zdorПроблемы здоровья и экологииHealth and Ecology Issues2220-09672708-6011Gomel State Medical University10.51523/2708-6011.2013-10-1-4zdor-1333Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESАДЕКВАТНАЯ АНТИТРОМБОТИЧЕСКАЯ ТЕРАПИЯ В АСПЕКТЕ СНИЖЕНИЯ СМЕРТНОСТИ ПО РЕЗУЛЬТАТАМ МЕЖДУНАРОДНЫХ КЛИНИЧЕСКИХ ИССЛЕДОВАНИЙ (обзор литературы)ADEQUATE ANTITHROMBOTIC THERAPY: REDUCTION OF MORTALITY BY THE RESULTS OF INTERNATIONAL CLINICAL TRIALS (literature review)СаливончикД. П.SalivonchykD. P.noemail@neicon.ruГомельский государственный медицинский университетGomel State Medical University201328032013012229Copyright © Саливончик Д.П., 20132013Саливончик Д.П.Salivonchyk D.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.gsmu.by/jour/article/view/1333

В статье рассматривается адекватная антитромботическая терапия при острых коронарных синдромах, позволяющая на основании доказательной медицины значительно снизить смертность пациентов. На современном этапе использование клопидогрела требует наиболее раннего его применения - при первом контакте врача с пациентом с учетом предстоящего чрескожного коронарного вмешательства.

The article considers adequate antithrombotic therapy in acute coronary syndromes, which on the basis of evidence-based medicine makes it possible to significantly reduce mortality in patients. At the present stage, the application of clopidogrel requires its earliest prescription to the patients during their first visit to the doctor with the account of forthcoming percutaneous coronary surgery.

антитромботическая терапияклопидогрел (Зилт)снижение смертностиantithrombotic therapyclopidogrel (Zilt)reduction in mortalityReferencesБезопасность препарата Зилт в реальной клинической практике / В. Н. Гонтаренко // Болезни сердца и сосудов. - 2001. - № 1. - С. 41-44.Безопасность препарата Зилт в реальной клинической практике / В. Н. Гонтаренко // Болезни сердца и сосудов. - 2001. - № 1. - С. 41-44.Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction / Circulation. - 2008. - Vol. 117. - P. 296-329.Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction / Circulation. - 2008. - Vol. 117. - P. 296-329.Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with STsegment elevation / M. S. Sabatine [et al.] // N. Engl. J. Med. - 2005. - Vol. 352. - P. 1179-1189.Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with STsegment elevation / M. S. Sabatine [et al.] // N. Engl. J. Med. - 2005. - Vol. 352. - P. 1179-1189.Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomized placebocontrolled trial / Z. M. Chen [et al.] // Lancet. - 2005. - Vol. 366. - P. 1607-1621.Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomized placebocontrolled trial / Z. M. Chen [et al.] // Lancet. - 2005. - Vol. 366. - P. 1607-1621.Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidenced-Based Clinical Practice Guidelines (8th Edition) / Chest. - 2008. - Vol. 133. - P. 67-887.Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidenced-Based Clinical Practice Guidelines (8th Edition) / Chest. - 2008. - Vol. 133. - P. 67-887.Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients / B. M. J. - 2002. - Vol. 324. - P. 71-86.Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients / B. M. J. - 2002. - Vol. 324. - P. 71-86.Aspirin, heparin, and fibrinolytic therapy in suspected acute myocardial infarction / R. Collins [et al.] // N. Engl. J. Med. - 1997. - Vol. 336. - P. 847-860.Aspirin, heparin, and fibrinolytic therapy in suspected acute myocardial infarction / R. Collins [et al.] // N. Engl. J. Med. - 1997. - Vol. 336. - P. 847-860.CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) // Lancet. - 1996. - Vol. 348. - P. 1329-1339.CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) // Lancet. - 1996. - Vol. 348. - P. 1329-1339.Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomized trials / R. Collins // B.M.J. - 1996. - Vol. 313. - P. 652-659.Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomized trials / R. Collins // B.M.J. - 1996. - Vol. 313. - P. 652-659.Clinical Equivalence of Generic and Brand-Name Drugs Used in Cardiovascular Disease: A Systematic Review and Meta-analysis / A. S. Kes-selheim [et al.] / J.A.M.A. - 2008. - Vol. 21. - P. 2514-2526.Clinical Equivalence of Generic and Brand-Name Drugs Used in Cardiovascular Disease: A Systematic Review and Meta-analysis / A. S. Kes-selheim [et al.] / J.A.M.A. - 2008. - Vol. 21. - P. 2514-2526.Clopidogrel used in combination with aspirin compared with aspirin alone in the treatment of non-ST-segment-elevation acute coronary syndromes: a systematic review and economic evaluation / C. Main [et al.] // Health Technol. Assess. - 2004. - Vol. 8. - P. 40.Clopidogrel used in combination with aspirin compared with aspirin alone in the treatment of non-ST-segment-elevation acute coronary syndromes: a systematic review and economic evaluation / C. Main [et al.] // Health Technol. Assess. - 2004. - Vol. 8. - P. 40.Effects of aspirin on coronary reocclusion and recurrent ischemia after thrombolysis: a meta-analysis / S. Roux [et al.] // J. Am. Coll. Cardiol. - 1992. - Vol. 19. - P. 671-677.Effects of aspirin on coronary reocclusion and recurrent ischemia after thrombolysis: a meta-analysis / S. Roux [et al.] // J. Am. Coll. Cardiol. - 1992. - Vol. 19. - P. 671-677.Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-segment elevation acute coronary syndromes: a systematic overview / J. L. Petersen [et al] // J.A.M.A. - 2004. - Vol. 292. - P. 89-96.Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-segment elevation acute coronary syndromes: a systematic overview / J. L. Petersen [et al] // J.A.M.A. - 2004. - Vol. 292. - P. 89-96.Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum: a meta-analysis / S. A. Murphy [et al.] // Eur. Heart J. - 2007. - Vol. 28. - P. 2077-2086.Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum: a meta-analysis / S. A. Murphy [et al.] // Eur. Heart J. - 2007. - Vol. 28. - P. 2077-2086.ESC Guidelines for the diagnosis and treatment of acute non-ST-segment elevation acute coronary syndrome 2008 / Eur. Heart J. - 2007. - Vol. 28. - P. 1598-1660.ESC Guidelines for the diagnosis and treatment of acute non-ST-segment elevation acute coronary syndrome 2008 / Eur. Heart J. - 2007. - Vol. 28. - P. 1598-1660.ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation / C. W. Hamm [et al.] // European Heart Journal. - 2011. - Vol. 10. - P. 1093.ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation / C. W. Hamm [et al.] // European Heart Journal. - 2011. - Vol. 10. - P. 1093.ESC Guidelines on cardiovascular disease prevention in clinical practice: executive summary / Eur. Heart J. - 2007. - Vol. 28. - P. 2375-2414.ESC Guidelines on cardiovascular disease prevention in clinical practice: executive summary / Eur. Heart J. - 2007. - Vol. 28. - P. 2375-2414.For the ACUITY Investigators. Bivalirudin for patients with acute coronary syndromes / G. W. Stone [et al.] // N. Engl. J. Med. - 2006. - Vol. 355. - P. 2203-2216.For the ACUITY Investigators. Bivalirudin for patients with acute coronary syndromes / G. W. Stone [et al.] // N. Engl. J. Med. - 2006. - Vol. 355. - P. 2203-2216.For the Clopidogrel in Unstable Angina to Prevent Recurrent Events Ttrial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: The PCI-CURE study / S. R. Mehta [et al.] // Lancet. - 2001. - Vol. 358. - P. 527-533.For the Clopidogrel