kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2016-1-86-94kpccz-181Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОРANALYTICAL REVIEWМЕДИКАМЕНТОЗНОЕ СОПРОВОЖДЕНИЕ ЧРЕСКОЖНЫХ КОРОНАРНЫХ ВМЕШАТЕЛЬСТВ С ИСПОЛЬЗОВАНИЕМ БИВАЛИРУДИНА: ОБЗОР СОВРЕМЕННЫХ РЕКОМЕНДАЦИЙBIVALIRUDIN FOR PERCUTANEOUS CORONARY INTERVENTIONS: REVIEW OF CURRENT GUIDELINESТАРАСОВР. С.TARASOVR. S.

650002, г. Кемерово, Сосновый бульвар, д. 6 Тел. 8 (3842) 64-18-06

6, Sosnoviy blvd., Kemerovo, 650002, Russian Federation Tel. 8 (3842) 64-18-06

tarars@kemcardio.ruГАНЮКОВВ. И.GANYUKOVV. I.Федеральное государственное бюджетное научное учреждение «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний», Кемерово, РоссияРоссияFederal State Budgetary Scientific Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, RussiaRussian Federation201608052016018694Copyright © ТАРАСОВ Р.С., ГАНЮКОВ В.И., 20162016ТАРАСОВ Р.С., ГАНЮКОВ В.И.TARASOV R.S., GANYUKOV V.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/181Цель

Цель. Обзор современных международных рекомендаций для анализа доказательной базы применения бивалирудина в качестве медикаментозного сопровождения чрескожных коронарных вмешательств (ЧКВ) у пациентов с различными формами ИБС.

Материалы и методы

Материалы и методы. На основании обзора рекомендаций Европейского общества кардиологов по реваскуляризации миокарда от 2014 г., Американского кардиологического колледжа по лечению пациентов с инфарктом миокарда с элевацией сегмента ST (ИМпST) от 2013 г., Европейского общества кардиологов по реваскуляризации миокарда у пациентов с острым коронарным синдромом без подъема сегмента ST (ОКСбпST) от 2015 г. выполнен анализ доказательной базы применения бивалирудина в качестве медикаментозного сопровождения ЧКВ у пациентов с различными формами ИБС.

Результаты

Результаты. Существующая доказательная база антикоагулянтного сопровождения ЧКВ у пациентов с различными формами ИБС подразумевает выбор безопасного и эффективного препарата в соответствии с профилями ишемического и геморрагического риска. Прямой ингибитор тромбина бивалирудин обладает коротким периодом полувыведения, предсказуемым антикоагулянтным профилем и имеет показания к применению для обеспечения ЧКВ при любой форме ИБС (стабильной, ОКСбпST и ОКСпST), основанные на большом количестве рандомизированных клинических исследований.

Заключение

Заключение. Не вызывает сомнений польза и эффективность бивалирудина у пациентов со стабильной ИБС и гепарининдуцированной тромбоцитопенией (ГИТ), также целесообразно его использование в когорте пациентов с высоким риском геморрагических осложнений. При ОКСбпST применение бивалирудина в качестве антикоагулянтного сопровождения ЧКВ имеет наивысший класс рекомендаций и уровень доказательной базы 1А. Класс и уровень доказательности для применения бивалирудина в качестве сопровождения первичного ЧКВ у пациентов с ОКСпST к 2014 г. уменьшился до класса IIa, уровня А и уступает НФГ, имеющему I класс рекомендаций, тем не менее повышение риска острого тромбоза стента, ассоциированное с назначением бивалирудина в данной группе пациентов, не приводит к возрастанию риска смерти по сравнению с НФГ. Действующие Европейские рекомендации по лечению пациентов с ОКСбпST и ОКСпST предписывают продление инфузии бивалирудина до четырех часов после окончания ЧКВ.

Purpose

Purpose. The purpose of this article was a review of contemporary international guidelines for the analysis of the evidence base for bivalirudin use as a medical support of percutaneous coronary intervention (PCI) in patients with different forms of coronary artery disease.

Materials and methods

Materials and methods. Based on a review of European and American guidelines for management and revascularization in patients with different forms of coronary artery disease of 2013, 2014 and 2015, the evidence base of bivalirudin use as a medical support for PCI in patients with different forms of coronary artery disease was analyzed.

Results

Results. The current evidence base for anticoagulant PCI support in patients with different forms of coronary artery disease means choosing safe and effective anticoagulant accordance to the profiles of ischemic and hemorrhagic risk. The direct thrombin inhibitor bivalirudin has a short half-life, predictable anticoagulant profile and has indications for use it in any form of coronary artery disease (Stable coronary artery disease, Non-STEMI and STEMI), based on a large number of randomized clinical trials.

Conclusions

Conclusions. There is no doubt that bivalirudin for patients with stable coronary artery disease and heparin-induced thrombocytopenia and for a cohort of patients with a high risk of bleeding complications has benefits and efficacy. Bivalirudin as the anticoagulant support for PCI in non-STEMI patients has the highest class and level of evidence. Class and level of evidence for the use of bivalirudin as PCI support in STEMI patients in 2014 decreased to class IIa, level A however increased risk of acute stent thrombosis associated with the bivalirudin using in this group of patients does not lead to an increased risk of death compared with unfractionated heparin.

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