References

russjcardiol

Российский кардиологический журнал

Russian Journal of Cardiology

1560-40712618-7620

«SILICEA-POLIGRAF» LLC

10.15829/1560-4071-2021-4305

russjcardiol-4305

Research Article

КЛИНИКА И ФАРМАКОТЕРАПИЯ

CLINIC AND PHARMACOTHERAPY

Раннее прекращение двойной антитромбоцитарной терапии за счет отмены ацетилсалициловой кислоты у больных с острым коронарным синдромом, подвергнутых чрескожным коронарным вмешательствам, как удачный подход к обеспечению геморрагической безопасности лечения

Early discontinuation of dual antiplatelet therapy via acetylsalicylic acid cessation in patients with acute coronary syndrome undergoing percutaneous coronary interventions to reduce the bleeding risk

https://orcid.org/0000-0002-3010-755X

Аверков

О. В.

Averkov

O. V.

Аверков О. В. — доктор медицинских наук, зам. главного врача по медицинской части, профессор кафедры госпитальной терапии № 1 имени П. Е. Лукомского лечебного факультета.

Москва

Moscow

oleg.averkov@gmail.com

Городская клиническая больница № 15 им. О. М. Филатова; ФГАОУ ВО Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияO.M. Filatov City Clinical Hospital № 15; Pirogov Russian National Research Medical UniversityRussian Federation

2021

16022021

26143054305

2021

Аверков О.В.

Averkov 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://russjcardiol.elpub.ru/jour/article/view/4305

Ранние чрескожные коронарные вмешательства (ЧКВ) и достаточно длительное агрессивное антитромботическое лечение, основой которого является двойная антитромбоцитарная терапия (ДАТТ), являются важнейшими элементами лечения больных с острым коронарным синдромом (ОКС). Наиболее изучено и традиционно рекомендуется при ОКС годичное применение ДАТТ в виде сочетания ацетилсалициловой кислоты (АСК) и блокатора P2Y12 рецепторов тромбоцитов. Геморрагические осложнения ДАТТ после ОКС и после ЧКВ, особенно заметные при использовании мощных блокаторов P2Y12 рецепторов тромбоцитов, заставили искать подходы, направленные на снижение риска таких осложнений. Одним из недавно обозначенных решений проблемы высокого риска кровотечений при ЧКВ и ОКС оказалась достаточно ранняя (через 1-3 мес. от начала лечения) отмена АСК с продолжением приема одного антиагреганта — блокатора P2Y12 рецепторов тромбоцитов. В аналитической статье приводятся факты и доводы, оправдывающие этот подход к изменению ДАТТ у больных с ОКС и/или ЧКВ.

Early percutaneous coronary intervention (PCI) and long-term aggressive antithrombotic treatment based on dual antiplatelet therapy (DAPT) are the most important elements in the treatment of patients with acute coronary syndrome (ACS). The most studied and recommended for ACS is the 12-month DAPT (combination of acetylsalicylic acid (ASA) and P2Y12 receptor antagonist). Bleeding events due to DAPT after ACS and after PCI forced the search for approaches aimed at reducing the risk of such complications, especially noticeable when using a powerful blocker of the P2Y12 receptor of platelets. One of the recently identified solutions turned out to be early (1-3 months after the therapy initiation) discontinuation of ASA with continued administration of one antiplatelet agent (P2Y12 receptor antagonist). The article provides arguments in favor of this approach.

острый коронарный синдромчрескожное коронарное вмешательстводвойная антитромбоцитарная терапияриск кровотеченийотмена ацетилсалициловой кислотыклопидогрелтикагрелорпрасугрел

acute coronary syndromepercutaneous coronary interventiondual antiplatelet therapybleeding riskacetylsalicylic acid discontinuationclopidogrelticagrelorprasugrel

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