russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2024-5354OIVBEMrussjcardiol-5354Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWПероральные антикоагулянты или антитромбоцитарные препараты после реконструктивных операций на клапанах сердца: современные рекомендации для практикующего врачаOral anticoagulants or antiplatelet drugs after heart valve reconstructive surgery: modern guidelines for the practitionershttps://orcid.org/0000-0002-7019-650XКузьминВ. П.KuzminV. P.

Кузьмин Владимир Петрович — к.м.н., доцент кафедры госпитальной терапии с курсами поликлинической терапии и трансфузиологии

Самара

Samara

okd@bk.ruhttps://orcid.org/0000-0003-0730-4608ГеворгянА. А.GevorgyanA. A.

Геворгян Арик Арменович — зав. кардиохирургическим отделением № 11, врач сердечно-сосудистый хирург высшей квалификационной категории

Самара

Samara

Agevorgjan@rambler.ruhttps://orcid.org/0000-0002-7133-1689ГиматдиноваГ. Р.GimatdinovaG. R.

Гиматдинова Гелия Рифкатовна — очный аспирант кафедры госпитальной терапии с курсами поликлинической терапии и трансфузиологи

Самара

Samara

gimatdinova1995@icloud.comhttps://orcid.org/0000-0002-4322-0447ДаниловаО. Е.DanilovaO. E.

Данилова Олеся Евгеньевна — к.м.н., доцент кафедры госпитальной терапии с курсами поликлинической терапии и трансфузиологии

Самара

Samara

dani29051978@yandex.ruhttps://orcid.org/0000-0003-0645-7645ДавыдкинИ. Л.DavydkinI. L.

Давыдкин Игорь Леонидович — проректор по научной работе, д.м.н., профессор, зав. кафедрой госпитальной терапии с курсами поликлинический терапии и трансфузиологии, директор НИИ гематологии, трансфузиологии и интенсивной терапии, главный внештатный гематолог Минздрава Самарской области

Самара

Samara

dagi2006@rambler.ruhttps://orcid.org/0000-0002-1100-3798КривоваС. П.KrivovaS. P.

Кривова Светлана Петровна — к.м.н., доцент кафедры госпитальной терапии с курсами поликлинической терапии и трансфузиологии

Самара

Samara

spkrsamara@mail.ruhttps://orcid.org/0000-0002-7983-642XХайретдиновР. К.KhairetdinovR. K.

Хайретдинов Раис Кэтдусович — к.м.н., доцент кафедры госпитальной терапии с курсами поликлинической терапии и трансфузиологии

Самара

Samara

doctorrais@mail.ruhttps://orcid.org/0000-0001-8240-5316ДавыдкинГ. И.DavydkinG. I.

Давыдкин Григорий Игоревич — студент 4 курса института клинической медицины, лауреат именной стипендии им. М. П. Агибалова

Самара

Samara

shvonder2001@mail.ruФГБОУ ВО Самарский государственный медицинский университет Минздрава РоссииРоссияSamara State Medical UniversityRussian FederationГБУЗ Самарский областной клинический кардиологический диспансер им. В. П. ПоляковаРоссияPolyakov Samara Regional Clinical Cardiology DispensaryRussian Federation202402022024291SОбразование53545354Copyright © Кузьмин В.П., Геворгян А.А., Гиматдинова Г.Р., Данилова О.Е., Давыдкин И.Л., Кривова С.П., Хайретдинов Р.К., Давыдкин Г.И., 20242024Кузьмин В.П., Геворгян А.А., Гиматдинова Г.Р., Данилова О.Е., Давыдкин И.Л., Кривова С.П., Хайретдинов Р.К., Давыдкин Г.И.Kuzmin V.P., Gevorgyan A.A., Gimatdinova G.R., Danilova O.E., Davydkin I.L., Krivova S.P., Khairetdinov R.K., Davydkin G.I.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/5354

После операций на клапанном аппарате сердца, как правило, рекомендуется проведение антикоагулянтной терапии. Длительность и необходимость сочетания пероральных антикоагулянтов с антитромбоцитарными препаратами зависит от типа проводимой манипуляции, коморбидности пациента и некоторых других факторов. Несколько рандомизированных исследований показали, что продолжение приема прямых пероральных антикоагулянтов в режиме монотерапии у некоторых групп пациентов, требующих кардиохирургических вмешательств, превосходит по эффективности и безопасности лечение, сочетающее антикоагулянтные и антитромбоцитарные лекарственные средства. В представленном литературном обзоре отражена тактика ведения пациентов после операций на клапанном аппарате сердца.

