nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2012-359nnp-329Research ArticleArticlesСтатьиNew possibilities in the prevention of stroke in atrial fibrillationНовые возможности профилактики инсульта при фибрилляции предсердийParfenovVladimir AnatolyevichParfenovVladimir Anatolyevich

Department of Nervous Diseases, Faculty of Therapeutics

Department of Nervous Diseases, Faculty of Therapeutics

vladimirparfenov@mail.ruVerbitskayaS VVerbitskayaS V

Department of Nervous Diseases, Faculty of Therapeutics

Department of Nervous Diseases, Faculty of Therapeutics

vladimirparfenov@mail.ru20121503201241NO1 (2012)3642Copyright © Parfenov V.A., Verbitskaya S.V., 20122012Parfenov V.A., Verbitskaya S.V.Parfenov V.A., Verbitskaya S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/329

The paper reviews the data available in the literature on the prevention of stroke in atrial fibrillation (AF). Until recently, mainly warfarin was noted to be used to prevent stroke in AF, which required regulatory laboratory (hematological) control. The authors give the results of the RE-LY trial that compared the efficacy of the new thrombin inhibitor dabigatran (pradax) in a dose of 150 or 110 mg twice daily and warfarin. The trial has indicated that the use of dabigatran in a dose of 150 mg twice daily results in a reduction in the rate of stroke and systemic embolism as compared to that with warfarin treatment. The administration of dabigatran in a dose of 150 or 110 mg twice daily decreases the rate of deaths from all cases, life-threatening hemorrhages, and hemorrhagic stroke as compared to that of warfarin. The prospects for using different doses of dabigatran in AF patients with prior ischemic stroke (IS) or transient ischemic attack (TIA) are discussed. In our country, most patients with prior IS or TIA in the presence of AF do not take warfarin due to the difficulty of regulatory laboratory control, the introduction of dabigatran into neurological care may increase the number of patients receiving effective anticoagulant therapy to prevent re-stroke.

Представлен обзор литературы, посвященной профилактике инсульта при фибрилляции предсердий (ФП). Отмечается, что до последнего времени для профилактики инсульта при ФП использовался преимущественно варфарин, что требовало регулярного лабораторного (гематологического) контроля. Приведены результаты исследования RE-LY, в котором у 18113 пациентов с ФП сравнивалась эффективность нового ингибитора тромбина дабигатрана (прадакса) в дозе 150 или 110 мг 2 раза в сутки и варфарина. В этом исследовании показано, что применение дабигатрана в дозе 150 мг 2раза в сутки уменьшает частоту инсульта и системной эмболии по сравнению с лечением варфарином. Использование дабигатрана в дозе 150 или 110 мг 2 раза в сутки снижает частоту геморрагического инсульта по сравнению с лечением варфарином. Обсуждаются перспективы применения разных доз дабигатрана у пациентов с ФП, перенесших ишемический инсульт (ИИ) или транзиторную ишемическую атаку (ТИА). В нашей стране значительная часть больных, перенесших ИИ или ТИА на фоне ФП, не принимает варфарин в связи с трудностью регулярного лабораторного контроля; внедрение в неврологическую практику дабигатрана может увеличить число больных, получающих эффективную антикоагулянтную терапию для профилактики повторного инсульта.

