russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2024-5577ZLUXQMrussjcardiol-5577Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWПероральные антикоагулянты в сравнении с антагонистами витамина К в лечении неклапанной фибрилляции предсердий у пациентов с хронической болезнью почек 4-5 стадииOral anticoagulants versus vitamin K antagonists in the treatment of non-valvular atrial fibrillation in patients with stage 4-5 chronic kidney diseasehttps://orcid.org/0000-0002-4961-5570СкородумоваЕ. Г.SkorodumovaE. G.

Скородумова Елизавета Геннадьевна — к.м.н., с.н.с. отдела неотложной кардиологии и ревматологии

Санкт-Петербург

Elizaveta G. Skorodumova

St. Petersburg

lisavetta91@mail.ruhttps://orcid.org/0000-0001-9351-6177РубаненкоО. А.RubanenkoO. A.

Рубаненко Олеся Анатольевна — д.м.н., доцент кафедры госпитальной терапии с курсами поликлинической терапии и трансфузиологии

Самара

Olesya A. Rubanenko

Samara

olesya.rubanenko@gmail.comhttps://orcid.org/0000-0002-3996-4689РубаненкоА. О.RubanenkoA. O.

Рубаненко Анатолий Олегович — к.м.н., доцент кафедры пропедевтической терапии с курсом кардиологии

Самара

Anatoly O. Rubanenko

Samara

anatolii.rubanenko@gmail.comhttps://orcid.org/0000-0002-8376-3104ЭнгиноевС. Т.EnginoevS. T.

Энгиноев Сослан Тайсумович — к.м.н., врач сердечно-сосудистый хирург, доцент кафедры сердечно-сосудистой хирургии ФПО

Астрахань

Soslan T. Enginoev

Astrakhan

 

surgery-89@yandex.ruhttps://orcid.org/0000-0003-1444-1037КерчеваМ. А.KerchevaM. A.

Керчева Мария Анатольевна — к.м.н., н.с. отделения неотложной кардиологии; н.с. лаборатории трансляционной медицины

Томск

Maria A. Kercheva

Tomsk

mariiakercheva@mail.ruhttps://orcid.org/0000-0002-1209-7765ЗаславскаяЕ. Л.ZaslavskayaE. L.

Заславская Екатерина Леонидовна — к.м.н., зав. отделением кардиологии № 1 с палатой интенсивной терапии для пациентов с острым коронарным синдромом; ассистент кафедры терапии факультетской с курсом эндокринологии и кардиологии с клиникой им. акад. Г. Ф. Ланга

Санкт-Петербург

Ekaterina L. Zaslavskaya

St. Petersburg

Dr.kzaslavskaya@gmail.comhttps://orcid.org/0000-0002-7579-4824ЕфремоваЕ. В.EfremovaE. V.

Ефремова Елена Владимировна — д.м.н., доцент, профессор кафедры терапии и профессиональных болезней

Ульяновск

Elena V. Efremova

Ulyanovsk

lena_1953@mail.ruhttps://orcid.org/0000-0001-6824-3963ГубареваЕ. Ю.GubarevaE. Yu.

Губарева Екатерина Юрьевна — к. м. н., доцент кафедры факультетской терапии, врач функциональной диагностики

Самара

Ekaterina Yu. Gubareva

Samara

e.yu.gubareva@samsmu.ruhttps://orcid.org/0000-0002-4649-5921ЛяпинаИ. Н.LyapinaI. N.

Ляпина Ирина Николаевна — к.м.н., с.н.с. лаборатории реабилитации отдела клинической кардиологии, врач-кардиолог центра легочной артериальной гипертензии консультативно-диагностического отделения

Кемерово

Irina N. Lyapina

Kemerovo

zaviirina@mail.ruВелиеваР. М.VelievaR. M.

Велиева Руфана Мамедовна — к.м.н., отделение кардиохирургии, кардиолог

Кемерово

Rufana M. Velieva

Kemerovo

velieva.rufana@mail.ruhttps://orcid.org/0000-0002-5017-0214СкородумоваЕ. А.SkorodumovaE. A.

Скородумова Елена Андреевна — д.м.н., в.н.с. отдела неотложной кардиологии и ревматологии

Санкт-Петербург

Elena A. Skorodumova

St. Petersburg

Elskor@mal.ruhttps://orcid.org/0000-0002-6831-2153СиверинаА. В.SiverinaA. V.

