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Тяжелые желудочно-кишечные кровотечения у больных с фибрилляцией предсердий, получающих пероральные антикоагулянты (по данным двадцатилетнего наблюдения в рамках Регистра длительной антитромботической терапии – РЕГАТА)
Тяжелые желудочно-кишечные кровотечения у больных с фибрилляцией предсердий, получающих пероральные антикоагулянты (по данным двадцатилетнего наблюдения в рамках Регистра длительной антитромботической терапии – РЕГАТА)
Кропачева Е.С., Хакимова М.Б., Кривошеева Е.Н., Землянская О.А., Панченко Е.П. Тяжелые желудочно-кишечные кровотечения у больных с фибрилляцией предсердий, получающих пероральные антикоагулянты (по данным двадцатилетнего наблюдения в рамках РЕГистра длительной Антитромботической ТерАпии – РЕГАТА). Терапевтический архив. 2021; 93 (9): 1037–1043. DOI: 10.26442/00403660.2021.09.201019
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Аннотация
Обоснование. Частота крупных кровотечений у больных с фибрилляцией предсердий (ФП), получающих пероральные антикоагулянты, составляет около 2–5% в год. В структуре крупных геморрагических осложнений не менее 1/2 занимают желудочно-кишечные кровотечения (ЖКК). В настоящее время отсутствует оптимальная шкала расчета риска, в связи с чем поиск клинических предикторов ЖКК остается актуальной задачей.
Цель. На основании длительного проспективного наблюдения за больными с ФП, получающими пероральные антикоагулянты, оценить частоту, структуру крупных ЖКК, а также выявить клинические предикторы их развития.
Материалы и методы. На основании 20-летнего наблюдения за 510 пациентами с ФП с высоким риском тромбоэмболических осложнений (медиана по шкале CHA2DS2-VASc составила 4 балла) в рамках регистра РЕГАТА (NCT043447187) оценены частота и структура развития крупных ЖКК. На основании анализа пар с проведением одно- и многофакторного анализов выявлены предикторы развития 32 крупных ЖКК.
Результаты. Частота крупных ЖКК у больных с ФП, получающих пероральные антикоагулянты, составила 1,42/100 пациенто-лет, преобладающей локализацией явились верхние отделы желудочно-кишечного тракта. В 1/2 случаев, несмотря на проведенное обследование, причина развития кровотечения найдена не была. Предикторами развития крупных ЖКК по данным логистической регрессии оказались: уровень гемоглобина ≤14,55 г/дл, индекс массы тела ≤28,4 кг/м2, эрозивно-язвенное поражение желудочно-кишечного тракта и большие геморрагические осложнения любой локализации в анамнезе.
Заключение. Выявление клинических предикторов ЖКК на фоне терапии пероральными антикоагулянтами позволяет определить пациентов, нуждающихся в более тщательном наблюдении с целью предотвращения развития жизнеугрожающего кровотечения и обеспечения адекватной антикоагулянтной терапии.
Ключевые слова: фибрилляция предсердий, пероральные антикоагулянты, желудочно-кишечное кровотечение
Aim. To assess the frequency and structure of large gastrointestinal bleeding, as well as to identify clinical predictors of their development based on long-term prospective observation of patients with atrial fibrillation receiving oral anticoagulants.
Materials and methods. Data were obtained from single center prospective REGistry of long-term AnTithrombotic TherApy (REGATTA NCT043447187). Investigation based on a 20-year follow-up with 510 patients with atrial fibrillation with a high thromboembolic risk (median CHA2DS2-VASc was 4 points). The REGATTA registry assessed the frequency and structure of major gastrointestinal bleeding. Predictors of the development of 32 large gastrointestinal bleeding were identified based on the analysis of pairs with univariate and multivariate analyses.
