у пациентов с ишемической болезнью сердца: выбор стратегии в зависимости от наличия коморбидной патологии

Остроумова О.Д., Кочетков А.И., Дубинина А.В., Телкова С.С., Гаврилова Н.Е., Долдо Н.М., Миронова Е.В. Антитромботическая терапия у пациентов с ишемической болезнью сердца: выбор стратегии в зависимости от наличия коморбидной патологии. Consilium Medicum. 2026;28(1):28–35. DOI: 10.26442/20751753.2026.1.203633

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Ostroumova OD, Kochetkov AI, Dubinina AV, Telkova SS, Gavrilova NE, Doldo NM, Mironova EV. Antithrombotic therapy in coronary artery disease: strategy choice based on comorbidity. A review. Consilium Medicum. 2026;28(1):28–35. DOI: 10.26442/20751753.2026.1.203633

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Аннотация

Ишемическая болезнь сердца (ИБС) сохраняет лидирующие позиции в структуре смертности, а ее частое сочетание с фибрилляцией предсердий (ФП) значимо утяжеляет прогноз, ставя врачей перед сложным выбором между профилактикой инсульта, защитой от коронарных событий и минимизацией риска кровотечений. Даже у пациентов со стабильной ИБС сохраняется высокий резидуальный риск тромботических осложнений, обусловленный персистирующей активацией коагуляционного каскада, который традиционная антиагрегантная монотерапия не позволяет контролировать в полной мере. Стратегия двойного ингибирования путей тромбообразования позволила улучшить результаты лечения: добавление ривароксабана в «сосудистой» дозе по 2,5 мг 2 раза в сутки к ацетилсалициловой кислоте обеспечивает значимое снижение риска сердечно-сосудистой смерти и ишемических событий с приемлемым профилем безопасности, что делает этот подход обоснованным у пациентов с высоким ишемическим риском, в частности после перенесенного инфаркта миокарда или при многососудистом поражении коронарного русла. При наличии ФП принципы антитромботической защиты принципиально меняются, требуя обязательного включения полноценной антикоагулянтной терапии. Ключевым подходом к решению проблемы становится стратегия снижения интенсивности лечения – от максимально коротких курсов тройной терапии (антикоагулянт + два антиагреганта) в остром периоде после чрескожного коронарного вмешательства к двойной антитромботической терапии (антикоагулянт + клопидогрел) на протяжении первого года наблюдения. В отдаленном периоде у стабильных пациентов обоснован переход на монотерапию антикоагулянтом, которая не уступает комбинированной терапии по эффективности профилактики тромботических событий и достоверно превосходит ее по безопасности, что подтверждено результатами крупных клинических исследований и метаанализов. Таким образом, ривароксабан обладает наиболее полной доказательной базой среди прямых пероральных антикоагулянтов, охватывающей весь спектр клинических ситуаций – от вторичной профилактики при изолированной ИБС до ведения пациентов с ее сочетанием с ФП, что позволяет реализовать по-настоящему индивидуализированный подход с тщательным учетом баланса ишемического и геморрагического рисков в реальной клинической практике.

Ключевые слова: ишемическая болезнь сердца, фибрилляция предсердий, ривароксабан, двойная антитромботическая терапия, прямой пероральный антикоагулянт

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Coronary artery disease (CAD) remains a leading cause of mortality, and its frequent coexistence with atrial fibrillation (AF) significantly worsens prognosis, presenting physicians with a complex choice between stroke prevention, protection from coronary events, and minimization of bleeding risk. Even in patients with stable CAD, a high residual risk of thrombotic complications persists, driven by ongoing activation of the coagulation cascade, which traditional antiplatelet monotherapy cannot fully control. The strategy of dual pathway inhibition of thrombus formation has improved treatment outcomes: adding rivaroxaban at a "vascular" dose of 2.5 mg twice daily to acetylsalicylic acid provides a significant reduction in the risk of cardiovascular death and ischemic events with an acceptable safety profile. This approach is justified in patients at high ischemic risk, particularly those with a history of myocardial infarction or multivessel CAD. In the presence of AF, the principles of antithrombotic protection fundamentally change, mandating the inclusion of full-dose anticoagulation. The key strategy to address this challenge is treatment de-escalation: from the shortest possible courses of triple therapy (anticoagulant plus two antiplatelet agents) in the acute phase after percutaneous coronary intervention to dual therapy (anticoagulant plus clopidogrel) during the first year of follow-up. In the long term, stable patients benefit from a transition to anticoagulant monotherapy, which is non-inferior to combination therapy in preventing thrombotic events and significantly superior in terms of safety, as confirmed by large clinical trials and meta-analyses. Thus, rivaroxaban possesses the most comprehensive evidence base among direct oral anticoagulants, covering the entire spectrum of clinical scenarios, from secondary prevention in isolated CAD to the management of patients with concomitant AF. This enables a truly individualized approach, carefully balancing ischemic and bleeding risks in real-world clinical practice.

