Профилактика инсульта и системных эмболий у больных фибрилляцией предсердий: в фокусе апиксабан


DOI: https://dx.doi.org/10.18565/therapy.2022.9.92-100

В.А. Кокорин, О.И. Боева

1) ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, г. Москва; 2) ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ, г. Москва
Аннотация. Обзор данных литературы посвящен вопросам выбора перорального антикоагулянта для профилактики ишемического инсульта и системных эмболий у пациентов с фибрилляцией предсердий. Приводятся подробные результаты исследований реальной клинической практики по сравнению эффективности и безопасности различных прямых оральных антикоагулянтов. Особое внимание уделено группам пациентов с фибрилляцией предсердий и ожирением, пожилых и ослабленных больных, а также пациентов с фибрилляцией предсердий и нарушенной функцией почек.

Литература


1. Hindricks G., Potpara T., Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and 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. Eur Heart J. 2021; 42(5): 373–498. https://dx.doi.org/10.1093/eurheartj/ehaa612.


2. Benjamin E.J., Wolf P.A., D’Agnostico R.B. et al. Impact of atrial fibrillation on the risk of death. The Framingham Heart Study. Circulation. 1998; 98(10): 946–52. https://dx.doi.org/10.1161/01.cir.98.10.946.


3. Wolf P.A., Dawber T.R., Thomas H.E., Kannel W.B. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham Study. Neurology. 1978; 28(10): 973–77. https://dx.doi.org/10.1212/wnl.28.10.973.


4. Клинические рекомендации. Фибрилляция и трепетание предсердий у взрослых. Общероссийская общественная организация «Российское кардиологическое общество», Всероссийское научное общество специалистов по клинической электрофизиологии, аритмологии и электростимуляции, Ассоциация сердечно-сосудистых хирургов России. Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 382. Доступ: https://cr.minzdrav.gov.ru/schema/382_1 (дата обращения – 01.11.2022).


5. Ezekowitz M.D., Bridgers S.L., James K.E. et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med. 1992; 327(20): 1406–12. https://dx.doi.org/10.1056/NEJM199211123272002.


6. Hylek E.M. Anticoagulation therapy for atrial fibrillation. Semin Thromb Hemost. 2013; 39(2): 147–52.https://dx.doi.org/10.1055/s-0033-1334812.


7. Connolly S.J., Ezekowitz M.D., Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361(12): 1139–51. https://dx.doi.org/10.1056/NEJMoa0905561.


8. Patel M.R., Mahaffey K.W., Garg J. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883–91. https://dx.doi.org/10.1056/NEJMoa1009638.


9. Granger C.B., Alexander J.H., McMurray J.J. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365(11): 981–92. https://dx.doi.org/10.1056/NEJMoa1107039


10. Giugliano R.P., Ruff C.T., Braunwald E. et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013; 369(22): 2093–104. https://dx.doi.org/10.1056/NEJMoa1310907.


11. Harenberg J., Marx S., Diener H-C. et al. Comparison of efficacy and safety of dabigatran, rivaroxaban and apixaban in patients with atrial fibrillation using network meta-analysis. Int Angiol. 2012; 31(4): 330–39.


12. Larsen T.B., Skjoth F., Nielsen P.B. et al. Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study. BMJ. 2016; 353: i3189.https://dx.doi.org/10.1136/bmj.i3189.


13. Bai Y., Shi X.-B., Ma C.-S., Lip G.Y.H. Meta-analysis of effectiveness and safety of oral anticoagulants in atrial fibrillation with focus on apixaban. Am J Cardiol. 2017; 120(9): 1689–95. https://dx.doi.org/10.1016/j.amjcard.2017.07.072.


14. Proietti M., Romanazzi I., Francesco Romiti G. et al. Real-world use of apixaban for stroke prevention in atrial fibrillation: A systematic review and meta-analysis. Stroke. 2018; 49(1): 98–106. https://dx.doi.org/10.1161/STROKEAHA.117.018395.


15. Lip G.Y.H., Keshishian A., Li X. et al. Effectiveness and safety of oral anticoagulants among nonvalvular atrial fibrillation patients. Stroke. 2018; 49(12): 2933–44. https://dx.doi.org/10.1161/STROKEAHA.118.020232.


16. Vinogradova Y., Coupland C., Hill T., Hippisley-Cox J. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ. 2018; 362: k2505. https://dx.doi.org/10.1136/bmj.k2505.


17. Chan Y.-H., Lee H.-F., See L.-C. et al. Effectiveness and safety of four direct oral anticoagulants in Asian patients with nonvalvular atrial fibrillation. Chest. 2019; 156(3): 529–43. https://dx.doi.org/10.1016/j.chest.2019.04.108.


18. Graham D.J., Baro E., Zhang R. et al. Comparative stroke, bleeding, and mortality risks in older medicare patients treated with oral anticoagulants for nonvalvular atrial fibrillation. Am J Med. 2019; 132(5): 596–604.e11.https://dx.doi.org/10.1016/j.amjmed.2018.12.023.


