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Неврология, нейропсихиатрия, психосоматика

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Современные подходы к антитромботической терапии у больных с кардиоэмболическим инсультом

https://doi.org/10.14412/2074-2711-2013-2356

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Аннотация

Частота кардиогенной эмболии среди всех ишемических инсультов достигает 38%. Кардиоэмболические инсульты отличаются большей выраженностью неврологического дефицита, высоким риском развития повторного острого нарушения мозгового кровообращения и летального исхода. Данный обзор посвящен вопросам этиопатогенеза формирования тромбов в полостях сердца, современным критериям верификации кардиоэмболических инсультов, результатам исследований новых оральных антикоагулянтов и новейшим рекомендациям по назначению антитромботической терапии с целью профилактики инсульта. Особое внимание уделено подходам к вторичной профилактике у пациентов с фибрилляцией предсердий неклапанной этиологии, так как именно мерцательная аритмия является наиболее частой причиной развития кардиоэмболического инсульта.

Об авторах

Oleg Ivanovich Vinogradov
ФГБУ «Национальный медико-хирургический центр им. Н.И. Пирогова», Москва
Россия


A N Kuznetsov
ФГБУ «Национальный медико-хирургический центр им. Н.И. Пирогова», Москва
Россия


N V Rybalko
ФГБУ «Национальный медико-хирургический центр им. Н.И. Пирогова», Москва
Россия