Keywords: coronary artery disease, atrial fibrillation, rivaroxaban, dual antithrombotic therapy, direct oral anticoagulant

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Список литературы

1. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-537. DOI:10.1093/eurheartj/ehae177
2. Александрова Г.А., Голубев Н.А., Краснова В.В., и др. Здравоохранение в России. 2025: стат. сб. М.: Росстат, 2025. 149 с. [Aleksandrova GA, Golubev NA, Krasnova VV, et al. Zdravookhranenie v Rossii. 2025: stat. sb. Moscow: Rosstat, 2025. 149 p. (in Russian)].
3. Peeters A, Mamun AA, Willekens F, Bonneux L. A cardiovascular life history. A life course analysis of the original Framingham Heart Study cohort. Eur Heart J. 2002;23(6):458-66. DOI:10.1053/euhj.2001.2838
4. Стабильная ишемическая болезнь сердца. Клинические рекомендации Минздрава России. 2024. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/155_2. Ссылка активна на 20.01.2026 [Stabil'naia ishemicheskaia bolezn' serdtsa. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/155_2. Accessed: 20.01.2026 (in Russian)].
5. Cacoub PP, Zeymer U, Limbourg T, et al. Effects of adherence to guidelines for the control of major cardiovascular risk factors on outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry Europe. Heart. 2011;97(8):660-7. DOI:10.1136/hrt.2010.213710
6. Шальнова С.А., Оганов Р.Г., Стэг Ф.Г., Форд Й. Ишемическая болезнь сердца. Современная реальность по данным всемирного регистра Сlarify. Кардиология. 2013;8(53):28-33 [Shalnova SA, Oganov RG, Steg PhG, Ford I. Coronary artery disease in Russia. Today’s reality evidenced by international Clarify registry. Kardiologiia. 2013;8(53):28-33 (in Russian)].
7. Панченко Е.П. Результаты трехлетнего наблюдения за амбулаторными больными с клиническими проявлениями атеротромбоза (анализ российской популяции регистра REACH). Кардиология. 2009;10:9-15 [Panchenko EP. Results of three year observation of outpatients with clinical manifestations of atherothrombosis (analysis of Russian population of REACH registry). Kardiologiia. 2009;49(10):9-15 (in Russian)].
8. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017;377(14):1319-30. DOI:10.1056/NEJMoa1709118
9. Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2018;391(10117):205-18. DOI:10.1016/S0140-6736(17)32458-3
10. Фибрилляция и трепетание предсердий у взрослых. Клинические рекомендации Минздрава России. 2025. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/382_2. Ссылка активна на 20.01.2026 [Fibrilliatsiia i trepetanie predserdii u vzroslykh. Klinicheskie rekomendatsii Minzdrava Rossii. 2025. Available at: https://cr.minzdrav.gov.ru/preview-cr/382_2. Accessed: 20.01.2026 (in Russian)].
11. Frederiksen TC, Benjamin EJ, Trinquart L, et al. Bidirectional Association Between Atrial Fibrillation and Myocardial Infarction, and Relation to Mortality in the Framingham Heart Study. J Am Heart Assoc. 2024;13(11):e032226. DOI:10.1161/JAHA.123.032226
12. Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304(12):1350-7. DOI:10.1001/jama.2010.1322
13. Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36(19):1163-70. DOI:10.1093/eurheartj/ehu505
14. Collaborative overview of randomised trials of antiplatelet therapy – I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ. 1994;308(6921):81-106.
15. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706-17. DOI:10.1056/NEJMoa060989
16. Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155-66. DOI:10.1056/NEJMoa1409312
17. Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791-800. DOI:10.1056/NEJMoa1500857
18. Falk E, Nakano M, Bentzon JF, et al. Update on acute coronary syndromes: the pathologists' view. Eur Heart J. 2013;34(10):719-28. DOI:10.1093/eurheartj/ehs411
19. Weitz JI. Insights into the role of thrombin in the pathogenesis of recurrent ischaemia after acute coronary syndrome. Thromb Haemost. 2014;112(5):924-31. DOI:10.1160/TH14-03-0265
20. Weitz JI, Angiolillo DJ, Geisler T, Heitmeier S. Dual Pathway Inhibition for Vascular Protection in Patients with Atherosclerotic Disease: Rationale and Review of the Evidence. Thromb Haemost. 2020;120(8):1147-58. DOI:10.1055/s-0040-1713376
21. Rizzi A, Petrucci G, Sacco M, et al. Effects of low-dose rivaroxaban combined with low-dose aspirin versus low-dose aspirin alone on in vivo platelet activation, endothelial function and inflammation in type 2 diabetes patients with stable atherosclerotic disease: the RivAsa randomized, crossover study. Diabetes Res Clin Pract. 2025;224:112244. DOI:10.1016/j.diabres.2025.112244
22. Coleman CI, Kharat AA, Bookhart B, Baker WL. Combination anticoagulant or P2Y12 inhibitor with low-dose aspirin versus low-dose aspirin alone in patients at risk or with documented coronary and/or peripheral artery disease. Curr Med Res Opin. 2022;38(1):27-34. DOI:10.1080/03007995.2021.1991294
23. Tsaban G, Alnsasra H, El Nasasra A, et al. Aspirin with Low-Dose Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention: A Cost per Outcome Analysis. Am J Cardiovasc Drugs. 2022;22(6):677-83. DOI:10.1007/s40256-022-00543-8
24. Hess CN, James S, Lopes RD, et al. Apixaban Plus Mono Versus Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights From the APPRAISE-2 Trial. J Am Coll Cardiol. 2015;66(7):777-87. DOI:10.1016/j.jacc.2015.06.027
25. Steg PG, Mehta SR, Jukema JW, et al. RUBY-1: a randomized, double-blind, placebo-controlled trial of the safety and tolerability of the novel oral factor Xa inhibitor darexaban (YM150) following acute coronary syndrome. Eur Heart J. 2011;32(20):2541-54. DOI:10.1093/eurheartj/ehr334
26. Saglietto A, Varbella V, Ballatore A, et al. Prognostic implications of atrial fibrillation in patients with stable coronary artery disease: a systematic review and meta-analysis of adjusted observational studies. Rev Cardiovasc Med. 2021;22(2):439-44. DOI:10.31083/j.rcm2202049
27. Frederiksen TC, Dahm CC, Preis SR, et al. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol. 2023;20(9):631-44. DOI:10.1038/s41569-023-00857-3
28. Merlini PA, Bauer KA, Oltrona L, et al. Persistent activation of coagulation mechanism in unstable angina and myocardial infarction. Circulation. 1994;90(1):61-8. DOI:10.1161/01.cir.90.1.61
29. Zelniker TA, Ruff CT, Antman EM, Giugliano RP. The efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and coronary artery disease: A meta-analysis of randomized trials. Eur Heart J Acute Cardiovasc Care. 2019;8(6):554-61. DOI:10.1177/2048872618796990
30. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации Минздрава России. 2024. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/154_4. Ссылка активна на 20.01.2026 [Ostryi koronarnyi sindrom bez pod"ema segmenta ST elektrokardiogrammy. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/154_4. Accessed: 20.01.2026 (in Russian)].
