pmedpharmФармация и фармакологияPharmacy & Pharmacology2307-92662413-2241Pyatigorsk Medical and Pharmaceutical Institute - branch of Volgograd State Medical Univer10.19163/2307-9266-2020-8-4-222-232pmedpharm-727Research ArticleОБЗОРЫ, ЛЕКЦИИREVIEWS, LECTURESФАРМАКОДИНАМИКА ОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ У БОЛЬНЫХ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ В ОСТРОМ ПЕРИОДЕ ИШЕМИЧЕСКОГО ИНСУЛЬТАPHARMACODYNAMICS OF ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION IN THE ACUTE PERIOD OF ISCHEMIC STROKEhttps://orcid.org/0000-0002-0258-4092ПетровВ. И.PetrovV. I.

Петров Владимир Иванович – доктор медицинских наук, профессор, академик РАН, заведующий кафедрой клинической фармакологии и интенсивной терапии; главный внештатный специалист - клинический фармаколог Министерства Здравоохранения Российской Федерации, заслуженный деятель науки РФ, заслуженный врач РФ. 

400131, г. Волгоград, площадь Павших Борцов, д. 1

Vladimir I. Petrov – Doctor of Sciences (Medicine), Professor, Academician of Russian Academy of Sciences, the Head of the Department of Clinical Pharmacology and Intensive Care; Chief Freelance Specialist – Clinical Pharmacologist of the Ministry of Health of the Russian Federation, Honored Scientist of the Russian Federation, Honored Physician of the Russian Federation. 

1, Pavshikh Bortsov Sq., Volgograd, 400131

brain@sprintnet.ruhttps://orcid.org/0000-0002-7957-3770ГерасименкоА. С.GerasimenkoA. S.

Герасименко Анастасия Сергеевна – ассистент кафедры клинической фармакологии и интенсивной терапии 

400131, г. Волгоград, площадь Павших Борцов, д. 1

Anastasia S. Gerasimenko – Assistant, Department of Clinical Pharmacology and Intensive Care 

1, Pavshikh Bortsov Sq., Volgograd, 400131

16any_61@mail.ruhttps://orcid.org/0000-0002-6565-2566ГорбатенкоВ. С.GorbatenkoV. S.

Горбатенко Владислав Сергеевич – кандидат медицинских наук, доцент кафедры клинической фармакологии и интенсивной терапии 

400131, г. Волгоград, площадь Павших Борцов, д. 1

Vladislav S. Gorbatenko – Candidate of Sciences (Medicine), Associate Professor of the Department of Clinical Pharmacology and Intensive Care 

1, Pavshikh Bortsov Sq., Volgograd, 400131

vsgorbatenko@volgmed.ruhttps://orcid.org/0000-0002-7311-4549ШаталоваО. В.ShatalovaO. V.

Шаталова Ольга Викторовна – доктор медицинских наук, профессор кафедры клинической фармакологии и интенсивной терапии 

400131, г. Волгоград, площадь Павших Борцов, д. 1

Olga V. Shatalova –Doctor of Sciences (Medicine), Professor of the Department of Clinical Pharmacology and Intensive Care 

1, Pavshikh Bortsov Sq., Volgograd, 400131

ovshatalova@volgmed.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Волгоградский государственный медицинский университет» Министерства Здравоохранения Российский ФедерацииРоссияVolgograd State Medical UniversityRussian Federation20203101202184222232Copyright © Петров В.И., Герасименко А.С., Горбатенко В.С., Шаталова О.В., 20212021Петров В.И., Герасименко А.С., Горбатенко В.С., Шаталова О.В.Petrov V.I., Gerasimenko A.S., Gorbatenko V.S., Shatalova O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmpharm.ru/jour/article/view/727Введение

Введение. Каждый пятый ишемический инсульт обусловлен наличием у пациента в анамнезе фибрилляции предсердий. Для предотвращения тромбоэмболических осложнений у пациентов с фибрилляцией предсердий в настоящее время широко применяются прямые и непрямые пероральные антикоагулянты. Однако, несмотря на назначение данной группы препаратов, ежегодно у 1–2% пациентов с фибрилляцией предсердий возникает ишемический инсульт. В данной ситуации встает ряд вопросов: возможно ли проведение тромболитической терапии у больных, принимавших антикоагулянты, стоит ли возобновлять антикоагулянтную терапию после перенесенного инсульта, когда именно это нужно делать и какие препараты для этого использовать.

