russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2021-4635russjcardiol-4635Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWУправление факторами риска желудочно-кишечных кровотечений на фоне антикоагулянтной терапииManagement of risk factors for gastrointestinal bleeding in patients receiving anticoagulant therapyhttps://orcid.org/0000-0003-4075-4096БакулинаН. В.BakulinaN. V.

Доктор медицинских наук, заведующий кафедрой внутренних болезней, клинической фармакологии и нефрологии.

Санкт-Петербург

St. Petersburg

sergeyvt2702@gmail.comhttps://orcid.org/0000-0001-5720-3528ТихоновС. В.TikhonovS. V.

Кандидат медицинских наук, доцент кафедры внутренних болезней, клинической фармакологии и нефрологии.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0002-0703-9763ЛищукН. Б.LishchukN. B.

Ассистент кафедры внутренних болезней, клинической фармакологии и нефрологии.

Санкт-Петербург

St. Petersburg

https://orcid.org/0000-0003-3859-1996КараяА. Б.KarayaA. B.

Врач терапевтического отделения № 2 клиники им. Петра Великого.

Санкт-Петербург

St. Petersburg

ФГБОУ ВО Северо Западный государственный медицинский университет им. И. И. Мечникова Минздрава РоссииРоссияI.I. Mechnikov North-Western State Medical UniversityRussian FederationФГБОУ ВО Северо-Западный государственный медицинский университет им. И.И. Мечникова Минздрава РоссииРоссияI.I. Mechnikov North-Western State Medical UniversityRussian Federation20210309202126846354635Copyright © Бакулина Н.В., Тихонов С.В., Лищук Н.Б., Карая А.Б., 20212021Бакулина Н.В., Тихонов С.В., Лищук Н.Б., Карая А.Б.Bakulina N.V., Tikhonov S.V., Lishchuk N.B., Karaya A.B.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/4635

Пероральные антикоагулянты (ПОАК) применяются для профилактики и лечения тромбозов и тромбоэмболических осложнений у пациентов с различными заболеваниями. Несмотря на высокую эффективность и безопасность, применение ПОАК может сопровождаться повышением риска кровотечений, в т.ч. желудочно-кишечных. Риск кровотечений зависит от профиля конкретного пациента и имеющихся у него факторов риска. Повышенный риск развития кровотечений ассоциирован с “проявляющим действием” препаратов на имеющиеся дефекты слизистой, активной хеликобактерной инфекцией.

Для уменьшения риска желудочно-кишечных кровотечений в клинической практике требуется коррекция модифицируемых факторов риска; эрадикация Н. pylori; использование корректных дозировок ПОАК; профилактическое назначение ингибиторов протонной помпы (ИПП) пациентам, набравшим ≥3 баллов по шкале HAS-BLED, получающим двойную или тройную антитромбоцитарную терапию, принимающим ПОАК в комбинации с нестероидными противовоспалительными препаратами, имеющим заболевания верхних отделов желудочно-кишечного тракта. В дополнение к ИПП пациентам может назначаться ребамипид, висмута трикалия дицитрат, урсодезоксихолевая кислота. ПОАК ривароксабан (Ксарелто®) имеет фармакокинетические и фармакодинамические преимущества, удобный однократный режим дозирования и благоприятный профиль безопасности, что обеспечивает эффективную защиту от тромбозов и тромбоэмболических осложнений в сочетании с минимизацией риска желудочно-кишечных кровотечений.

Direct oral anticoagulants (DOACs) are used to prevent and treat thrombosis and thromboembolic events in patients with various diseases. Despite its high efficacy and safety, DOAC therapy is accompanied by increased risk of hemorrhage, including gastrointestinal bleeding. Bleeding risk depends on individual patient profile and their risk factors. An increased risk of bleeding is associated with manifesting effect of DOACs on existing mucosal defects, active Helicobacter pylori infection. To reduce the risk of gastrointestinal bleeding in clinical practice, changing of following modifiable risk factors is required: H. pylori eradication; dose-adjusted DOAC therapy; prophylactic proton pump inhibitors (PPIs) administration to patients with HAS-BLED score ≥3, receiving dual or triple antithrombotic therapy, taking DOACs in combination with non-steroidal antiinflammatory drugs, to those with upper gastrointestinal diseases. In addition to PPIs, patients may be prescribed with rebamipide, bismuth tripotassium dicitrate, ursodeoxycholic acid. DOAC rivaroxaban (Xarelto®) has pharmacokinetic and pharmacodynamic advantages, a convenient single dosing regimen and a favorable safety profile, which provides effective protection against thrombosis and thromboembolic events in combination with low risk of gastrointestinal bleeding.

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