31. Острый инфаркт миокарда с подъемом сегмента ST электрокардиограммы. Клинические рекомендации Минздрава России. 2024. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/157_5. Ссылка активна на 20.01.2026 [Ostryi infarkt miokarda s pod"emom segmenta ST elektrokardiogrammy. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/157_5. Accessed: 20.01.2026 (in Russian)].
32. Ravi V, Pulipati P, Vij A, Kodumuri V. Meta-Analysis Comparing Double Versus Triple Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease. Am J Cardiol. 2020;125(1):19-28. DOI:10.1016/j.amjcard.2019.09.045
33. Andò G, Costa F. Double or triple antithrombotic therapy after coronary stenting and atrial fibrillation: A systematic review and meta-analysis of randomized clinical trials. Int J Cardiol. 2020;302:95-102. DOI:10.1016/j.ijcard.2019.12.054
34. Westenbrink BD, Alings M, Granger CB, et al. Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. Am Heart J. 2017;185:140-9. DOI:10.1016/j.ahj.2016.12.008
35. Westenbrink BD, Alings M, Connolly SJ, et al. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial. J Thromb Haemost. 2015;13(5):699-707. DOI:10.1111/jth.12874
36. LaMori JC, Mody SH, Gross HJ, et al. Burden of comorbidities among patients with atrial fibrillation. Ther Adv Cardiovasc Dis. 2013;7(2):53-62. DOI:10.1177/1753944712464101
37. Vanbeselaere V, Truyers C, Elli S, et al. Association between atrial fibrillation, anticoagulation, risk of cerebrovascular events and multimorbidity in general practice: a registry-based study. BMC Cardiovasc Disord. 2016;16:61. DOI:10.1186/s12872-016-0235-1
38. Телкова С.С., Кочетков А.И., Воробьева А.Е., и др. К вопросу о структуре сопутствующих заболеваний и назначении антикоагулянтной терапии у пациентов пожилого и старческого возраста с фибрилляцией предсердий. Эффективная фармакотерапия. 2023;19(55):30-7 [Telkova SS, Kochetkov AI, Vorobyova AYe, et al. To the Question of the Structure of Concomitant Diseases and the Prescription of Anticoagulant Therapy in Elderly and Senile Patients with Atrial Fibrillation. Effective Pharmacotherapy. 2023;19(55):30-7 (in Russian)]. DOI:10.33978/2307-3586-2023-19-55-30-37
39. Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016;375(25):2423-34. DOI:10.1056/NEJMoa1611594
40. Mahaffey KW, Stevens SR, White HD, et al. Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial. Eur Heart J. 2014;35(4):233-41. DOI:10.1093/eurheartj/eht428
41. Ma F, Yuan L, Wen X, et al. Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis. Clin Appl Thromb Hemost. 2022;28:10760296221131033. DOI:10.1177/10760296221131033
42. Yasuda S, Kaikita K, Akao M, et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med. 2019;381(12):1103-13. DOI:10.1056/NEJMoa1904143
43. Matoba T, Yasuda S, Kaikita K, et al. Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting: Insights From the AFIRE Trial. JACC Cardiovasc Interv. 2021;14(21):2330-40. DOI:10.1016/j.jcin.2021.07.045
44. Yamaguchi J, Arashi H, Hagiwara N, et al. Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE Randomized Clinical Trial. JAMA Cardiol. 2025;10(10):990-9. DOI:10.1001/jamacardio.2025.2611
45. Смехова И.Е., Оковитый С.В. Оценка эквивалентности in vitro таблеток ривароксабана. Consilium Medicum. 2025;27(12):818-23 [Smekhova IE, Okovityi SV. In vitro equivalence assessment of rivaroxaban tablets. Consilium Medicum. 2025;27(12):818-23 (in Russian)]. DOI:10.26442/20751753.2025.12.203530

