Статья
Подходы к выбору антикоагулянтной терапии у больных с неклапанной фибрилляцией предсердий и ишемической болезнью сердца
В статье представлены подходы к выбору антитромботической терапии (АТ) у больных неклапанной фибрилляцией предсердий (ФП) и ишемической болезнью сердца (ИБС) как при остром коронарном синдроме (ОКС), так и стабильных формах, в т.ч. у перенесших чрескожное коронарное вмешательство. Определение режимов и длительность АТ зависят от формы ИБС, риска кровотечений, анатомии имплантированных стентов в коронарных артериях. В составе АТ в современных регламентирующих документах больным ИБС и ФП рекомендуется любой оральный антикоагулянт: антагонисты витамина К, прямой ингибитор тромбина — дабигатран, селективные ингибиторы Xa фактора свертывания — ривароксабан, апиксабан. Наибольшая доказательная база среди новых оральных антикоагулянтов при данной клинической ситуации представлена для дабигатрана. Выбор двойного и тройного режимов АТ для больных ИБС и с ФП дискутируется. Среди антитромбоцитарных препаратов для комбинации с антикоагулянтом предпочтителен клопидогрел как более безопасный препарат в сравнении с аспирином. Возможность использования для комбинированной терапии с антикоагулянтами тикагрелора и прасугрела ограничена. Указывается на необходимость применения ингибиторов протонной помпы при назначении как двойной, так и тройной АТ больным с неклапанной ФП и ИБС.
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