Цель

Цель. Целью написания данного обзора было резюмировать имеющиеся клинические рекомендации и результаты исследований, посвященные изучению особенностей антикоагулянтной терапии у пациентов с фибрилляцией предсердий, перенесших ишемический инсульт.

Материалы и методы

Материалы и методы. Для обзора использовали сведения научной литературы из открытых и доступных источников за период 1997–2020 гг., размещенных в электронных базах данных: PubMed, Scopus, Web of Science Core Collection, Cochrane Library, ClinicalTrials.gov; Elibrary, Киберленинка, Google-академия. Поисковые запросы – «ишемический инсульт+фибрилляция предсердий+антикоагулянты»; «ишемический инсульт+фибрилляция предсердий+прямые оральные коагулянты» и «фибрилляция предсердий+ишемический инсульт+варфарин» как в русском, так и английском эквиваленте.

Результаты и заключение

Результаты и заключение. Проблема применения антикоагулянтов для профилактики повторных тромбоэмболических осложнений у пациентов с ФП в остром периоде инсульта в настоящее время изучена недостаточно. Сложности вызывает проведение ТЛТ у пациентов, принимавших ПОАК, в первую очередь, из-за невозможности точной оценки состояния гемостаза в виду недоступности рутинного проведения специфических тестов, во вторую очередь, отсутствие зарегистрированных антидотов для большинства препаратов и их высокая стоимость. Также отсутствуют РКИ, посвященные изучению оптимального времени для возобновления или инициации антикоагулянтной терапии в остром периоде ИИ и оптимальных препаратов для данной группы пациентов. Большинство существующих рекомендаций по этим аспектам основаны на согласованном мнении экспертов, что говорит о необходимости дальнейших исследований в данной области. 

Background

Background. Every fifth ischemic stroke is caused by a patient’s history of atrial fibrillation. Nowadays, direct and indirect oral anticoagulants are widely used to prevent thromboembolic complications in patients with atrial fibrillation. However, despite the prescription of this group of drugs, every year 1–2% of patients with atrial fibrillation have an ischemic stroke. In this situation, a number of questions take rise: if it is possible to carry out thrombolytic therapy in the patients who have been taking anticoagulants; if it is worth resuming anticoagulant therapy after a stroke; when exactly this should be done; and what drugs should be used to prevent another stroke.

The aim of this review was to summarize the available clinical guidelines and research results on the study of the anticoagu- lant therapy characteristics in patients with atrial fibrillation after an ischemic stroke.

Materials and methods

Materials and methods. For this review, the information presented in the scientific literature from open and available sourc- es, has been used. The information had been placed in the following electronic databases: PubMed, Scopus, Web of Sci- ence Core Collection, Cochrane Library, ClinicalTrials.gov; Elibrary, Cyberleninka, Google Academy. The covering period was 1997–2020. The search queries were: “ischemic stroke + atrial fibrillation + anticoagulants”; “ischemic stroke + atrial fibrillation + direct oral coagulants” and “atrial fibrillation + ischemic stroke + warfarin” in both Russian and English equivalents.

Results and conclusion

Results and conclusion. Currently, the problem of the use of anticoagulants for the prevention of recurrent thromboembolic complications in patients with AF in the acute period of a stroke, is studied insufficiently. The difficulties are caused by the delivery of TLT in the patients who have been taking DOACs, first of all, due to the impossibility of an accurate assessment of the hemostasis state because of the unavailability of routine specific tests; and second, as a result of the lack of registered antidotes for most drugs, and their high costs. Besides, there are no RCTs dedicated to the study of the optimal time for the resumption or initiation of anticoagulant therapy in the acute period of an IS, and the optimal drugs for this group of patients. Most of the existing recommendations on these aspects, are based on the consensus of experts, and this fact indicates the need for further research in the area under review.

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The authors declare that there are no conflicts of interest present.