clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2020-98-7-491-497clinmed-94Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПрофилактика и лечение кровотечений, ассоциированных с приемом прямых оральных антикоагулянтовThe prevention and treatment of bleeding associated with direct oral anticoagulantsНосковЯ. А.NoskovYa. A.

Носков Ярослав Алексеевич — кандидат медицинских наук, старший ординатор гематологического отделения клиники кафедры факультетской терапии

194044, Санкт-Петербург

Yaroslav A. Noskov — MD, PhD, senior resident of the Hematology Department of the Clinic of the Department of Faculty Therapy

194044, St. Petersburg

dady-08@mail.ruПоляковА. С.PolyakovA. S.

194044, St. Petersburg

БратиловаЕ. С.BratilovaE. S.

194044, St. Petersburg

ТыренкоВ. В.TyrenkoV. V.

194044, St. Petersburg

ФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны РоссииРоссияMilitary Medical Academy named after S.M. Kirov of the Russian Defense MinistryRussian Federation202031122020967491497Copyright © Носков Я.А., Поляков А.С., Братилова Е.С., Тыренко В.В., 20202020Носков Я.А., Поляков А.С., Братилова Е.С., Тыренко В.В.Noskov Y.A., Polyakov A.S., Bratilova E.S., Tyrenko V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/94

Прямые оральные антикоагулянты (ПОАК), которые включают в себя ингибитор тромбина (дабигатран) и ингибиторы активированного фактора Х свертывания крови (ривароксабан, апиксабан, эдоксабан, бетриксабан), получили широкое распространение во всем мире для профилактики и лечения венозных тромбозов. Популярность ПОАК объясняется удобной и предсказуемой фармакодинамикой, отсутствием необходимости в регулярном мониторинге терапевтического эффекта, а также менее выраженным влиянием пищи и препаратов на их биодоступность. Однако, как и для любых других антикоагулянтов, для ПОАК характерен повышенный риск кровотечений, в особенности желудочно-кишечных. Корректный подход к назначению ПОАК и профилактике кровотечений на фоне лечения антикоагулянтами способен существенно снизить вероятность развития жизнеугрожающих осложнений. В случае развития кровотечения показано применение специфических и неспецифических антидотов ПОАК. Значимое кровотечение требует знания лечащим врачом четкого порядка действий в соответствии с опубликованными алгоритмами для спасения жизни пациента.

Direct оral Anticoagulants (DOACs) include direct thrombin inhibitor (dabigatran) and factor X inhibitors (rivaroxaban, apixaban, edoxaban, betrixaban). The) are widely used worldwide for the prevention and treatment of venous thrombosis. The popularity of DOACs is explained by convenient and predictable pharmacodynamics, the lack of need for regular monitoring of the therapeutic effect, as well as more predictable food-drug interaction and bioavailability. However, like any other anticoagulants, DOACs are characterized by an increased risk of bleeding, especially gastrointestinal one. The correct approach to the prescription of DOACs and prevention of bleeding during treatment including the intake of anticoagulants can significantly reduce the probability of life-threatening complications. In the case of bleeding, the use of specific and nonspecific DOACs antidotes is indicated. Significant bleeding requires the attending physician to know a clear course of action in accordance with published algorithms to save the patient’s life.

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