Results. The frequency of major gastrointestinal bleeding in patients with atrial fibrillation receiving oral anticoagulants at 1 year was 1.42 per 100 patients; the predominant localization was upper gastrointestinal tract. Predictors of the development of major gastrointestinal bleeding according to multiple regression data analysis were hemoglobin level ≤14.55 g/dL, body mass index ≤28.4 kg/m2, gastrointestinal ulcer or erosive lesion and major hemorrhagic complications in history of disease. In 1/2 cases the sourse of bleeding remained unclear.
Conclusion. Searching for clinical predictors of gastrointestinal bleeding can identify patients receiving oral anticoagulants who is need of intensive monitoring risk factors to prevent the development of life-threatening bleeding and to provide with adequate anticoagulant therapy.
Keywords: atrial fibrillation, oral anticoagulants, gastrointestinal bleeding
Цель. На основании длительного проспективного наблюдения за больными с ФП, получающими пероральные антикоагулянты, оценить частоту, структуру крупных ЖКК, а также выявить клинические предикторы их развития.
Материалы и методы. На основании 20-летнего наблюдения за 510 пациентами с ФП с высоким риском тромбоэмболических осложнений (медиана по шкале CHA2DS2-VASc составила 4 балла) в рамках регистра РЕГАТА (NCT043447187) оценены частота и структура развития крупных ЖКК. На основании анализа пар с проведением одно- и многофакторного анализов выявлены предикторы развития 32 крупных ЖКК.
Результаты. Частота крупных ЖКК у больных с ФП, получающих пероральные антикоагулянты, составила 1,42/100 пациенто-лет, преобладающей локализацией явились верхние отделы желудочно-кишечного тракта. В 1/2 случаев, несмотря на проведенное обследование, причина развития кровотечения найдена не была. Предикторами развития крупных ЖКК по данным логистической регрессии оказались: уровень гемоглобина ≤14,55 г/дл, индекс массы тела ≤28,4 кг/м2, эрозивно-язвенное поражение желудочно-кишечного тракта и большие геморрагические осложнения любой локализации в анамнезе.
Заключение. Выявление клинических предикторов ЖКК на фоне терапии пероральными антикоагулянтами позволяет определить пациентов, нуждающихся в более тщательном наблюдении с целью предотвращения развития жизнеугрожающего кровотечения и обеспечения адекватной антикоагулянтной терапии.
Ключевые слова: фибрилляция предсердий, пероральные антикоагулянты, желудочно-кишечное кровотечение
________________________________________________
Aim. To assess the frequency and structure of large gastrointestinal bleeding, as well as to identify clinical predictors of their development based on long-term prospective observation of patients with atrial fibrillation receiving oral anticoagulants.
Materials and methods. Data were obtained from single center prospective REGistry of long-term AnTithrombotic TherApy (REGATTA NCT043447187). Investigation based on a 20-year follow-up with 510 patients with atrial fibrillation with a high thromboembolic risk (median CHA2DS2-VASc was 4 points). The REGATTA registry assessed the frequency and structure of major gastrointestinal bleeding. Predictors of the development of 32 large gastrointestinal bleeding were identified based on the analysis of pairs with univariate and multivariate analyses.
Results. The frequency of major gastrointestinal bleeding in patients with atrial fibrillation receiving oral anticoagulants at 1 year was 1.42 per 100 patients; the predominant localization was upper gastrointestinal tract. Predictors of the development of major gastrointestinal bleeding according to multiple regression data analysis were hemoglobin level ≤14.55 g/dL, body mass index ≤28.4 kg/m2, gastrointestinal ulcer or erosive lesion and major hemorrhagic complications in history of disease. In 1/2 cases the sourse of bleeding remained unclear.
Conclusion. Searching for clinical predictors of gastrointestinal bleeding can identify patients receiving oral anticoagulants who is need of intensive monitoring risk factors to prevent the development of life-threatening bleeding and to provide with adequate anticoagulant therapy.