19. Kjerpeseth L.J., Selmer R., Ariansen I. et al. Comparative effectiveness of warfarin, dabigatran, rivaroxaban and apixaban in non-valvular atrial fibrillation: A nationwide pharmacoepidemiological study. PLoS One. 2019; 14(8): e0221500.https://dx.doi.org/10.1371/journal.pone.0221500.


20. Rutherford O.-C.W., Jonasson C., Ghanima W. et al. Comparison of dabigatran, rivaroxaban, and apixaban for effectiveness and safety in atrial fibrillation: A nationwide cohort study. Eur Heart J Cardiovasc Pharmacother. 2020; 6(2): 75–85.https://dx.doi.org/10.1093/ehjcvp/pvz086.


21. Jansson M., Sjalander S., Sjogren V. et al. Direct comparisons of effectiveness and safety of treatment with apixaban, dabigatran and rivaroxaban in atrial fibrillation. Thromb Res. 2020; 185: 135–41. https://dx.doi.org/10.1016/j.thromres.2019.11.010.


22. Ray W.A., Chung C.P., Stein C.M. et al. Association of rivaroxaban vs apixaban with major ischemic or hemorrhagic events in patients with atrial fibrillation. JAMA. 2021; 326(23): 2395–404. https://dx.doi.org/10.1001/jama.2021.21222.


23. Mamas M.A., Batson S., Pollock K.G. et al. Meta-analysis comparing apixaban versus rivaroxaban for management of patients with nonvalvular atrial fibrillation. Am J Cardiol. 2022; 166: 58–64. https://dx.doi.org/10.1016/j.amjcard.2021.11.021.


24. Lau W.C.Y., Torre C.O., Man K.K.C. et al. Comparative effectiveness and safety between apixaban, dabigatran, edoxaban, and rivaroxaban among patients with atrial fibrillation: A multinational population-based cohort study. Ann Intern Med. 2022; 175(11): 1515–24. https://dx.doi.org/10.7326/M22-0511.


25. Schafer A., Flierl U., Berliner D., Bauersachs J. Anticoagulants for stroke prevention in atrial fibrillation in elderly patients. Cardiovasc Drugs Ther. 2020; 34(4): 555–68. https://dx.doi.org/10.1007/s10557-020-06981-3.


26. Bristol-Myers Squibb, Pfizer. Eliquis® (apixaban) Summary of product characteristics. 2017. URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002148/WC500107728.pdf (date of access – 01.11.2022).


27. Boehringer Ingelheim Pharmaceuticals Inc. Pradaxa® (dabigatran etexilate) Prescribing Information. 2018. URL: http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing%20Information/PIs/Pradaxa/Pradaxa.pdf (date of access – 01.11.2022).


28. Martinez B.K., Sood N.A., Bunz T.J., Coleman C.I. Effectiveness and safety of apixaban, dabigatran, and rivaroxaban versus warfarin in frail patients with nonvalvular atrial fibrillation. J Am Heart Assoc. 2018; 7(8): e008643. https://dx.doi.org/10.1161/JAHA.118.008643.


29. Okumura K., Yamashita T., Suzuki S., Akao M.; J-ELD AF Investigators. A multicenter prospective cohort study to investigate the effectiveness and safety of apixaban in Japanese elderly atrial fibrillation patients (J-ELD AF Registry). Clin Cardiol. 2020; 43(3): 251–59. https://dx.doi.org/10.1002/clc.23294.


30. Martin K., Beyer–Westendorf J., Davidson B.L. et al. Use of the direct oral anticoagulants in obese patients: guidance from the SSC of the ISTH. J Thromb Haemost. 2016; 14(6): 1308–13. https://dx.doi.org/10.1111/jth.13323.


31. Hohnloser S.H., Fudim M., Alexander J.H. et al. Efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation and extremes in body weight. Circulation. 2019; 139(20): 2292–300. https://dx.doi.org/10.1161/CIRCULATIONAHA.118.037955.


32. O’Kane C.P., Avalon J.C.O., Lacoste J.L. et al. Apixaban and rivaroxaban use for atrial fibrillation in patients with obesity and BMI ≥50 kg/m2. Pharmacotherapy. 2022; 42(2): 112–18. https://dx.doi.org/10.1002/phar.2651.


33. Bayer AG. Xarelto® (rivaroxaban) summary of product characteristics. 2018. URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000944/WC500057108.pdf (date of access – 01.11.2022).


34. Daiichi Sankyo Europe GmbH. Lixiana® (edoxaban) summary of product characteristics. 2017. URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002629/WC500189045.pdf (date of access – 01.11.2022).


Об авторах / Для корреспонденции


Валентин Александрович Кокорин, д.м.н., доцент, профессор кафедры госпитальной терапии им. акад.
П.Е. Лукомского лечебного факультета ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России. Адрес: 117997, г. Москва, ул. Островитянова, д. 1. E-mail: valentinkokorin@yahoo.com. ORCID: https://orcid.org/0000-0001-8614-6542
Ольга Игоревна Боева, д.м.н., доцент, профессор кафедры терапии, кардиологии и функциональной диагностики с курсом нефрологии ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ. Адрес: 121359, г. Москва, ул. Маршала Тимошенко, д. 19, стр. 1А. E-mail: box0271@mail.ru. ORCID: https://orcid.org/0000-0002-1816-8309


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