medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-19-29-38medalphabet-1709Research ArticleСтатьиОпыт применения в России идаруцизумаба – специфического антагониста дабигатранаExperience of using idarucizumab, specific antagonist of dabigatran, in RussiaПечеринаТ. Б.PecherinaT. B.

к.м.н., с.н.с. лаборатории патологии кровообращения отдела клинической кардиологии

г. Кемерово

Kemerovo

ЛарионовМ. В.LarionovM. V.

к.м.н., зав. отделением анестезиологии и реанимации, н.с. лаборатории анестезиологии-реаниматологии и патофизиологии критических состояний отдела хирургии сердца и сосудов

г. Кемерово

Kemerovo

ХанД. С.KhanD. S.

гл. внештатный специалист по острым нарушениям мозгового кровообращения Минздрава Приморского края, врач-невролог, зав. отделением для больных острым нарушением мозгового кровообращения

г. Владивосток

Vladivostok

ШпагинаЛ. А.ShpaginaL. A.

д.м.н., проф., зав. кафедрой госпитальной терапии и медицинской реабилитации; гл. врач

г. Новосибирск

Novosibirsk

ПудовЕ. В.PudovE. V.

к.м.н., зав. неврологическим отделением для больных с острыми нарушениями мозгового кровообращения

г. Нижний Новгород

Nizhny Novgorod

БарбарашО. Л.BarbarashO. L.

д.м.н., член-корр. РАН, директор

г. Кемерово

Kemerovo

ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian FederationРСЦ ГБУЗ «Приморская краевая клиническая больница № 1»РоссияPrimorsky Regional Clinical Hospital No. 1Russian FederationФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России; ГБУЗ Новосибирской области «Городская клиническая больница № 2»РоссияNovosibirsk State Medical University; City Clinical Hospital No. 2Russian FederationГБУЗ Нижегородской области «Городская клиническая больница № 5 Нижегородского района г. Нижнего Новгорода»РоссияCity Clinical Hospital No. 5Russian Federation202002112020119Коморбидные состояния (1)2938Copyright © Печерина Т.Б., Ларионов М.В., Хан Д.С., Шпагина Л.А., Пудов Е.В., Барбараш О.Л., 20202020Печерина Т.Б., Ларионов М.В., Хан Д.С., Шпагина Л.А., Пудов Е.В., Барбараш О.Л.Pecherina T.B., Larionov M.V., Khan D.S., Shpagina L.A., Pudov E.V., Barbarash O.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1709

Фибрилляция предсердий (ФП) – наиболее часто встречающаяся в клинической практике разновидность аритмий. Доказано, что наличие ФП увеличивает риск развития инсульта в пять раз относительно популяции людей без ФП. Одним из важных вопросов в ведении пациентов с фибрилляцией предсердий является управление риском тромбоэмболических осложнений, а именно оптимальный подбор антикоагулянтной терапии. Большинство пероральных антикоагулянтов (ПОАК) (дабигатран, апиксабан, ривароксабан) представляют собой эффективное и безопасное средство у больных с неклапанной ФП в сравнении с варфарином. Однако и при применении новых ПОАК имеется доказанный риск кровотечений, который варьирует от незначительного до угрожающего жизни. В настоящее время существуют утвержденные неспецифичные стратегии реверсии и восполнения факторов свертывания, связанные с применением ПОАК, с определенными показаниями у пациента с тяжелым или угрожающим жизни кровотечением, экстренными хирургическим вмешательствами или перед тромболитической терапией. В последние годы активно изучаются и специфичные антагонисты ПОАК. Из таких препаратов в России одобрен только идаруцизумаб (регистрация лекарственного средства в России с сентября 2018 года), что делает более безопасным использование дабигатрана в реальной клинической практике. В статье представлены клинические случаи, иллюстрирующие эффективность применения специфичного антагониста дабигатрана этексилата (идаруцизумаба) у пациентов с неклапанной фибрилляцией предсердий. На клинических примерах проиллюстрированы сложности ведения пациентов с фибрилляцией предсердий и геморрагическими осложнениями на фоне приема пероральных антикоагулянтов.

Atrial fibrillation (AF) is the most common type of arrhythmias in clinical practice. It has been proven that the presence of AF increases the risk of stroke by five times relative to the population of people without AF. One of the important issues in the management of patients with atrial fibrillation is the management of the risk of thromboembolic complications, namely the optimal selection of anticoagulant therapy. Most oral anticoagulants (dabigatran, apixaban, rivaroxaban) are the most effective and safest drug in patients with nonvalvular AF compared to warfarin. However, even with the use of new oral anticoagulants, there is a proven risk of bleeding, which ranges from minor to life-threatening. Currently, there are approved non-specific strategies for reversing and replenishing clotting factors associated with the use of oral anticoagulants, with certain indications in a patient with severe or life-threatening bleeding, emergency surgery, or before thrombolytic therapy. Over the past few years, specific oral anticoagulants antagonists have been actively studied. Of the specific oral anticoagulants antagonists, only idarucizumab has been approved in Russia (registration of the drug in Russia since September 2018), which makes it safer to use dabigatran in real clinical practice. The article presents clinical cases illustrating the effectiveness of the use of a specific antagonist dabigatran etexilate (idarucizumab) in patients with nonvalvular atrial fibrillation. Clinical examples illustrate the difficulties of managing patients with atrial fibrillation and hemorrhagic complications while taking oral anticoagulants.

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