Keywords: atrial fibrillation, oral anticoagulants, gastrointestinal bleeding
Полный текст
Список литературы
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2. January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-32. DOI:10.1016/j.jacc.2019.01.011
3. J-RHYTHM Registry Investigators. Determinants of warfarin use and international normalized ratio levels in atrial fibrillation patients in Japan. – Subanalysis of the J-RHYTHM Registry. Circ J. 2011;75(10):2357-62. DOI:10.1253/circj.cj-11-0427
4. Wieloch M, Själander A, Frykman V, et al. Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thromboembolic complications from the national quality registry AuriculA. Eur Heart J. 2011;32(18):2282-9. DOI:10.1093/eurheartj/ehr134
5. 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 meta-analysis of randomised trials. Lancet. 2014;383(15):955-96. DOI:10.1016/S0140-6736(13)62343-0
6. Beyer-Westendorf J, Förster K, Pannach S, et al. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood. 2014;124(6):955-62. DOI:10.1182/blood-2014-03-563577.124:955-962
7. Testa S, Ageno W, Antonucci E, et al. Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: results from the START-Event registry. Intern Emerg Med. 2018;13(7):1051-8. DOI:10.1007/s11739-018-1877-z
8. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. DOI:10.1056/NEJMoa0905561
9. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91. DOI:10.1056/NEJMoa1009638
10. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92. DOI:10.1056/NEJMoa1107039
11. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of Upper and Lower Gastrointestinal Bleeding in Patients Taking Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, or Anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
12. Becattini С, Franco L, Beyer-Westendorf J, et al. Major bleeding with vitamin K antagonists or direct oral anticoagulants in real-life. Int J Cardiol. 2017;227:261-6. DOI:10.1016/j.ijcard.2016.11.117
13. Yuhara H, Corley DA, Nakahara F, et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol. 2014;49:992-1000. DOI:10.1007/s00535-013-0905-z
14. Fang MC, Go AS, Chang Y, et al. A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am CollCardiol. 2011;58(4):395-401. DOI:10.1016/j.jacc.2011.03.031
15. O’Brien EC, Simon ND, Thomas LE, et al. The ORBIT Bleeding Score: A Simple Bedside Score to Assess Bleeding Risk in Atrial Fibrillation. Eur Heart J. 2015;36(46):3258-64. DOI:10.1093/eurheartj/ehv476
16. Miller CS, Dorreen A, Martel MH, et al. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(11):1674-83. DOI:10.1016/j.cgh.2017.04.031
17. Abraham NS, Singh S, Alexander GC, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ. 2015;350. DOI:10.1136/bmj.h1857
18. Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterol. 2007;133(5):1697-717. DOI:10.1053/j.gastro.2007.06.007
19. Aoki T, Nagata N, Yamada A, et al. Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy? Endosc Int Open. 2019;7(3):E337-E346. DOI:10.1055/a-0824-6647
20. Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. NEJM. 2017;376:1054-63. DOI: 10.1056/NEJMcp1603455
21. Кропачева Е.С., Староверова А.И., Землянская О.А., и др. Предикторы развития геморрагических осложнений у больных фибрилляцией предсердий, длительно получающих терапию варфарином. Кардиологический вестник. 2020;37 [Kropacheva ES, Staroverova AI, Zemlyanskaya OA, et al. Predictors of the development of hemorrhagic complications in patients with atrial fibrillation receiving long-term warfarin therapy. Kardiologicheskii vestnik. 2020;37 (in Russian)].
