geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-2-2020-138-146geriatr-34Research ArticleОБЗОРЫREVIEWSПрофилактика инсульта у пожилых пациентов с фибрилляцией предсердий: возможности апиксабанаPrevention of stroke in elderly patients with a trial fibrillation: possibilities of Apixabanhttps://orcid.org/0000-0002-6021-7864ВоробьеваН. М.VorobyevaN. M.

Воробьeва Наталья Михайловна, д-р мед. наук, заведующая лабораторией сердечно-сосудистого старения

телефон: +7(915) 192-22-78

Москва

MD, PhD, Head of Laboratory of Cardiovascular Aging

+7(915) 192-22-78

Moscow

natalyavorobjeva@mail.ruhttps://orcid.org/0000-0002-4193-688XТкачеваО. Н.TkachevaO. N.

Ткачева Ольга Николаевна, д-р мед. наук, профессор, директор

телефон: +7(499) 187-64-67

Москва

MD, PhD, professor, Director

+7(499) 187-64-67

Moscow

tkacheva@rgnkc.ruФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России, Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Russian Clinical and Research Center of GerontologyRussian Federation20202505202002138146Copyright © Воробьева Н.М., Ткачева О.Н., 20202020Воробьева Н.М., Ткачева О.Н.Vorobyeva N.M., Tkacheva O.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/34

В обзорной статье обсуждаются возможности применения одного из пероральных антикоагулянтов прямого действия – апиксабана – для профилактики инсульта и/или системных эмболий у пожилых пациентов с неклапанной фибрилляцией предсердий. Рассмотрены результаты рандомизированных клинических исследований с участием апиксабана – ARISTOTLE и AVERROES, включая анализ подгрупп у пациентов в возрасте ≥75 лет и ≥80 лет – в ARISTOTLE, ≥75 лет и ≥85 лет – в AVERROES. Исследования показали, что пациенты пожилого возраста получают больше преимуществ от назначения апиксабана, нежели варфарина (в ARISTOTLE) или ацетилсалициловой кислоты (в AVERROES). Также рассмотрены результаты двух ретроспективных наблюдательных исследований, подтверждающие благоприятный профиль эффективности и безопасности апиксабана у пожилых пациентов с фибрилляцией предсердий в реальной клинической практике, и основные положения консенсусного документа FORTA, целью которого является индивидуализация лечения пожилых пациентов на основании клинических характеристик больного.

In review article, we discuss the opportunity of use of one of the direct oral anticoagulants – apixaban – for prevention of stroke and/or systemic embolism in elderly patients with non-valvular a trial fibrillation. We consider results of randomized clinical trials of apixaban – ARISTOTLE and AVERROES, including the subgroups analysis in patients in the age of ≥75 years and ≥80 years – in ARISTOTLE, ≥75 years and ≥85 years – in AVERROES. These studies have shown that elderly patients had more benefit from apixaban administration than warfarin (in ARISTOTLE) or acetylsalicylic acid (in AVERROES). The results of two retrospective observational studies confirming the favorable profile of apixaban effectiveness and safety in elderly patients with a trial fibrillation in real clinical practice, and the main provisions of the consensus document FORTA, the purpose of which is to individualize treatment of elderly patients based on clinical characteristics of the patient, are also considered.