Список литературы

1. <div><p>Adams HP Jr, Bendixen BH, Kappele LJ et al. Classification of sybtype of acute stroke: Definituin for use in a multicentre clinical trial, TOAST, Trial of Org 10172 in Acute Stroke Treatment. Stroke.1993;24(1):35–41.</p><p>Кузнецов АН, Виноградов ОИ, Кучеренко СС. Ишемический инсульт. Диагностика. Лечение. Профилактика: карманный справочник. Mосква: РАЕН; 2012. [Kuznetsov AN, Vinogradov OI, Kucherenko SS. Ishemicheskiy insul't. Diagnostika. Lechenie. Profilaktika: karmannyy spravochnik. Moscow: RAEN; 2012.]</p><p>Инсульт. Принципы диагностики, лечения и профилактики. Краткое руководство для врачей. Под редакцией Верещагина НВ, Пирадова МА, Суслиной ЗА. Москва: Интермедика; 2002. 208 с. [Insul't. Printsipy diagnostiki, lecheniya i profilaktiki. Kratkoe rukovodstvo dlya vrachey. Pod redaktsiey Vereshchagina NV, Piradova MA, Suslinoy ZA. Mosсow: Intermedika; 2002. 208 р.]</p><p>Шевченко ЮЛ, Одинак АН, Кузнецов АН, Ерофеев АА. Кардиогенный и ангиогенный церебральный эмболический инсульт. Москва: ГЭОТАР-Медиа; 2006. 272 с. [Shevchenko YuL, Odinak AN, Kuznetsov AN, Erofeev AA. Kardiogennyy i angiogennyy tserebral'nyy embolicheskiy insul't. Moscow: GEOTAR-Media; 2006. 272 p.]</p><p>Шевченко ЮЛ, Михайленко АА, Кузнецов АН, Ерофеев АА. Кардиохирургическая агрессия и головной мозг. Санкт-Петербург: Наука; 1997. 152 c. [Shevchenko YuL, Mikhaylenko AA, Kuznetsov AN, Erofeev AA. Kardiokhirurgicheskaya agressiya i golovnoy mozg. St.-Petersburg: Nauka; 1997. 152 p.]</p><p>Практическая кардионеврология. Под редакцией Суслиной ЗА, Фонякина АВ. Москва: ИМА-ПРЕСС; 2010. 304 с. [Prakticheskaya kardionevrologiya. Pod redaktsiey Suslinoy ZA, Fonyakina AV. Moscow: IMA-PRESS; 2010. 304 p.]</p><p>Stroke Prevention in Atrial Fibrillation Investigators. Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation: the stroke prevention in atrial fibrillation study. J Stroke Cerebrovasc Dis. 1995;5(3):147–57.</p><p>Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978;28(10): 973–7. DOI: 10.1212%2FWNL.28.10.973.</p><p>Caplan LR. Brain embolism revisited. Neurology. 1993;43:1281–7. DOI: 10.1212%2FWNL.43.7.1281.</p><p>Наnna JP, Furlan AJ. Cardiac disease and embolic sources. Brain ischemia: Basic concepts and clinical relevalence. Caplan – Lond LD, editor. Springer-Verlag. 1995;299–315.</p><p>Arboixa A, Alioc J. Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis. Curr Cardiol Rev.2010;6(3):150–61. DOI: 10.2174%2F157340310791658730.</p><p>Johnson RC, Crissman RS, DiDio LJA. Endocardial alterationin myocardial infarction. Lab Invest. 1979;40:183–93.</p><p>Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: Analysis of 152 necropsy patients. Am J Cardiol. 1987;60(16):1340–55. DOI: 10.1016%2F0002-9149%2887%2990618-7.</p><p>Нochman JS, Platia EB, Bulkley BH. Endocardial abnormalities in left ventricular aneurysm. A clinicopathologic study. Ann Intern Med. 1984;100(1):29–35.</p><p>Francis CW, Markham RE, Barlow GH et al. Thrombin activity of fibrin thrombi and soluble plasmic derivates. J Lab Clin Med. 1983;102(2):220–30.</p><p>Lassila R, Badimon JJ, Vallabhajasula S, Badimon L. Dynamic monitoring of platelet deposition on severely damaged vessel wall in flowing blood. Effects of different stenosis on thrombus growth. Arteriosclerosis. 1990;10(2):306–15. DOI: 10.1161%2F01.ATV.10.2.306.</p><p>Visser CA, Kan G, Meltzer RS et al. Long-term follow-up of left ventricular thrombus after acute myocardial infarction. A two-dimensional echocardiographic study in 96 patients. Chest. 1984;86(4):532–6. DOI: 10.1378%2Fchest.86.4.532.</p><p>Lapeyre AC, Steele PM, Kazmier FJ at al. Systemic embolism in chronic left ventricular aneurysm: incidence and the role of anticoagulation. J Am Coll Cardiol. 1985;6(3):534–8. DOI: 10.1016%2FS0735-1097%2885%2980109-1.</p><p>Cabin HS, Roberts WC. Left ventricular aneyrism, intra-aneurismal thrombus and systemic embolus in coronary heart disease. Chest.1980;77(5):586–90.</p><p>Dauzat M, Deklunder G, Aldis A et al. Gas bubble emboli detected by transcranial Doppler sonography in patients with prosthetic heart valves: a preliminary report. J Ultrasound Med. 1994:13(2):129–35.</p><p>Georgiadis D. Microembolism in prosthetic valve patients. Stroke. 1998;29:2237.</p><p>Abdoh N, Zettervall O, Carlson J et al. Is occult atrial disorder a frequent cause of non-Hemorragic stroke? Long-term ECG in 86 patients. Stroke. 1982;13(6):832–7.</p><p>Delcker A, Diener HC. Neurologische Diagnostik und therapeutische Massnahmen bei zerebralen Embolien. Herz. 1991;16(6):434–43.</p><p>Cujec B, Polasek P, Voll C, Shuaib A. Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients. Stroke. 1991;22(6):727–33. DOI: 10.1161%2F01.STR.22.6.727.</p><p>Albers GW. Atrial fibrillation and stroke: three new studies, three remaining questions. Arch Intern Med. 1994;154(13):1443–8. DOI: 10.1001%2Farchinte.1994.00420130030006.</p><p>Antman EM, Anbe DT, Armstrong PW et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110(9):e82–292.</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(13):1449–57.</p><p>Font, Krupinski J, Arboix A. Antithrombotic medication for cardioembolic stroke prevention. Stroke Res Treat. 2011;2011:607852. DOI: 10.4061/2011/607852. Epub 2011 Jun 22.</p><p>Go AS, Hylek EM, Phillips KA et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA. 2001;285(18): 2370–5.