22. Lip GY, Skjøth F, Nielsen BP, et al. The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants. Am J Med. 2018;131(5): 574.e13-574.e27. DOI:10.1016/j.amjmed.2017.11.046
23. Goodman SG, Wojdyla DM, Piccini JP, et al. Factors Associated With Major Bleeding Events. J Am Coll Cardiol. 2014;63(9):891-900. DOI:10.1016/j.jacc.2013.11.013
24. Netley J, Howard K, Wilson W, et al. Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review. J Thromb Thrombolysis. 2019;48(3):359-65. DOI:10.1007/s11239-019-01857-2
25. Patti G, Pecen L, Lucerna M, et al. Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation. Am J Med. 2019;132(6):749-57. DOI:10.1016/j.amjmed.2018.12.036
26. Shinohara M, Fujino T, Yao S, et al. Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol. 2019;73(1):7-13. DOI:10.1016/j.jjcc.2018.05.012
27. Tittl L, Endig S, Marten S, et al. Impact of BMI on clinical outcomes of NOAC therapy in daily care – Results of the prospective Dresden NOAC Registry (NCT01588119). Int J Cardiol. 2018;262:85-91. DOI:10.1016/j.ijcard.2018.03.060
28. De Caterina R, Lip GYH. The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight – a systematic literature review. Clin Res Cardiol. 2017;106:565-72. DOI:10.1007/s00392-017-1102-5
2. January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-32. DOI:10.1016/j.jacc.2019.01.011
3. J-RHYTHM Registry Investigators. Determinants of warfarin use and international normalized ratio levels in atrial fibrillation patients in Japan. – Subanalysis of the J-RHYTHM Registry. Circ J. 2011;75(10):2357-62. DOI:10.1253/circj.cj-11-0427
4. Wieloch M, Själander A, Frykman V, et al. Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thromboembolic complications from the national quality registry AuriculA. Eur Heart J. 2011;32(18):2282-9. DOI:10.1093/eurheartj/ehr134
5. 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 meta-analysis of randomised trials. Lancet. 2014;383(15):955-96. DOI:10.1016/S0140-6736(13)62343-0
6. Beyer-Westendorf J, Förster K, Pannach S, et al. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood. 2014;124(6):955-62. DOI:10.1182/blood-2014-03-563577.124:955-962
7. Testa S, Ageno W, Antonucci E, et al. Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: results from the START-Event registry. Intern Emerg Med. 2018;13(7):1051-8. DOI:10.1007/s11739-018-1877-z
8. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. DOI:10.1056/NEJMoa0905561
9. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91. DOI:10.1056/NEJMoa1009638
10. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92. DOI:10.1056/NEJMoa1107039
11. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of Upper and Lower Gastrointestinal Bleeding in Patients Taking Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, or Anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
12. Becattini С, Franco L, Beyer-Westendorf J, et al. Major bleeding with vitamin K antagonists or direct oral anticoagulants in real-life. Int J Cardiol. 2017;227:261-6. DOI:10.1016/j.ijcard.2016.11.117
13. Yuhara H, Corley DA, Nakahara F, et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol. 2014;49:992-1000. DOI:10.1007/s00535-013-0905-z
14. Fang MC, Go AS, Chang Y, et al. A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am CollCardiol. 2011;58(4):395-401. DOI:10.1016/j.jacc.2011.03.031
15. O’Brien EC, Simon ND, Thomas LE, et al. The ORBIT Bleeding Score: A Simple Bedside Score to Assess Bleeding Risk in Atrial Fibrillation. Eur Heart J. 2015;36(46):3258-64. DOI:10.1093/eurheartj/ehv476
16. Miller CS, Dorreen A, Martel MH, et al. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(11):1674-83. DOI:10.1016/j.cgh.2017.04.031
17. Abraham NS, Singh S, Alexander GC, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ. 2015;350. DOI:10.1136/bmj.h1857
18. Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterol. 2007;133(5):1697-717. DOI:10.1053/j.gastro.2007.06.007
19. Aoki T, Nagata N, Yamada A, et al. Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy? Endosc Int Open. 2019;7(3):E337-E346. DOI:10.1055/a-0824-6647
20. Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. NEJM. 2017;376:1054-63. DOI: 10.1056/NEJMcp1603455
21. Kropacheva ES, Staroverova AI, Zemlyanskaya OA, et al. Predictors of the development of hemorrhagic complications in patients with atrial fibrillation receiving long-term warfarin therapy. Kardiologicheskii vestnik. 2020;37 (in Russian).
