kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2013-3-62-71kpccz-32Research ArticleПРАКТИЧЕСКОМУ ВРАЧУВЫБОР И СОЧЕТАНИЕ АНТИТРОМБОЦИТАРНЫХ СРЕДСТВ ПРИ ИНФАРКТЕ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА STCHOICE AND COMBINATION OF ANTIPLATELET MEDICATIONS IN ST ELEVATION MYOCARDIAL INFARCTIONАверковО. В.AverkovO. V.Городская клиническая больница № 15 имени О. М. Филатова, Российский университет дружбы народов, МоскваРоссияCity Clinical Hospital № 15 n. a. O. M. Filatov and People’s Friendship University of Russia, MoscowRussian Federation201328062015036271Copyright © Аверков О.В., 20152015Аверков О.В.Averkov O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/32

Представлено современное состояние антитромбоцитарной терапии при инфаркте миокарда с подъемом сегмента ST. Обсуждается возможность замены клопидогрела, одного из элементов этой терапии, на более новые и мощные антиагреганты тикагрелор и празугрел. Приведена доказательная база каждого из препаратов. Анализу подвергнуты результаты исследований, посвященных сравнению клопидогрела с тикагрелором и празугрелом. Подчеркивается, что всерьез на место клопидогрела может претендовать только тикагрелор и только в рамках стратегии, основанной на первичном чрескожном коронарном вмешательстве. В рамках остальных стратегий, включающих тромболитическую терапию, фармакоинвазивный подход и вынужденное воздержание от реперфузии, клопидогрел остается безальтернативным элементом двойной антитромбоцитарной терапии больных с инфарктом миокарда с подъемом сегмента ST на ЭКГ. Констатируется, что с внедрением двойной антитромбоцитарной терапии, целесообразность широкого использования блокаторов GPIIb/IIIa во время чрескожных внутрикоронарных процедур у обсуждаемых больных существенно изменилась.

The state of the art in antiplatelet therapy in ST elevation myocardial infarction patients was reviewed. The possibility of clopidogrel substitution for the newer and more potent antiplatelet drugs such as ticagrelor and prasugrel was discussed. The rationale for the use of each medication was presented. The results of clinical trials comparing clopidogrel with ticagrelor and prasugrel were analyzed. It was highlighted that only ticagrelor can substitute clopidogrel and only in primary coronary intervention setting. In other settings including thrombolytic therapy, pharmacoinvasive approach or no reperfusion, clopidogrel has no alternatives as a part of dual antiplatelet therapy in ST elevation myocardial infarction. It was observed that with dual antiplatelet therapy the rationale for GPIIb/IIIa inhibitors use during percutaneous coronary interventions became significantly different in the category of patients under discussion.

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