фибрилляция предсердийпрофилактика инсультаварфариндабигатран (прадакса)atrial fibrillationstroke preventionwarfarindabigatran (pradax)References<div><p>Wolf P.A., Abbott R.D., Kannel W.B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8.</p><p>Stroke in Atrial Fibrillation Working Group. Independent predictors of stroke in atrial fibrillation: a systematic review. Neurology 2007;69:546-54.</p><p>Gage B.F., Waterman A.D., Shannon W. et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864-70.</p><p>Bleeding during antithrombotic therapy in patients with atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. Arch Intern Med 1996;156:409-16.</p><p>Суслина З.А., Фонякин А.В., Гераскина Л.А. и др. Практическая кардионеврология. М.: ИМА-ПРЕСС, 2010;304 с.</p><p>Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449-57.</p><p>EAFT Group Secondary prevention in nonrheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-62.</p><p>Sacco R. L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:227-76.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:17-21.</p><p>The ACTIVE Investigators Effect of dopidogrel аdded to aspirin in patients with atrial fibrillation. N Engl J Med 2009;360:2066-78.</p><p>Ansell J. Warfarin versus new agents: interpreting the data. Hematology Am Soc Hematol Educ Program 2010;2010:221-8.</p><p>Connolly S.J. Ezekowitz M.D. Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.</p><p>Diener H.C., Connolly S.J., Ezekowitz M.D. et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol 2010;9:1157-63.</p><p>Reddy P., Atay J.K., Selbovitz L.G. et al. Dabigatran: a review of clinical and pharmacoeconomic evidence. Crit Pathw Cardiol 2011;10:117-27.</p><p>Van Ryn J., Stangier J., Haertter S. et al. Dabigatran etexilate — a novel. reversible. oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 2010;103:1116-27.</p><p>Beasley B.N., Unger E.F., Temple R. Anticoagulant options - why the FDA approved a higher but not a lower dose of dabigatran. N Engl J Med 2011;364:1788-90.</p><p>Pink J., Lane S., Pirmohamed M. et al. Dabigatran etexilate versus warfarin in management of non-valvular atrial fibrillation in UK context: quantitative benefit-harm and economic analyses. BMJ 2011;343:d6333. doi: 10.1136/bmj.d6333.</p><p>Kamel H., Johnston S.C., Easton J.D. et al. Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Patients With Atrial Fibrillation and Prior Stroke or Transient Ischemic Attack. Stroke 2012. [Epub ahead of print].</p></div><br /><div><p>Wolf P.A., Abbott R.D., Kannel W.B. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8.</p><p>Stroke in Atrial Fibrillation Working Group. Independent predictors of stroke in atrial fibrillation: a systematic review. Neurology 2007;69:546-54.</p><p>Gage B.F., Waterman A.D., Shannon W. et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864-70.</p><p>Bleeding during antithrombotic therapy in patients with atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. Arch Intern Med 1996;156:409-16.</p><p>Суслина З.А., Фонякин А.В., Гераскина Л.А. и др. Практическая кардионеврология. М.: ИМА-ПРЕСС, 2010;304 с.</p><p>Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449-57.</p><p>EAFT Group Secondary prevention in nonrheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-62.</p><p>Sacco R. L., Adams R., Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Furie K.L., Kasner S.E., Adams R.J. et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2011;42:227-76.</p><p>Вербицкая С.В., Парфенов В.А. Вторичная профилактика инсульта в амбулаторных условиях. Неврол журн 2011;1:17-21.</p><p>The ACTIVE Investigators Effect of dopidogrel аdded to aspirin in patients with atrial fibrillation. N Engl J Med 2009;360:2066-78.</p><p>Ansell J. Warfarin versus new agents: interpreting the data. Hematology Am Soc Hematol Educ Program 2010;2010:221-8.</p><p>Connolly S.J. Ezekowitz M.D. Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139-51.</p><p>Diener H.C., Connolly S.J., Ezekowitz M.D. et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Lancet Neurol 2010;9:1157-63.</p><p>Reddy P., Atay J.K., Selbovitz L.G. et al. Dabigatran: a review of clinical and pharmacoeconomic evidence. Crit Pathw Cardiol 2011;10:117-27.</p><p>Van Ryn J., Stangier J., Haertter S. et al. Dabigatran etexilate — a novel. reversible. oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 2010;103:1116-27.</p><p>Beasley B.N., Unger E.F., Temple R. Anticoagulant options - why the FDA approved a higher but not a lower dose of dabigatran. N Engl J Med 2011;364:1788-90.</p><p>Pink J., Lane S., Pirmohamed M. et al. Dabigatran etexilate versus warfarin in management of non-valvular atrial fibrillation in UK context: quantitative benefit-harm and economic analyses. BMJ 2011;343:d6333. doi: 10.1136/bmj.d6333.</p><p>Kamel H., Johnston S.C., Easton J.D. et al. Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Patients With Atrial Fibrillation and Prior Stroke or Transient Ischemic Attack. Stroke 2012. [Epub ahead of print].</p></div><br />

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