The place of dabigatran in the treatment of patients with atrial fibrillation in the light of modern recommendations

Author:

Kropacheva E. S.1ORCID,Panchenko E. P.1ORCID

Affiliation:

1. National Medical Research Centre of Cardiology named after Academician E.I. Chazov

Abstract

This review is devoted to the aspects of anticoagulant therapy in patients with atrial fibrillation in the light of the modern understanding of this type of arrhythmia as a polymorbid continuously developing syndrome. According to experts, the management strategy of this category of patients is based on an integrated assessment, including the risk of stroke, the presence of symptoms, assessment of structural heart disease and mandatory accounting of concomitant pathology. In this approach, the appointment of anticoagulant therapy as a prevention of stroke in a patient with atrial fibrillation is put in the first place. At the same time, experts emphasize the need for a dynamic reassessment of risks, as well as the use of a multidisciplinary team of specialists to make a complex decision. The review summarizes the basic concepts of the integrated approach, describes various variants of clinical scenarios, including aspects of anticoagulant maintenance of cardioversion and catheter ablation, multicomponent therapy after percutaneous coronary intervention. A separate chapter is devoted to modern algorithms of perioperative management of a patient receiving oral anticoagulants, which is based on the stratification of interventions according to the risk of perioperative bleeding and the characteristics of the anticoagulant prescribed to the patient. The place of dabigatran in the primary and secondary prevention of stroke and systemic embolism in patients with atrial fibrillation is described, studies that served as the basis of the evidence base for the use of dabigatran in patients with atrial fibrillation are presented. The data of register observations, meta-analyses devoted to the evaluation of the efficacy and safety of dabigatran in certain categories of patients (elderly patients, patients with chronic heart failure, diabetes mellitus) are presented, which form the basis of decision-making in real clinical practice.

Publisher

Remedium, Ltd.

Subject

General Medicine

Reference26 articles.

1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612.

2. Lip G.Y.H. The ABC pathway: an integrated approach to improve AF management. Nat Rev Cardiol. 2017;14(11):627–628. https://doi.org/10.1038/nrcardio.2017.153.

3. Yoon M., Yang P.S., Jang E., Yu H.T., Kim T.H., Uhm J.S. et al. Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management: A Nationwide Cohort Study. Thromb Haemost. 2019;119(10):1695–1703. https://doi.org/10.1055/s-0039-1693516.

4. Connolly S.J., Ezekowitz M.D., Yusuf S., Eikelboom J., Oldgren J., Parekh A. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–1151. https://doi.org/10.1056/NEJMoa0905561.

5. Connolly S.J., Wallentin L., Ezekowitz M.D., Eikelboom J., Oldgren J., Reilly P.A. et al. The Long-Term Multicenter Observational Study of Dabigatran Treatment in Patients With Atrial Fibrillation (RELY-ABLE) Study. Circulation. 2013;128(3):237–243. https://doi.org/10.1161/CIRCULATIONAHA.112.001139.

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3