фибрилляция предсердийпожилой пациентантикоагулянтыапиксабанварфаринa trial fibrillationelderly patientanticoagulantsapixabanwarfarinReferencesSchnabel R.B., Yin X., Gona P., Larson M.G., Beiser A.S., McManus D.D. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 386: 154–162. DOI: 10.1016/S0140-6736(14)61774-8.Schnabel R.B., Yin X., Gona P., Larson M.G., Beiser A.S., McManus D.D. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 386: 154–162. DOI: 10.1016/S0140-6736(14)61774-8.Go A.S., Hylek E.M., Phillips K.A., Chang Y., Henault L. E., Selby J.V. et al. Prevalence of diagnosed a trial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285: 2370–2375. DOI: 10.1001/jama.285.18.2370.Go A.S., Hylek E.M., Phillips K.A., Chang Y., Henault L. E., Selby J.V. et al. Prevalence of diagnosed a trial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285: 2370–2375. DOI: 10.1001/jama.285.18.2370.Lloyd-Jones D.M., Wang T.J., Leip E.P., Larson M. G., Levy D., Vasan R. S. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004; 110: 1042–1046. DOI: 10.1161/01.CIR.0000140263.20897.42.Lloyd-Jones D.M., Wang T.J., Leip E.P., Larson M. G., Levy D., Vasan R. S. et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004; 110: 1042–1046. DOI: 10.1161/01.CIR.0000140263.20897.42.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: 1139–1151. DOI: 10.1056/NEJMoa0905561.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: 1139–1151. DOI: 10.1056/NEJMoa0905561.Patel M.R., Mahaffey K.W., Garg J., Pan G., Singer D.E., Hacke W. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365: 883–891. DOI: 10.1056/NEJMoa1009638.Patel M.R., Mahaffey K.W., Garg J., Pan G., Singer D.E., Hacke W. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365: 883–891. DOI: 10.1056/NEJMoa1009638.Granger C.B., Alexander J.H., McMurray J.J., Lopes R.D., Hylek E.M., Hanna M. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365: 981–992. DOI: 10.1056/NEJMoa1107039.Granger C.B., Alexander J.H., McMurray J.J., Lopes R.D., Hylek E.M., Hanna M. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011; 365: 981–992. DOI: 10.1056/NEJMoa1107039.Turagam M.K., Velagapudi P., Flaker G.C. Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants. Clin Interv Aging. 2015; 10: 1431–1444. DOI: 10.2147/CIA.S80641.Turagam M.K., Velagapudi P., Flaker G.C. Stroke prevention in the elderly atrial fibrillation patient with comorbid conditions: focus on non-vitamin K antagonist oral anticoagulants. Clin Interv Aging. 2015; 10: 1431–1444. DOI: 10.2147/CIA.S80641.Halvorsen S., Atar D., Yang H., De Caterina R., Erol C., Garcia D. et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 2014; 35: 1864–1872. DOI: 10.1093/eurheartj/ehu046.Halvorsen S., Atar D., Yang H., De Caterina R., Erol C., Garcia D. et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: observations from the ARISTOTLE trial. Eur Heart J. 2014; 35: 1864–1872. DOI: 10.1093/eurheartj/ehu046.Rao M.P., Vinereanu D., Wojdyla D.M., Alexander J.H., Atar D., Hylek E.M. et al. Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation: Insights From the ARISTOTLE Trial. Am J Med. 2018; 131: 269–275.e2. DOI: 10.1016/j.amjmed.2017.10.036.Rao M.P., Vinereanu D., Wojdyla D.M., Alexander J.H., Atar D., Hylek E.M. et al. Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation: Insights From the ARISTOTLE Trial. Am J Med. 2018; 131: 269–275.e2. DOI: 10.1016/j.amjmed.2017.10.036.Connolly S.J., Eikelboom J., Joyner C., Diener H.C., Hart R., Golitsyn S. et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011; 364: 806– 817. DOI: 10.1016/j.jcin.2016.10.023.Connolly S.J., Eikelboom J., Joyner C., Diener H.C., Hart R., Golitsyn S. et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011; 364: 806– 817. DOI: 10.1016/j.jcin.2016.10.023.Ng K.H., Shestakovska O., Connolly S.J., Eikelboom J.W., Avezum A., Diaz R. et al. Efficacy and safety of apixaban compared with aspirin in the elderly: a subgroup analysis from the AVERROES trial. Age Ageing. 2016; 45: 77–83. DOI: 10.1093/ageing/afv156.Ng K.H., Shestakovska O., Connolly S.J., Eikelboom J.W., Avezum A., Diaz R. et al. Efficacy and safety of apixaban compared with aspirin in the elderly: a subgroup analysis from the AVERROES trial. Age Ageing. 2016; 45: 77–83. DOI: 10.1093/ageing/afv156.Deitelzweig S., Luo X., Gupta K., Trocio J., Mardekian J., Curtice T. et al. Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients.Curr Med Res Opin. 2017; 33: 1745–1754. DOI: 10.1080/03007995.2017.1334638.Deitelzweig S., Luo X., Gupta K., Trocio J., Mardekian J., Curtice T. et al. Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients.Curr Med Res Opin. 2017; 33: 1745–1754. DOI: 10.1080/03007995.2017.1334638.Li X., Deitelzweig S., Keshishian A., Hamilton M., Horblyuk R., Gupta K. et al. Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in «real-world» clinical practice. A propensity-matched analysis of 76,940 patients. Thromb Haemost. 2017; 117: 1072–1082. DOI: 10.1160/TH17-01-0068.Li X., Deitelzweig S., Keshishian A., Hamilton M., Horblyuk R., Gupta K. et al. Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in «real-world» clinical practice. A propensity-matched analysis of 76,940 patients. Thromb Haemost. 2017; 117: 1072–1082. DOI: 10.1160/TH17-01-0068.Diener H.-C., Aisenberg J., Ansell J., Atar D., Breithardt G., Eikelboom J. et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2. Eur Heart J. 2017; 38: 860–868. DOI: 10.1093/eurheartj/ehw069.Diener H.-C., Aisenberg J., Ansell J., Atar D., Breithardt G., Eikelboom J. et al. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2. Eur Heart J. 2017; 38: 860–868. DOI: 10.1093/eurheartj/ehw069.Wehling M. Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged (FORTA) [in German]. Dtsch Med Wochenschr. 2008; 133: 2289–2291. DOI: 10.1055/s-0028-1091275.Wehling M. Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged (FORTA) [in German]. Dtsch Med Wochenschr. 2008; 133: 2289–2291. DOI: 10.1055/s-0028-1091275.Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc. 2009; 57: 560–561. DOI: 10.1111/j.1532-5415.2009.02131.x.Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc. 2009; 57: 560–561. DOI: 10.1111/j.1532-5415.2009.02131.x.Kuhn-Thiel A.M., Weis C., Wehling M. FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014; 31: 131–140. DOI: 10.1007/s40266-013-0146-0.Kuhn-Thiel A.M., Weis C., Wehling M. FORTA authors/expert panel members. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014; 31: 131–140. DOI: 10.1007/s40266-013-0146-0.Wehling M., Collins R., Gil V.M., Hanon O., Hardt R., Hoffmeister M. et al. Appropriateness of oral anticoagulants for the long-term treatment of atrial fibrillation in older people. Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016). Drugs Aging. 2017; 34: 499–507. DOI: 10.1007/s40266-017-0466-6.Wehling M., Collins R., Gil V.M., Hanon O., Hardt R., Hoffmeister M. et al. Appropriateness of oral anticoagulants for the long-term treatment of atrial fibrillation in older people. Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016). Drugs Aging. 2017; 34: 499–507. DOI: 10.1007/s40266-017-0466-6.

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