22. Lip GY, Skjøth F, Nielsen BP, et al. The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants. Am J Med. 2018;131(5): 574.e13-574.e27. DOI:10.1016/j.amjmed.2017.11.046
23. Goodman SG, Wojdyla DM, Piccini JP, et al. Factors Associated With Major Bleeding Events. J Am Coll Cardiol. 2014;63(9):891-900. DOI:10.1016/j.jacc.2013.11.013
24. Netley J, Howard K, Wilson W, et al. Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review. J Thromb Thrombolysis. 2019;48(3):359-65. DOI:10.1007/s11239-019-01857-2
25. Patti G, Pecen L, Lucerna M, et al. Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation. Am J Med. 2019;132(6):749-57. DOI:10.1016/j.amjmed.2018.12.036
26. Shinohara M, Fujino T, Yao S, et al. Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol. 2019;73(1):7-13. DOI:10.1016/j.jjcc.2018.05.012
27. Tittl L, Endig S, Marten S, et al. Impact of BMI on clinical outcomes of NOAC therapy in daily care – Results of the prospective Dresden NOAC Registry (NCT01588119). Int J Cardiol. 2018;262:85-91. DOI:10.1016/j.ijcard.2018.03.060
28. De Caterina R, Lip GYH. The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight – a systematic literature review. Clin Res Cardiol. 2017;106:565-72. DOI:10.1007/s00392-017-1102-5
2. January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-32. DOI:10.1016/j.jacc.2019.01.011
3. J-RHYTHM Registry Investigators. Determinants of warfarin use and international normalized ratio levels in atrial fibrillation patients in Japan. – Subanalysis of the J-RHYTHM Registry. Circ J. 2011;75(10):2357-62. DOI:10.1253/circj.cj-11-0427
4. Wieloch M, Själander A, Frykman V, et al. Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thromboembolic complications from the national quality registry AuriculA. Eur Heart J. 2011;32(18):2282-9. DOI:10.1093/eurheartj/ehr134
5. 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 meta-analysis of randomised trials. Lancet. 2014;383(15):955-96. DOI:10.1016/S0140-6736(13)62343-0
6. Beyer-Westendorf J, Förster K, Pannach S, et al. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood. 2014;124(6):955-62. DOI:10.1182/blood-2014-03-563577.124:955-962
7. Testa S, Ageno W, Antonucci E, et al. Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: results from the START-Event registry. Intern Emerg Med. 2018;13(7):1051-8. DOI:10.1007/s11739-018-1877-z
8. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. DOI:10.1056/NEJMoa0905561
9. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91. DOI:10.1056/NEJMoa1009638
10. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92. DOI:10.1056/NEJMoa1107039
11. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of Upper and Lower Gastrointestinal Bleeding in Patients Taking Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, or Anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
12. Becattini С, Franco L, Beyer-Westendorf J, et al. Major bleeding with vitamin K antagonists or direct oral anticoagulants in real-life. Int J Cardiol. 2017;227:261-6. DOI:10.1016/j.ijcard.2016.11.117
13. Yuhara H, Corley DA, Nakahara F, et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol. 2014;49:992-1000. DOI:10.1007/s00535-013-0905-z
14. Fang MC, Go AS, Chang Y, et al. A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am CollCardiol. 2011;58(4):395-401. DOI:10.1016/j.jacc.2011.03.031
15. O’Brien EC, Simon ND, Thomas LE, et al. The ORBIT Bleeding Score: A Simple Bedside Score to Assess Bleeding Risk in Atrial Fibrillation. Eur Heart J. 2015;36(46):3258-64. DOI:10.1093/eurheartj/ehv476
16. Miller CS, Dorreen A, Martel MH, et al. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(11):1674-83. DOI:10.1016/j.cgh.2017.04.031
17. Abraham NS, Singh S, Alexander GC, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ. 2015;350. DOI:10.1136/bmj.h1857
18. Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterol. 2007;133(5):1697-717. DOI:10.1053/j.gastro.2007.06.007
19. Aoki T, Nagata N, Yamada A, et al. Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy? Endosc Int Open. 2019;7(3):E337-E346. DOI:10.1055/a-0824-6647
20. Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. NEJM. 2017;376:1054-63. DOI: 10.1056/NEJMcp1603455
21. Кропачева Е.С., Староверова А.И., Землянская О.А., и др. Предикторы развития геморрагических осложнений у больных фибрилляцией предсердий, длительно получающих терапию варфарином. Кардиологический вестник. 2020;37 [Kropacheva ES, Staroverova AI, Zemlyanskaya OA, et al. Predictors of the development of hemorrhagic complications in patients with atrial fibrillation receiving long-term warfarin therapy. Kardiologicheskii vestnik. 2020;37 (in Russian)].