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1. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-537. DOI:10.1093/eurheartj/ehae177
2. Aleksandrova GA, Golubev NA, Krasnova VV, et al. Zdravookhranenie v Rossii. 2025: stat. sb. Moscow: Rosstat, 2025. 149 p. (in Russian).
3. Peeters A, Mamun AA, Willekens F, Bonneux L. A cardiovascular life history. A life course analysis of the original Framingham Heart Study cohort. Eur Heart J. 2002;23(6):458-66. DOI:10.1053/euhj.2001.2838
4. Stabil'naia ishemicheskaia bolezn' serdtsa. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/155_2. Accessed: 20.01.2026 (in Russian).
5. Cacoub PP, Zeymer U, Limbourg T, et al. Effects of adherence to guidelines for the control of major cardiovascular risk factors on outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry Europe. Heart. 2011;97(8):660-7. DOI:10.1136/hrt.2010.213710
6. Shalnova SA, Oganov RG, Steg PhG, Ford I. Coronary artery disease in Russia. Today’s reality evidenced by international Clarify registry. Kardiologiia. 2013;8(53):28-33 (in Russian).
7. Panchenko EP. Results of three year observation of outpatients with clinical manifestations of atherothrombosis (analysis of Russian population of REACH registry). Kardiologiia. 2009;49(10):9-15 (in Russian).
8. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017;377(14):1319-30. DOI:10.1056/NEJMoa1709118
9. Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2018;391(10117):205-18. DOI:10.1016/S0140-6736(17)32458-3
10. Fibrilliatsiia i trepetanie predserdii u vzroslykh. Klinicheskie rekomendatsii Minzdrava Rossii. 2025. Available at: https://cr.minzdrav.gov.ru/preview-cr/382_2. Accessed: 20.01.2026 (in Russian).
11. Frederiksen TC, Benjamin EJ, Trinquart L, et al. Bidirectional Association Between Atrial Fibrillation and Myocardial Infarction, and Relation to Mortality in the Framingham Heart Study. J Am Heart Assoc. 2024;13(11):e032226. DOI:10.1161/JAHA.123.032226
12. Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304(12):1350-7. DOI:10.1001/jama.2010.1322
13. Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36(19):1163-70. DOI:10.1093/eurheartj/ehu505
14. Collaborative overview of randomised trials of antiplatelet therapy – I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ. 1994;308(6921):81-106.
15. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706-17. DOI:10.1056/NEJMoa060989
16. Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155-66. DOI:10.1056/NEJMoa1409312
17. Bonaca MP, Bhatt DL, Cohen M, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791-800. DOI:10.1056/NEJMoa1500857
18. Falk E, Nakano M, Bentzon JF, et al. Update on acute coronary syndromes: the pathologists' view. Eur Heart J. 2013;34(10):719-28. DOI:10.1093/eurheartj/ehs411
19. Weitz JI. Insights into the role of thrombin in the pathogenesis of recurrent ischaemia after acute coronary syndrome. Thromb Haemost. 2014;112(5):924-31. DOI:10.1160/TH14-03-0265
20. Weitz JI, Angiolillo DJ, Geisler T, Heitmeier S. Dual Pathway Inhibition for Vascular Protection in Patients with Atherosclerotic Disease: Rationale and Review of the Evidence. Thromb Haemost. 2020;120(8):1147-58. DOI:10.1055/s-0040-1713376
21. Rizzi A, Petrucci G, Sacco M, et al. Effects of low-dose rivaroxaban combined with low-dose aspirin versus low-dose aspirin alone on in vivo platelet activation, endothelial function and inflammation in type 2 diabetes patients with stable atherosclerotic disease: the RivAsa randomized, crossover study. Diabetes Res Clin Pract. 2025;224:112244. DOI:10.1016/j.diabres.2025.112244
22. Coleman CI, Kharat AA, Bookhart B, Baker WL. Combination anticoagulant or P2Y12 inhibitor with low-dose aspirin versus low-dose aspirin alone in patients at risk or with documented coronary and/or peripheral artery disease. Curr Med Res Opin. 2022;38(1):27-34. DOI:10.1080/03007995.2021.1991294
23. Tsaban G, Alnsasra H, El Nasasra A, et al. Aspirin with Low-Dose Ticagrelor or with Low-Dose Rivaroxaban for Secondary Prevention: A Cost per Outcome Analysis. Am J Cardiovasc Drugs. 2022;22(6):677-83. DOI:10.1007/s40256-022-00543-8
24. Hess CN, James S, Lopes RD, et al. Apixaban Plus Mono Versus Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights From the APPRAISE-2 Trial. J Am Coll Cardiol. 2015;66(7):777-87. DOI:10.1016/j.jacc.2015.06.027
25. Steg PG, Mehta SR, Jukema JW, et al. RUBY-1: a randomized, double-blind, placebo-controlled trial of the safety and tolerability of the novel oral factor Xa inhibitor darexaban (YM150) following acute coronary syndrome. Eur Heart J. 2011;32(20):2541-54. DOI:10.1093/eurheartj/ehr334
26. Saglietto A, Varbella V, Ballatore A, et al. Prognostic implications of atrial fibrillation in patients with stable coronary artery disease: a systematic review and meta-analysis of adjusted observational studies. Rev Cardiovasc Med. 2021;22(2):439-44. DOI:10.31083/j.rcm2202049