After heart valve surgery, anticoagulant therapy is usually recommended. The duration and necessity of combining oral anticoagulants with antiplatelet drugs depends on the type of manipulation performed, patient comorbidity and some other factors. Several randomized trials have shown that continued direct oral anticoagulation as monotherapy in some groups of patients requiring cardiac surgery is superior in efficacy and safety to treatment combining anticoagulant and antiplatelet drugs. The presented literature review reflects the management strategy of patients after heart valve operations.

антикоагулянтыантиагрегантыантитромбоцитарные средствасердечные клапаныэндоваскулярная хирургияanticoagulantsantiplatelet agentsheart valvesendovascular surgeryReferencesLeon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374(17):1609-20. doi:10.1056/NEJMoa1514616.Leon MB, Smith CR, Mack MJ, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374(17):1609-20. doi:10.1056/NEJMoa1514616.Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373-498. doi:10.1093/eurheartj/ehaa612.Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373-498. doi:10.1093/eurheartj/ehaa612.Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955-62. doi:10.1016/S0140-6736(13)62343-0.Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955-62. doi:10.1016/S0140-6736(13)62343-0.Berg T, Sibbing D, Rocca B, et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J. 2021;42:2265-9. doi:10.1093/eurheartj/ehab196.Berg T, Sibbing D, Rocca B, et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J. 2021;42:2265-9. doi:10.1093/eurheartj/ehab196.Hochholzer W, Nührenberg T, Flierl U.Antithrombotische Therapie nach strukturellen kardialen. Interventionen Kardiologe. 2021;15:57-70. doi:10.1007/s12181-020-00441-w.Hochholzer W, Nührenberg T, Flierl U.Antithrombotische Therapie nach strukturellen kardialen. Interventionen Kardiologe. 2021;15:57-70. doi:10.1007/s12181-020-00441-w.Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-91. doi:10.1093/eurheartj/ehx391.Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-91. doi:10.1093/eurheartj/ehx391.Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159-e1195. doi:10.1161/CIR.0000000000000503.Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159-e1195. doi:10.1161/CIR.0000000000000503.Geis NA, Kiriakou C, Chorianopoulos E, et al. Feasibility and safety of vitamin K antagonist monotherapy in atrial fibrillation patients undergoing transcatheter aortic valve implantation. EuroIntervention. 2017;12:2058-66. doi:10.4244/EIJ-D-15-00259.Geis NA, Kiriakou C, Chorianopoulos E, et al. Feasibility and safety of vitamin K antagonist monotherapy in atrial fibrillation patients undergoing transcatheter aortic valve implantation. EuroIntervention. 2017;12:2058-66. doi:10.4244/EIJ-D-15-00259.D'Ascenzo F, Benedetto U, Bianco M, et al. Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER Registry: the management of DAPT after TAVI. EuroIntervention. 2017;13(12):e1392-e1400. doi:10.4244/EIJ-D-17-00198.D'Ascenzo F, Benedetto U, Bianco M, et al. Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER Registry: the management of DAPT after TAVI. EuroIntervention. 2017;13(12):e1392-e1400. doi:10.4244/EIJ-D-17-00198.Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ, et al. Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2016;9:1706-17. doi:10.1016/j.jcin.2016.06.025.Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ, et al. Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2016;9:1706-17. doi:10.1016/j.jcin.2016.06.025.Van Mieghem NM, Faquir N, Rahhab Z, et al. Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2015;8:718-24. doi:10.1016/j.jcin.2015.01.020.Van Mieghem NM, Faquir N, Rahhab Z, et al. Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2015;8:718-24. doi:10.1016/j.jcin.2015.01.020.Nijenhuis VJ, Brouwer J, Delewi R, et al. Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med. 2020;382:1696-707. doi:10.1056/NEJMoa1915152.Nijenhuis VJ, Brouwer J, Delewi R, et al. Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med. 2020;382:1696-707. doi:10.1056/NEJMoa1915152.Jochheim D, Barbanti M, Capretti G, et al. Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019;12:1566-76. doi:10.1016/j.jcin.2019.03.003.Jochheim D, Barbanti M, Capretti G, et al. Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019;12:1566-76. doi:10.1016/j.jcin.2019.03.003.Collet JP, Van Belle E, Thiele H, et al. Apixaban vs. standard of care after transcatheter aortic valve implantation: the ATLANTIS trial. Eur Heart J. 2022;43:2783-97. doi:10.1093/eurheartj/ehac242.Collet JP, Van Belle E, Thiele H, et al. Apixaban vs. standard of care after transcatheter aortic valve implantation: the ATLANTIS trial. Eur Heart J. 2022;43:2783-97. doi:10.1093/eurheartj/ehac242.Van Mieghem NM, Unverdorben M, Hengstenberg C, et al. Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR. N Engl J Med. 2021;385:2150-60. doi:10.1056/NEJMoa2111016.Van Mieghem NM, Unverdorben M, Hengstenberg C, et al. Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR. N Engl J Med. 2021;385:2150-60. doi:10.1056/NEJMoa2111016.Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093-104. doi:10.1056/NEJMoa1310907.Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2013;369:2093-104. doi:10.1056/NEJMoa1310907.Chakravarty T, Søndergaard L, Friedman J, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet. 2017;389:2383- 92. doi:10.1016/S0140-6736(17)30757-2.Chakravarty T, Søndergaard L, Friedman J, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet. 2017;389:2383- 92. doi:10.1016/S0140-6736(17)30757-2.Ueyam H, Kuno T, Ando T, et al. Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2020;125:1102-7. doi:10.1016/j.amjcard.2019.12.039.Ueyam H, Kuno T, Ando T, et al. Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2020;125:1102-7. doi:10.1016/j.amjcard.2019.12.039.Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561-632. doi:10.1093/eurheartj/ehab395.Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561-632. doi:10.1093/eurheartj/ehab395.Donal E, Leurent G, Ganivet A, et al. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper. Eur Heart J Cardiovasc Imaging. 2021;23(12):1617-27. doi:10.1093/ehjci/jeab255.Donal E, Leurent G, Ganivet A, et al. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper. Eur Heart J Cardiovasc Imaging. 2021;23(12):1617-27. doi:10.1093/ehjci/jeab255.Arora S, Vemulapalli S, Stebbins A, et al. The Prevalence and Impact of Atrial Fibrillation on 1-Year Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair: Results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. JACC Cardiovasc Interv. 2019;12:569-78. doi:10.1016/j.jcin.2018.12.012.Arora S, Vemulapalli S, Stebbins A, et al. The Prevalence and Impact of Atrial Fibrillation on 1-Year Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair: Results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. JACC Cardiovasc Interv. 2019;12:569-78. doi:10.1016/j.jcin.2018.12.012.Praz F, Spargias K, Chrissoheris M, et al. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study. Lancet. 2017;390:773-80. doi:10.1016/S0140-6736(17)31600-8.Praz F, Spargias K, Chrissoheris M, et al. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study. Lancet. 2017;390:773-80. doi:10.1016/S0140-6736(17)31600-8.Dangas GD, Tijssen J, Wöhrle J, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement. N Engl J Med. 2020;382(2):120-9. doi:10.1056/NEJMoa1911425.Dangas GD, Tijssen J, Wöhrle J, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement. N Engl J Med. 2020;382(2):120-9. doi:10.1056/NEJMoa1911425.Makkar RR, Fontana G, Jilaihawi H, et al. Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. N Engl J Med. 2015;373:2015-24. doi:10.1056/NEJMoa1509233.Makkar RR, Fontana G, Jilaihawi H, et al. Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves. N Engl J Med. 2015;373:2015-24. doi:10.1056/NEJMoa1509233.Pache G, Schoechlin S, Blanke P, et al. Early hypo-attenuated leaflet thickening in balloonexpandable transcatheter aortic heart valves. Eur Heart J. 2016;37:2263-71. doi:10.1093/eurheartj/ehv526.Pache G, Schoechlin S, Blanke P, et al. Early hypo-attenuated leaflet thickening in balloonexpandable transcatheter aortic heart valves. Eur Heart J. 2016;37:2263-71. doi:10.1093/eurheartj/ehv526.Rosseel L, De Backer O, Søndergaard L.Clinical Valve Thrombosis and Subclinical Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: Is There a Need for a Patient-Tailored Antithrombotic Therapy Front Cardiovasc Med. 2019;6:44. doi:10.3389/fcvm.2019.00044.Rosseel L, De Backer O, Søndergaard L.Clinical Valve Thrombosis and Subclinical Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: Is There a Need for a Patient-Tailored Antithrombotic Therapy Front Cardiovasc Med. 2019;6:44. doi:10.3389/fcvm.2019.00044.Makkar RR, Blanke P, Leipsic J, et al. Subclinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Valves: PARTNER 3 Cardiac Computed Tomography Substudy. J Am Coll Cardiol. 2020;75:3003-15. doi:10.1016/j.jacc.2020.04.043.Makkar RR, Blanke P, Leipsic J, et al. Subclinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Valves: PARTNER 3 Cardiac Computed Tomography Substudy. J Am Coll Cardiol. 2020;75:3003-15. doi:10.1016/j.jacc.2020.04.043.

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