russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2020-4131russjcardiol-4131Research ArticleКЛИНИКА И ФАРМАКОТЕРАПИЯGUIDELINES FOR THE PRACTITIONERУправление рисками у коморбидных пациентов с фибрилляцией предсердий: возможности эдоксабанаRisk management in patients with atrial fibrillation and comorbid conditions: potentialities of edoxabanhttps://orcid.org/0000-0002-4642-3610БарбарашО. Л.BarbarashO. L.

д.м.н., профессор, член-корр. РАН, директор

Кемерово

olb61@mail.ruhttps://orcid.org/0000-0003-3729-616XКашталапВ. В.KashtalapV. V.

 д.м.н., доцент, зав. отделом клинической кардиологии

Кемерово

v_kash@mail.ruФГБНУ Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний,РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian Federation202001102020251041314131Copyright © Барбараш О.Л., Кашталап В.В., 20202020Барбараш О.Л., Кашталап В.В.Barbarash O.L., Kashtalap V.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/4131

В обзорной статье представлены современные данные о клинической и прогностической значимости, а также о распространенности коморбидной патологии у пациентов с фибрилляцией предсердий (ФП). Обсуждается частота выявления артериальной гипертензии, сахарного диабета и хронической сердечной недостаточности у пациентов с ФП по данным отечественных и зарубежных регистровых исследований, рандомизированных клинических исследований. Обозначена проблема влияния коморбидности на риск развития при ФП эмболических и геморрагических осложнений. Представлены возможности нового перорального антикоагулянта - эдоксабана (по результатам исследования ENGAGE AF-TIMI 48) по управлению рисками тромбоэмболических и геморрагических событий при ФП в условиях коморбидности. Обсуждены результаты запланированных субанализов исследования ENGAGE AF-TIMI 48, продемонстрировавших сопоставимую с варфарином эффективность  в профилактике риска эмболических осложнений и большую безопасность в отношении развития геморрагических событий вне зависимости от наличия у пациентов основных типов коморбидности.

The review article presents current data on the clinical and prognostic significance, as well as on the prevalence of comorbidities in patients with atrial fibrillation (AF). The prevalence of hypertension, diabetes and heart failure in patients with AF is discussed according to the Russian and foreign registry studies, randomized clinical trials. The problem of the effect of comorbidity on the risk of embolism and bleeding in AF is outlined. Potentialities of a novel oral anticoagulant edoxaban (based on the ENGAGE AF-TIMI 48 trial) for managing the risks of thromboembolic and bleeding events in AF and comorbidities. Sub-analyzes of the ENGAGE AF-TIMI 48 trial were discussed, which demonstrated efficacy comparable to warfarin in the embolism prevention and higher safety against bleeding, regardless of the comorbidity profile.

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