Применение прямых пероральных антикоагулянтов в особых группах пациентов: возможности и ограничения

Abstract

The paper is focused on the issues of using direct oral anticoagulants (DOACs) in the subgroups of patients with specific characteristics. The current data on the effects of DOACs in such patients during anticoagulant therapy aimed at prevention of thromboembolic complications in both patients with atrial fibrillation (AF) and venous thromboembolic complications (VTECs) are provided. Insufficient knowledge of the DOAC effects in such populations of patients, i.e. in very old people, people with kidney disease and obese patients, that results from the small number of patients with similar characteristics included in the large-scale randomized clinical trials, is noted. The paper discusses the pharmacological features of using DOACs in patients with the listed above characteristics and possible changes in clinical efficacy and safety of DOACs used in clinical practice separately. The data on three DOACs available in Russia, apixaban, rivaroxaban and dabigatran, are provided. The data of the clinical trial analysis provided in the paper make it possible to generally assume the appropriateness of using DOACs for treatment and prevention of VTECs in patients with pronounced obesity, as well as the advantages of apixaban over other DOACs in patients with AF and concomitant obesity. The issues of using DOACs in patients with kidney disease are considered. The scarcity of evidence-based information about patients with pronounced kidney dysfunction is noted. The provided data on the effects of DOACs in very old people show the advantages of taking apixaban in this population of patients with AF, based primarily on safety indicators.