Сиверина Анна Викторовна — к. м. н., н.с. отдела неотложной кардиологии и ревматологии

Санкт-Петербург

Anna V. Siverina

St. Petersburg

gudkovanna_09@mail.ruГБУ Санкт-Петербургский научно-исследовательский институт скорой помощи им. И. И. ДжанелидзеРоссияSt. Petersburg I. I. Dzhanelidze Research Institute of Emergency MedicineRussian FederationФГБОУ ВО Самарский государственный медицинский университет Минздрава РоссииРоссияSamara State Medical UniversityRussian FederationФГБУ Федеральный центр сердечно-сосудистой хирургии Минздрава РоссииРоссияFederal Center for Cardiovascular SurgeryRussian FederationНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр РАНРоссияResearch Institute of Cardiology, Tomsk National Research Medical CenterRussian FederationГБУЗ Ленинградская областная больницаРоссияLeningrad Regional HospitalRussian FederationФГБОУ ВО Ульяновский государственный университетРоссияUlyanovsk State UniversityRussian FederationФГБНУ Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеванийРоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian FederationКемеровский областной клинический кардиологический диспансерРоссияKemerovo Regional Clinical Cardiological DispensaryRussian Federation202420042024291SОбразование55775577Copyright © Скородумова Е.Г., Рубаненко О.А., Рубаненко А.О., Энгиноев С.Т., Керчева М.А., Заславская Е.Л., Ефремова Е.В., Губарева Е.Ю., Ляпина И.Н., Велиева Р.М., Скородумова Е.А., Сиверина А.В., 20242024Скородумова Е.Г., Рубаненко О.А., Рубаненко А.О., Энгиноев С.Т., Керчева М.А., Заславская Е.Л., Ефремова Е.В., Губарева Е.Ю., Ляпина И.Н., Велиева Р.М., Скородумова Е.А., Сиверина А.В.Skorodumova E.G., Rubanenko O.A., Rubanenko A.O., Enginoev S.T., Kercheva M.A., Zaslavskaya E.L., Efremova E.V., Gubareva E.Y., Lyapina I.N., Velieva R.M., Skorodumova E.A., Siverina A.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/5577Цель

Цель. Сравнить эффективность и безопасность прямых пероральных антикоагулянтов (ПОАК) с антагонистом витамина К (АВК) у пациентов с фибрилляцией предсердий (ФП) и хронической болезнью почек (ХБП) 4 и 5 стадии.

Материал и методы

Материал и методы. Был проведен поиск в базах данных PubMed, Google Scholar, Web of Science с 1990 по 2022гг исследований, в которых сравнивали ПОАК с АВК у пациентов с ФП и ХБП 4 и 5 стадии. Для поиска статей использовалась стратегия PICO: пациент, вмешательство, сравнение, исходы. Данные были извлечены независимыми исследователями и подвергнуты метаанализу.

Результаты

Результаты. Всего в данный метаанализ были отобраны 6 исследований. В отношении эффективности ПОАК оказались сопоставимыми с АВК. В отношении безопасности ПОАК и АВК также не имели статистических различий: геморрагический инсульт, малые/желудочно-кишечные кровотечения, общая смертность, но была статистическая значимость в отношении больших кровотечений.

Заключение

Заключение. В отношении эффективности и безопасности в общем показатели ПОАК оказались сопоставимыми с АВК, однако имелся ряд различий: назначение ПОАК пациентам с 4 и 5 стадиями ХБП, а также находящимся на гемодиализе, сопровождалось статистически значимым уменьшением количества больших кровотечений по сравнению с терапией варфарином.

Aim

Aim. To compare the effectiveness and safety of direct oral anticoagulants (DOACs) with a vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) and stage 4 and 5 chronic kidney disease (CKD).

Material and methods

Material and methods. We searched in the PubMed, Google Scholar, and Web of Science databases from 1990 to 2022 for studies that compared DOACs with VKAs in patients with AF and stage 4 and 5 CKD. The patient, intervention, comparison, outcome (PICO) search strategy was used. Data were extracted by independent researchers and meta-analyzed.

Results

Results. A total of 6 studies were included in this meta-analysis. In terms of effectiveness, DOACs were comparable to VKAs. In terms of safety, DOACs and VKAs also had no statistical differences in hemorrhagic stroke, minor/gastrointestinal bleeding, overall mortality, but there was statistical significance in major bleeding. 

Conclusion

Conclusion. In terms of efficacy and safety, in general, DOACs were comparable to VKAs, but there were a number of following differences: the administration of DOACs to patients with stage 4 and 5 CKD, as well as those on hemodialysis, was accompanied by a significant reduction in the number of major bleedings, compared with warfarin therapy.

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