</p><p>Van Walraven C, Hart RC, Singer DE et al. Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. JAMA. 2002;288(19):2441–8. DOI: 10.1001%2Fjama.288.19.2441.</p><p>Singer DE, Albers GW, Dalen JE et al. Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):429S-456S. DOI: 10.1378%2Fchest.126.3_suppl.429S.</p><p>Домашенко МА, Макcимова МЮ, Коробкова ДЗ, Гафарова МЭ. Опыт применения дабигатрана в первичной и вторичной профилактики кардио-эмболического инсульта. Неврология, нейропсихиатрия, психосоматика. 2013;2:69–77. [Domashenko MA, Makcimova MYu, Korobkova DZ, Gafarova ME. Opyt primeneniya dabigatrana v pervichnoy i vtorichnoy profilaktiki kardio-embolicheskogo insul'ta. Nevrologiya, neyropsikhiatriya, psikhosomatika. 2013;2:69–77.]</p><p>Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet. 1993;342(8882):1255–62.</p><p>Connolly SJ, Ezekowitz MD, Yusuf S et al. Newly identified events in the RE-LY trial. N Engl J Med. 2010;363:1863–2372. DOI: 10.1056/NEJMc1007378.</p><p>Hohnloser SH, Oldgren J, Yang S et al. Myocardial ischemic events in patients with atrial fibrillation treated with dabigatran or warfarin in the RE-LY trial. Circulation. 2012;125(5):669–76. DOI: 10.1161/CIRCULATIONAHA.111.055970. Epub 2012 Jan 3.</p><p>Meissner I, Khandheria BK, Heit JA et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol. 2006;47(2):440–5. Epub 2005 Dec 6.</p><p>Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001 Nov 1;345(18):1318-30. DOI: 10.1056%2FNEJMra010082.</p><p>Diener HC, Connolly SJ, Ezekowitz MD et al. Dabigatran compared with warfarin in patients with atrial fibrillation and previous tresient ischemic attack or stroke: a subgroup analysis of RE-LY trial. Lancet Neurol. 2010;9: 1157–63. DOI: 10.1016/S1474-4422(10)70274-X. Epub 2010 Nov 6.</p><p>Van de Werf F, Brueckmann M, Connolly SJ et al. A comparison of dabigatran etexilate with warfarin in patients with mechanical heart valves: THE Randomized, phase II study to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN). Am Heart J. 2012;163(6):931–7.e1. DOI: 10.1016/j.ahj.2012.03.011.</p><p>Granger CB, Alexander JH, McMurray JJ et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011;365(11):981–92. DOI: 10.1056/NEJMoa1107039. Epub 2011 Aug 27.</p><p>Furie KL, Goldstein LB, Albers GW et al. Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: a science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012 Dec;43(12):3442–53. DOI: 10.1161/STR.0b013e318266722a. Epub 2012 Aug 2.</p><p>Visser CA, Kan G, Meltzer RS et al. Embolic potential of left ventricular thrombus after myocardial infarction: A two-dimentional echocardiographic study of 119 patients. J Am Coll Cardiol. 1985;5(6):1276–80.</p><p>Loh E, Sutton MC, Wun CC et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med. 1997 Jan 23;336(4):251–7. DOI: 10.1056%2FNEJM199701233360403.</p><p>Natarajan D, Hotchandani RK, Nigam PD. Reduced incidence of left ventricular thrombi with intravenous streptokinase in acute anterior myocardial infarction: prospective evaluation by cross-sectional echocardiography. Int J Cardiol. 1988;20(2):201–7. DOI: 10.1016%2F0167-5273%2888%2990264-1.</p><p>Sherman DG, Dyken ML, Fisher M et al. Cerebral embolism. Chest. 1986;89(suppl 2):82S–98S.</p><p>Held AC, Gore JM, Paraskos J et al. Impact of thrombolytic therapy on left ventricular mural thrombi in acute myocardial infarction. Am J Cardiol. 1988;62(4):310–1.</p><p>Azar AJ, Koudstaal PJ, Wintzen AR et al. Risk of stroke during long-term anticoagulant therapy in patients after myocardial infarction. Ann Neurol. 1996;39(3):301–7. DOI: 10.1002%2Fana.410390306.</p><p>Van Es RF, Jonker JJ, Verheugt FW et al. Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial. Lancet. 2002;360(9327):109–13. DOI: 10.1016%2FS0140-6736%2802%2909409-6.</p><p>Dries DL, Domanski MJ, Waclawiw MA, Gersh BJ. Effect of antithrombotic therapy on risk of sudden coronary death in patients with congestive heart failure. Am J Cardiol. 1997;79(7):909–13. DOI: 10.1016%2FS0002-9149%2897%2900013-1.</p><p>Salem DN, Stein PD, Al-Ahmad A et al. Antithrombotic therapy in valvular heart disease–native and prosthetic: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):457S-482S. DOI: 10.1378%2Fchest.126.3_suppl.457S.</p><p>American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006 Aug 1;114(5):e84–231.</p><p>Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med. 1996 Aug 8;335(6):407–16. DOI: 10.1056%2FNEJM199608083350607.</p><p>Sacco RL, 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(2):577–617. DOI: 10.1161%2F01.STR.0000199147.30016.74.</p><p>Heiro M, Nikoskelainen J, Engblom E et al. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. 2000;160(18):2781–7. DOI: 10.1001%2Farchinte.160.18.2781.</p></div><br />


Для цитирования:


Vinogradov O.I., Kuznetsov A.N., Rybalko N.V. Современные подходы к антитромботической терапии у больных с кардиоэмболическим инсультом. Неврология, нейропсихиатрия, психосоматика. 2013;5(2S):28-39. https://doi.org/10.14412/2074-2711-2013-2356

For citation:


Vinogradov O.I., Kuznetsov A.N., Rybalko N.V. Current approaches to antithrombotic therapy in patients with cardioembolic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(2S):28-39. (In Russ.) https://doi.org/10.14412/2074-2711-2013-2356

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)