cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2020.9.n1178cardio-1178Research ArticleОБЗОРЫREVIEWSСравнительная эффективность и безопасность прямых пероральных антикоагулянтов у пациентов с неклапанной фибрилляцией предсердий и сниженной функцией почекComparative efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney diseasehttps://orcid.org/0000-0002-6565-2566ГорбатенкоВ. С.GorbatenkoV. S.

к.м.н., доцент каф. клинической фармакологии и интенсивной терапии ФГБОУ ВО ВолгГМУ Минздрава России, 400131, г. Волгоград,

Ph.D., docent department of clinical pharmacology and intensive care

vlad30.03@mail.ruhttps://orcid.org/0000-0002-7957-3770ГерасименкоА. С.GerasimenkoA. S.

аспирант каф. клинической фармакологии и интенсивной терапии

postgraduate student department of clinical pharmacology and intensive care

16any_61@mail.ruhttps://orcid.org/0000-0002-7311-4549ШаталоваО. В.ShatalovaO. V.

д.м.н., профессор кафедры клинической фармакологии и интенсивной терапии

Ph.D., professor department of clinical pharmacology and intensive care

shov_med@mail.ruФГБОУ ВО ВолгГМУ Минздрава РФ, Волгоград, РоссияРоссияVolgograd State Medical University, RussiaRussian Federation202014102020609102109Copyright © Kardiomag, 20202020KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1178

Цель Оценить сравнительную эффективность и безопасность прямых пероральных антикоагулянтов (ПОАК) при профилактике инсульта у пациентов с неклапанной фибрилляцией предсердий и сниженным клиренсом креатинина.Материал и методы Провели систематический поиск литературы и непрямое сравнение ПОАК.Результаты Для выполнения непрямого сравнения было включено пять рандомизированных клинических исследований. По эффективности профилактики инсульта и системных эмболий препараты были сопоставимы. В профиле безопасности были выявлены отличия. Апиксабан достоверно снижал относительный риск крупных кровотечений по сравнению с ривароксабаном на 27 % (относительный риск (ОР) 0,73; 95 % доверительный интервал (ДИ): 0,55–0,98). В группе пациентов с клиренсом креатинина <50 мл / мин преимущества апиксабана увеличивались: снижение относительного риска на 48 % по сравнению с ривароксабаном (ОР=0,52; 95 % ДИ: 0,32–0,84), на 50 % по сравнению с дабигатраном 300 мг / сутки (ОР=0,50; 95 % ДИ: 0,31–0,81) и на 48 % по сравнению с дабигатраном 220 мг / сутки (ОР=0,52; 95 % ДИ: 0,32–0,85)Заключение По результатам непрямого сравнения ПОАК обладают сопоставимой эффективностью, наиболее предпочтительным в отношении безопасности у пациентов с фибрилляцией предсердий и клиренсом креатинина менее 50 мл / мин является апиксабан.

Aim To compare efficacy and safety of direct oral anticoagulants (DOACs) for prevention of stroke in patients with nonvalvular atrial fibrillation and reduced creatinine clearance.Material and methods Systematic search for literature and indirect comparison of DOACs were performed.Results The indirect comparison included five randomized clinical trials. The DOACs were comparable by the efficacy of preventing stroke and systemic embolism. The safety profiles had differences. Apixaban significantly decreased the relative risk of major bleeding compared to rivaroxaban by 27 % (relative risk (RR) 0.73; 95 % confidence interval (CI): 0.55–0.98). The apixaban advantage was even greater in the group of patients with a creatinine clearance <50 ml/min: RR was reduced by 48 % compared to rivaroxaban (RR=0.52; 95 % CI: 0.32–0.84), by 50 % compared to dabigatran 300 mg/day (RR=0.50; 95 % CI: 0.31–0.81), and by 48 % compared to dabigatran 220 mg/day (RR=0.52; 95 % CI: 0.32–0.85)Conclusion The indirect comparison of DOACs showed that their efficacy was comparable. With respect of safety, apixaban is the preferrable DOAC for patients with atrial fibrillation and creatinine clearance below 50 ml/min.

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