cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2020.4.n1042cardio-1042Research ArticleОБЗОРЫREVIEWSВыбор антитромботической терапии у больных ишемической болезнью сердца и сахарным диабетом 2-го типаChoosing Antithrombotic Therapy in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus: How to Reduce the Risk of Deathhttps://orcid.org/0000-0001-7003-5186КозиоловаН. А.KoziolovaN. A.

Doctor of medical sciences, Professor, Head of the Department of Propaedeutics of internal diseases № 2, State funded educational institution of the highest  education “E.A. Wagner Perm State Medical University” Public Health Ministry of Russian Federation, Perm, Russia

nakoziolova@mail.ruhttps://orcid.org/0000-0003-1103-3812КараваевП. Г.KaravaevP. G.

Assistant of the Department of Propaedeutics of internal diseases № 2, State funded educational institution of the highest  education “E.A. Wagner Perm State Medical University” Public Health Ministry of Russian Federation, Perm, Russia

pakarawaew@mail.ruhttps://orcid.org/0000-0002-8769-7335ВекличА. С.VeklichA. S.andrei_veklich@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Пермский государственный медицинский университет имени академика Е.А. Вагнера» Министерства здравоохранения Российской Федерации, Пермь, РоссияРоссияState funded educational institution of the highest education “E.A. Wagner Perm State Medical University” Public Health Ministry of Russian Federation, Perm, RussiaRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Пермский государственный медицинский университет имени академика Е.А. Вагнера» МинистерстваРоссияState funded educational institution of the highest education “E.A. Wagner Perm State Medical University” Public Health Ministry of Russian Federation, Perm, RussiaRussian Federation202018032020604109119Copyright © Kardiomag, 20202020KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1042

В обзоре представлены распространенность сахарного диабета (СД) 2-го типа у больных ишемической болезнью сердца (ИБС), общность факторов риска возникновения, значительное ухудшение прогноза при их сочетании. Показаны патофизиологические механизмы дисфункции тромбоцитов и негативное изменение системы коагуляции у больных ИБС при наличии СД 2-го типа, что предопределяет активацию протромботического пути формирования гемостаза. Трудности оптимального выбора антитромботической терапии продемонстрированы как у больных СД 2-го типа без сердечно-сосудистых заболеваний в анамнезе, так и у больных ИБС в сочетании с СД 2-го типа. В обзоре обращается внимание на то, что данные рандомизированных клинических исследований (РКИ), выполненных у больных СД 2-го типа и острым коронарным синдромом или после коронарной реваскуляризации, нельзя экстраполировать на всю популяцию пациентов со стабильной ИБС. В настоящее время предпочтительным выбором антитромботической терапии у больных СД 2-го типа и стабильной ИБС является комбинация ривароксабана 2,5 мг 2 раза в сутки с ацетилсалициловой кислотой 100 мг / сут, обладающая максимальной клинической выгодой, по сравнению с другими стратегиями, представленными в РКИ.

This review presents prevalence of type 2 diabetes mellitus (DM) in patients with ischemic heart disease (IHD), risk factors in common, and a considerable worsening of prognosis in their combination. The authors addressed pathophysiological mechanisms of platelet dysfunction and negative changes in the coagulation system in IHD patients with type 2 DM, which predetermine activation of the prothrombotic pathway of hemostasis formation. Difficulties in optimal selection of antithrombotic therapy were demonstrated for both patients with type 2 DM without a history of cardiovascular diseases and IHD patients with type 2 DM. The authors paid attention to the fact that results of randomized clinical studies (RCS) that included patients with type 2 DM and acute coronary syndrome or after coronary revascularization cannot be extrapolated to the entire population of patients with stable IHD. At present, the preferable choice of antithrombotic therapy for patients with type 2 DM and stable IHD is a combination of rivaroxaban 2.5 mg twice a day and acetylsalicylic acid 100 mg/day. This combination provides a maximal clinical benefit compared to other strategies presented in RCS.

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