in Unstable Angina to Prevent Recurrent Events Ttrial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: The PCI-CURE study / S. R. Mehta [et al.] // Lancet. - 2001. - Vol. 358. - P. 527-533.For the ExTRACT-TIMI 25 Investigators. Enoxaparin versus Unfractionated Heparin with Fibrinolysis for ST-Elevation Myocardial Infarction / E. M. Antman [et al.] // N. Engl. J. Med. - 2006. - Vol. 354. - P. 1477-1488.For the ExTRACT-TIMI 25 Investigators. Enoxaparin versus Unfractionated Heparin with Fibrinolysis for ST-Elevation Myocardial Infarction / E. M. Antman [et al.] // N. Engl. J. Med. - 2006. - Vol. 354. - P. 1477-1488.For the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 2 (ISAR-REACT 2) Trial Investigators. Abciximab in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention After Clopidogrel Pretreatment. The ISAR-REACT 2 Randomized Trial / A. Kastrati [et al.] // J.A.M.A. - 2006. - Vol. 295. - P. 1531-1538.For the Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 2 (ISAR-REACT 2) Trial Investigators. Abciximab in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention After Clopidogrel Pretreatment. The ISAR-REACT 2 Randomized Trial / A. Kastrati [et al.] // J.A.M.A. - 2006. - Vol. 295. - P. 1531-1538.For the TRITON-TIMI 38 Investigators. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes / S. D. Wiviott [et al] // New Engl. J. Med. - 2007. - Vol. 357. - P. 2001-2015.For the TRITON-TIMI 38 Investigators. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes / S. D. Wiviott [et al] // New Engl. J. Med. - 2007. - Vol. 357. - P. 2001-2015.Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group / Lancet. - 1994. - Vol. 343. - P. 311-322.Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group / Lancet. - 1994. - Vol. 343. - P. 311-322.ISIS-2 Collaborative group (1988). «Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2» / Lancet - 1988. - Vol. 8607. - P. 349-360.ISIS-2 Collaborative group (1988). «Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2» / Lancet - 1988. - Vol. 8607. - P. 349-360.The GUSTO Investigators. An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction / N. Engl. J. Med. - 1993. - Vol. 329. - P. 673-682.The GUSTO Investigators. An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction / N. Engl. J. Med. - 1993. - Vol. 329. - P. 673-682.The OASIS-6 Trial Group. Effects of Fondaparinux on Mortality and Reinfarction in Patients With Acute ST-Segment Elevation Myocardial Infarction. The OASIS-6 Randomized Trial // J.A.M.A. - 2006. - Vol. 295. - P. 1519-1530.The OASIS-6 Trial Group. Effects of Fondaparinux on Mortality and Reinfarction in Patients With Acute ST-Segment Elevation Myocardial Infarction. The OASIS-6 Randomized Trial // J.A.M.A. - 2006. - Vol. 295. - P. 1519-1530.The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Guidelines for percutaneous coronary interventions / Eur. Heart J. - 2005. - Vol. 26. - P. 804-847.The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Guidelines for percutaneous coronary interventions / Eur. Heart J. - 2005. - Vol. 26. - P. 804-847.Thrombolysis and Adjunctive Therapy in Acute Myocardial Infarction / V. Menon [et al.] // Chest. - 2004. - Vol. 126. - P. 549-575.Thrombolysis and Adjunctive Therapy in Acute Myocardial Infarction / V. Menon [et al.] // Chest. - 2004. - Vol. 126. - P. 549-575.Ticagrelor versus clopidogrel in patients with acute coronary syndromes / L. Wallentin [et al.] // N. Engl. J. Med. - 2009. - Vol. 361(11). - P. 1045-1057.Ticagrelor versus clopidogrel in patients with acute coronary syndromes / L. Wallentin [et al.] // N. Engl. J. Med. - 2009. - Vol. 361(11). - P. 1045-1057.

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