27. Frederiksen TC, Dahm CC, Preis SR, et al. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol. 2023;20(9):631-44. DOI:10.1038/s41569-023-00857-3
28. Merlini PA, Bauer KA, Oltrona L, et al. Persistent activation of coagulation mechanism in unstable angina and myocardial infarction. Circulation. 1994;90(1):61-8. DOI:10.1161/01.cir.90.1.61
29. Zelniker TA, Ruff CT, Antman EM, Giugliano RP. The efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and coronary artery disease: A meta-analysis of randomized trials. Eur Heart J Acute Cardiovasc Care. 2019;8(6):554-61. DOI:10.1177/2048872618796990
30. Ostryi koronarnyi sindrom bez pod"ema segmenta ST elektrokardiogrammy. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/154_4. Accessed: 20.01.2026 (in Russian).
31. Ostryi infarkt miokarda s pod"emom segmenta ST elektrokardiogrammy. Klinicheskie rekomendatsii Minzdrava Rossii. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/157_5. Accessed: 20.01.2026 (in Russian).
32. Ravi V, Pulipati P, Vij A, Kodumuri V. Meta-Analysis Comparing Double Versus Triple Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease. Am J Cardiol. 2020;125(1):19-28. DOI:10.1016/j.amjcard.2019.09.045
33. Andò G, Costa F. Double or triple antithrombotic therapy after coronary stenting and atrial fibrillation: A systematic review and meta-analysis of randomized clinical trials. Int J Cardiol. 2020;302:95-102. DOI:10.1016/j.ijcard.2019.12.054
34. Westenbrink BD, Alings M, Granger CB, et al. Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. Am Heart J. 2017;185:140-9. DOI:10.1016/j.ahj.2016.12.008
35. Westenbrink BD, Alings M, Connolly SJ, et al. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial. J Thromb Haemost. 2015;13(5):699-707. DOI:10.1111/jth.12874
36. LaMori JC, Mody SH, Gross HJ, et al. Burden of comorbidities among patients with atrial fibrillation. Ther Adv Cardiovasc Dis. 2013;7(2):53-62. DOI:10.1177/1753944712464101
37. Vanbeselaere V, Truyers C, Elli S, et al. Association between atrial fibrillation, anticoagulation, risk of cerebrovascular events and multimorbidity in general practice: a registry-based study. BMC Cardiovasc Disord. 2016;16:61. DOI:10.1186/s12872-016-0235-1
38. Telkova SS, Kochetkov AI, Vorobyova AYe, et al. To the Question of the Structure of Concomitant Diseases and the Prescription of Anticoagulant Therapy in Elderly and Senile Patients with Atrial Fibrillation. Effective Pharmacotherapy. 2023;19(55):30-7 (in Russian). DOI:10.33978/2307-3586-2023-19-55-30-37
39. Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016;375(25):2423-34. DOI:10.1056/NEJMoa1611594
40. Mahaffey KW, Stevens SR, White HD, et al. Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial. Eur Heart J. 2014;35(4):233-41. DOI:10.1093/eurheartj/eht428
41. Ma F, Yuan L, Wen X, et al. Efficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis. Clin Appl Thromb Hemost. 2022;28:10760296221131033. DOI:10.1177/10760296221131033
42. Yasuda S, Kaikita K, Akao M, et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med. 2019;381(12):1103-13. DOI:10.1056/NEJMoa1904143
43. Matoba T, Yasuda S, Kaikita K, et al. Rivaroxaban Monotherapy in Patients With Atrial Fibrillation After Coronary Stenting: Insights From the AFIRE Trial. JACC Cardiovasc Interv. 2021;14(21):2330-40. DOI:10.1016/j.jcin.2021.07.045
44. Yamaguchi J, Arashi H, Hagiwara N, et al. Age-Stratified Effect of Rivaroxaban Monotherapy for Atrial Fibrillation in Stable Coronary Artery Disease: A Post Hoc Analysis of the AFIRE Randomized Clinical Trial. JAMA Cardiol. 2025;10(10):990-9. DOI:10.1001/jamacardio.2025.2611
45. Smekhova IE, Okovityi SV. In vitro equivalence assessment of rivaroxaban tablets. Consilium Medicum. 2025;27(12):818-23 (in Russian). DOI:10.26442/20751753.2025.12.203530

Авторы

О.Д. Остроумова*^1,2, А.И. Кочетков¹, А.В. Дубинина^1,3, С.С. Телкова¹, Н.Е. Гаврилова^1,4, Н.М. Долдо³, Е.В. Миронова³

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Российская Федерация
²ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Российская Федерация
³ЧУЗ «ЦКБ “РЖД-Медицина“», Москва, Российская Федерация
⁴ООО «Скандинавский центр здоровья», Москва, Российская Федерация
*ostroumova.olga@mail.ru

________________________________________________

Olga D. Ostroumova*^1,2, Aleksey I. Kochetkov¹, Anna V. Dubinina^1,3, Svetlana S. Telkova¹, Natalia E. Gavrilova^1,4, Nicolai M. Doldo³, Elena V. Mironova³

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
²Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
³Central Clinical Hospital “Russian Railways-Medicine”, Moscow, Russian Federation
⁴Scandinavian Health Center LLC, Moscow, Russian Federation
*ostroumova.olga@mail.ru

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