TY - JOUR

T1 - Эффективность, безопасность и приверженность при использовании новых антикоагулянтов у пациентов с фибрилляцией предсердий старше 75 лет

AU - Turov, Alex N.

AU - Panfilov, Sergey

AU - Tschiglinzeva, Oxana

N1 - Туров А.Н., Панфилов С.В., Чиглинцева О.В. Эффективность, безопасность и приверженность при использовании новых антикоагулянтов у пациентов с фибрилляцией предсердий старше 75 лет // Рациональная Фармакотерапия в Кардиологии. - 2020. - Т. 16. - № 1. - С. 10-18

PY - 2020

Y1 - 2020

N2 - Aim. To study the efficacy, safety, and adherence to therapy with new oral anticoagulants in patients older than 75 years with atrial fibrillation. Material and methods. Patients (n=431) over 75 years old (82.7±3.4 years) with various types of atrial fibrillation/flutter (AF) were included in a nonrandomized observational study of new oral anticoagulants (NOAC) in real clinical practice. A history of cardiac surgery was in 27.6% of patients. All patients had >3 risk factors for ischemic stroke (CHA2DS2-VASс 4.81±0.4 points) and >1 risk factor for bleeding (HAS-BLED 3.01±0.2 points). The duration of the observation study was from 12 to 42 (26.9±4.9) months. Dabigatran was taken in 38.5% (n=166) of patients, rivaroxaban – in 41.3% (n=178), apixaban – in 20.2% (n=87) of patients. Results. The incidence of new cases of myocardial infarction was 0.8% per year, surgical revascularization – 0.9% per year, cardiovascular death – 0.8% per year. The frequency of ischemic stroke was 1.1% per year, transient ischemic attacks – 0.4% per year, all thromboembolic episodes – 1.77% per year. The incidence of intracranial hemorrhage was 0.2% per year, of minor bleeding – 4.4% per year, of the combined cardiac point (the total frequency of all strokes, major bleeding, myocardial infarction, mortality from cardiovascular causes, revascularization procedures) – 4.2% per year. Significant differences in the frequency of endpoints depending on the drug of NOAC taken by patients were not found. Violations of the regimen and doses were more often observed with twice daily intake (63.9% for dabigatran and 59.8% for apixaban) than with a single dosage regimen per day (45.5% for rivaroxaban). The leading causes of non-adherence to NOAC therapy in patients over 75 years of age included skipping the next scheduled dose (43.6%) and changing the frequency of the drug taking (16.9%). For NOAC with a double dose per day, dabigatran and apixaban, the frequency of administration was violated in 27.7% and 28.7%, respectively, and with a single dose per day, rivaroxaban – in 1.1%. Conclusion. Therapy with NOAC in patients older than 75 years with AF is effective and safe. There were no statistically significant differences in the incidence of thromboembolic or hemorrhagic events during three NOACs treatment in patients with AF older than 75 years. The incidence of non-adherence was less for rivaroxaban. The leading causes of non-adherence to NOAC treatment in patients older than 75 years were the omission of the next scheduled intake and a change in the frequency of the drug taking.

AB - Aim. To study the efficacy, safety, and adherence to therapy with new oral anticoagulants in patients older than 75 years with atrial fibrillation. Material and methods. Patients (n=431) over 75 years old (82.7±3.4 years) with various types of atrial fibrillation/flutter (AF) were included in a nonrandomized observational study of new oral anticoagulants (NOAC) in real clinical practice. A history of cardiac surgery was in 27.6% of patients. All patients had >3 risk factors for ischemic stroke (CHA2DS2-VASс 4.81±0.4 points) and >1 risk factor for bleeding (HAS-BLED 3.01±0.2 points). The duration of the observation study was from 12 to 42 (26.9±4.9) months. Dabigatran was taken in 38.5% (n=166) of patients, rivaroxaban – in 41.3% (n=178), apixaban – in 20.2% (n=87) of patients. Results. The incidence of new cases of myocardial infarction was 0.8% per year, surgical revascularization – 0.9% per year, cardiovascular death – 0.8% per year. The frequency of ischemic stroke was 1.1% per year, transient ischemic attacks – 0.4% per year, all thromboembolic episodes – 1.77% per year. The incidence of intracranial hemorrhage was 0.2% per year, of minor bleeding – 4.4% per year, of the combined cardiac point (the total frequency of all strokes, major bleeding, myocardial infarction, mortality from cardiovascular causes, revascularization procedures) – 4.2% per year. Significant differences in the frequency of endpoints depending on the drug of NOAC taken by patients were not found. Violations of the regimen and doses were more often observed with twice daily intake (63.9% for dabigatran and 59.8% for apixaban) than with a single dosage regimen per day (45.5% for rivaroxaban). The leading causes of non-adherence to NOAC therapy in patients over 75 years of age included skipping the next scheduled dose (43.6%) and changing the frequency of the drug taking (16.9%). For NOAC with a double dose per day, dabigatran and apixaban, the frequency of administration was violated in 27.7% and 28.7%, respectively, and with a single dose per day, rivaroxaban – in 1.1%. Conclusion. Therapy with NOAC in patients older than 75 years with AF is effective and safe. There were no statistically significant differences in the incidence of thromboembolic or hemorrhagic events during three NOACs treatment in patients with AF older than 75 years. The incidence of non-adherence was less for rivaroxaban. The leading causes of non-adherence to NOAC treatment in patients older than 75 years were the omission of the next scheduled intake and a change in the frequency of the drug taking.

KW - atrial fibrillation

KW - new oral anticoagulants

KW - dabigatran

KW - rivaroxaban

KW - apixaban

KW - adherence

KW - patients over 75 years old

KW - ORAL ANTICOAGULANTS

KW - FOLLOW-UP

KW - WARFARIN

KW - STROKE

KW - DABIGATRAN

KW - RISK

KW - RIVAROXABAN

KW - PREVENTION

KW - GUIDELINES

KW - MANAGEMENT

KW - Atrial fibrillation

KW - New oral anticoagulants

KW - Dabigatran

KW - Patients over 75 years old

KW - Adherence

KW - Rivaroxaban

KW - Apixaban

UR - http://www.scopus.com/inward/record.url?scp=85102047983&partnerID=8YFLogxK

UR - https://elibrary.ru/item.asp?id=42451592

U2 - 10.20996/1819-6446-2020-20-07

DO - 10.20996/1819-6446-2020-20-07

M3 - статья

VL - 16

SP - 10

EP - 18

JO - Рациональная фармакотерапия в кардиологии

JF - Рациональная фармакотерапия в кардиологии

SN - 1819-6446

IS - 1

ER -