Abstract
Pulmonary embolism (PE) is the third most common cardiovascular disease after myocardial infarction and stroke, and one of the leading causes of death in Europe.
 Aim. Analysis of the modern scientific base concerning the possibilities and limitations of use of anticoagulant therapy (ACT) at different stages of medical care in PE depending on risk stratification. The article reflects the position of modern Clinical guidelines, the results of recent studies and some controversial and unresolved issues of the ACT for PE.
 Conclusion. Currently, a sufficient evidence base has been obtained in favor of the fact that the ACT increases the survival rate of patients with past PE even taking into account an increase in the frequency of hemorrhagic complications; the choice of therapy schemes for PE is based on the stratification of the risk of patients; the schemes of the ACT for the acute period, for the subsequent prevention of relapses of PE are developed, the evidence of the expediency of its further prolongation (a study of rivaroxaban at a dose of 10 mg for prolonged therapy) is obtained. Use of direct oral anticoagulants (DOAC) in patients with past PE has a more optimal efficacy/safety profile compared to vitamin K antagonists (VCA). However, not all the issues of the ACT for PE are solved, therefore the prospects for the study and application of the ACT in PE include: reasonability of obtaining substantiated data on use of DOAC after thrombolysis, in patients with reduced renal function, with antiphospholipid syndrome, with neoplastic diseases, and also for determination of exact periods of extended therapy. It is necessary to search for additional prognostic factors for PE, to study and register specific antidotes for DOAC (currently in the Russian Federation a specific antidote to dabigatran Idarucizumab-registered); to increase the share of DOAC in the ACT as drugs with a proven best profile efficacy/safety compared to VCA.
Highlights
Тромбоэмболия легочной артерии (ТЭЛА) – третье по распространенности сердечнососудистое заболевание после инфаркта миокарда и инсульта, а также одна из основных причин смертности в Европе
If a patient develops a relapse of Pulmonary embolism (PE) with the underlying intake of warfarin or direct oral anticoagulants (DOAC), it is proposed to transfer him to lowmolecular weight heparins (LMWH); if the patient has already received LMWH before, the dose should be increased
1) Not a single direct oral anticoagulant was studied in case of suspicion of PE; 2) In clinical studies of direct oral coagulants, patients with a severe organic pathology were not included, so evidence base is absent; 3) Use of any anticoagulant therapy requires a regular control of the clinical condition of the patient, active interaction of a patient and a doctor which is not always possible in the routine clinical practice; 4) Warfarin with considerably poorer efficacy/safety profile remains the most commonly administered preparation
Summary
СОВРЕМЕННАЯ ПОЗИЦИЯ АНТИКОАГУЛЯНТОВ ПРИ ОСТРОЙ ТЭЛА: ДОСТИЖЕНИЯ, ОГРАНИЧЕНИЯ, ПЕРСПЕКТИВЫ. Pulmonary embolism (PE) is the third most common cardiovascular disease after myocardial infarction and stroke, and one of the leading causes of death in Europe. DOI:10.23888/PAVLOVJ201927193-106 scientific base concerning the possibilities and limitations of use of anticoagulant therapy (ACT) at different stages of medical care in PE depending on risk stratification. Not all the issues of the ACT for PE are solved, the pro spects for the study and application of the ACT in PE include: reasonability of obtaining substa ntiated data on use of DOAC after thrombolysis, in patients with reduced renal function, with antiphospholipid syndrome, with neoplastic diseases, and for determination of exact periods of extended therapy. The aim of work was analysis of the modern scientific base concerning possibilities and limitations of use of anticoagulants (parenteral, peroral) at different stages of medical assistance in PE depending of stratification of risk
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