22. Lip GY, Skjøth F, Nielsen BP, et al. The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants. Am J Med. 2018;131(5): 574.e13-574.e27. DOI:10.1016/j.amjmed.2017.11.046
23. Goodman SG, Wojdyla DM, Piccini JP, et al. Factors Associated With Major Bleeding Events. J Am Coll Cardiol. 2014;63(9):891-900. DOI:10.1016/j.jacc.2013.11.013
24. Netley J, Howard K, Wilson W, et al. Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review. J Thromb Thrombolysis. 2019;48(3):359-65. DOI:10.1007/s11239-019-01857-2
25. Patti G, Pecen L, Lucerna M, et al. Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation. Am J Med. 2019;132(6):749-57. DOI:10.1016/j.amjmed.2018.12.036
26. Shinohara M, Fujino T, Yao S, et al. Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol. 2019;73(1):7-13. DOI:10.1016/j.jjcc.2018.05.012
27. Tittl L, Endig S, Marten S, et al. Impact of BMI on clinical outcomes of NOAC therapy in daily care – Results of the prospective Dresden NOAC Registry (NCT01588119). Int J Cardiol. 2018;262:85-91. DOI:10.1016/j.ijcard.2018.03.060
28. De Caterina R, Lip GYH. The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight – a systematic literature review. Clin Res Cardiol. 2017;106:565-72. DOI:10.1007/s00392-017-1102-5
________________________________________________
2. January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-32. DOI:10.1016/j.jacc.2019.01.011
3. J-RHYTHM Registry Investigators. Determinants of warfarin use and international normalized ratio levels in atrial fibrillation patients in Japan. – Subanalysis of the J-RHYTHM Registry. Circ J. 2011;75(10):2357-62. DOI:10.1253/circj.cj-11-0427
4. Wieloch M, Själander A, Frykman V, et al. Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thromboembolic complications from the national quality registry AuriculA. Eur Heart J. 2011;32(18):2282-9. DOI:10.1093/eurheartj/ehr134
5. 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 meta-analysis of randomised trials. Lancet. 2014;383(15):955-96. DOI:10.1016/S0140-6736(13)62343-0
6. Beyer-Westendorf J, Förster K, Pannach S, et al. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood. 2014;124(6):955-62. DOI:10.1182/blood-2014-03-563577.124:955-962
7. Testa S, Ageno W, Antonucci E, et al. Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: results from the START-Event registry. Intern Emerg Med. 2018;13(7):1051-8. DOI:10.1007/s11739-018-1877-z
8. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. DOI:10.1056/NEJMoa0905561
9. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365(10):883-91. DOI:10.1056/NEJMoa1009638
10. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-92. DOI:10.1056/NEJMoa1107039
11. Lanas Á, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of Upper and Lower Gastrointestinal Bleeding in Patients Taking Nonsteroidal Anti-inflammatory Drugs, Antiplatelet Agents, or Anticoagulants. Clin Gastroenterol Hepatol. 2015;13(5):906-12.e2. DOI:10.1016/j.cgh.2014.11.007
12. Becattini С, Franco L, Beyer-Westendorf J, et al. Major bleeding with vitamin K antagonists or direct oral anticoagulants in real-life. Int J Cardiol. 2017;227:261-6. DOI:10.1016/j.ijcard.2016.11.117
13. Yuhara H, Corley DA, Nakahara F, et al. Aspirin and non-aspirin NSAIDs increase risk of colonic diverticular bleeding: a systematic review and meta-analysis. J Gastroenterol. 2014;49:992-1000. DOI:10.1007/s00535-013-0905-z
14. Fang MC, Go AS, Chang Y, et al. A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am CollCardiol. 2011;58(4):395-401. DOI:10.1016/j.jacc.2011.03.031
15. O’Brien EC, Simon ND, Thomas LE, et al. The ORBIT Bleeding Score: A Simple Bedside Score to Assess Bleeding Risk in Atrial Fibrillation. Eur Heart J. 2015;36(46):3258-64. DOI:10.1093/eurheartj/ehv476
16. Miller CS, Dorreen A, Martel MH, et al. Risk of Gastrointestinal Bleeding in Patients Taking Non-Vitamin K Antagonist Oral Anticoagulants: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2017;15(11):1674-83. DOI:10.1016/j.cgh.2017.04.031
17. Abraham NS, Singh S, Alexander GC, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ. 2015;350. DOI:10.1136/bmj.h1857
18. Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) institute technical review on obscure gastrointestinal bleeding. Gastroenterol. 2007;133(5):1697-717. DOI:10.1053/j.gastro.2007.06.007
19. Aoki T, Nagata N, Yamada A, et al. Next endoscopic approach for acute lower gastrointestinal bleeding without an identified source on colonoscopy: upper or capsule endoscopy? Endosc Int Open. 2019;7(3):E337-E346. DOI:10.1055/a-0824-6647
20. Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. NEJM. 2017;376:1054-63. DOI: 10.1056/NEJMcp1603455
21. Kropacheva ES, Staroverova AI, Zemlyanskaya OA, et al. Predictors of the development of hemorrhagic complications in patients with atrial fibrillation receiving long-term warfarin therapy. Kardiologicheskii vestnik. 2020;37 (in Russian).
22. Lip GY, Skjøth F, Nielsen BP, et al. The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants. Am J Med. 2018;131(5): 574.e13-574.e27. DOI:10.1016/j.amjmed.2017.11.046
23. Goodman SG, Wojdyla DM, Piccini JP, et al. Factors Associated With Major Bleeding Events. J Am Coll Cardiol. 2014;63(9):891-900. DOI:10.1016/j.jacc.2013.11.013
24. Netley J, Howard K, Wilson W, et al. Effects of body mass index on the safety and effectiveness of direct oral anticoagulants: a retrospective review. J Thromb Thrombolysis. 2019;48(3):359-65. DOI:10.1007/s11239-019-01857-2
25. Patti G, Pecen L, Lucerna M, et al. Net Clinical Benefit of Non-Vitamin K Antagonist vs Vitamin K Antagonist Anticoagulants in Elderly Patients with Atrial Fibrillation. Am J Med. 2019;132(6):749-57. DOI:10.1016/j.amjmed.2018.12.036
26. Shinohara M, Fujino T, Yao S, et al. Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol. 2019;73(1):7-13. DOI:10.1016/j.jjcc.2018.05.012
27. Tittl L, Endig S, Marten S, et al. Impact of BMI on clinical outcomes of NOAC therapy in daily care – Results of the prospective Dresden NOAC Registry (NCT01588119). Int J Cardiol. 2018;262:85-91. DOI:10.1016/j.ijcard.2018.03.060
28. De Caterina R, Lip GYH. The non-vitamin K antagonist oral anticoagulants (NOACs) and extremes of body weight – a systematic literature review. Clin Res Cardiol. 2017;106:565-72. DOI:10.1007/s00392-017-1102-5
Авторы
Е.С. Кропачева, М.Б. Хакимова*, Е.Н. Кривошеева, О.А. Землянская, Е.П. Панченко
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*fbmmsu@gmail.com
National Medical Research Center of Cardiology, Moscow, Russia
*fbmmsu@gmail.com
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*fbmmsu@gmail.com
________________________________________________
National Medical Research Center of Cardiology, Moscow, Russia
*fbmmsu@gmail.com
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