Approaches to choosing a direct oral anticoagulant in the treatment of polymorbid patients with atrial fibrillation


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Abstract

Atrial fibrillation (AF) is the most common arrhythmia worldwide. An important trend in modern healthcare is the high prevalence of comorbidities in clinical practice, especially the presence of concomitant diseases is found in patients with a cardiological profile, and from this point of view patients with AF are no exception. Most often, AF coexists with arterial hypertension, coronary heart disease (CHD), chronic heart failure (CHF), and chronic kidney disease (CKD). A fundamental principle in the management of AF patients is the administration of appropriate anticoagulant therapy. To date, the use of direct oral anticoagulants (DOACs) is a priority in this issue. One of the representatives of this drug class is apixaban, which has confirmed its advantages in patients with AF and has its own body of evidence for clinical efficacy and safety, including comorbidity settings. Apixaban has demonstrated consistently high efficacy in patients with AF and CHD, CHF, and CKD, and its clinical potential and safety profile are not different from that in the general population. The focus of comorbidity is also on the lesions of the gastrointestinal mucous membrane in patients with AF, which potentially increase the risk of this location bleedings. Taking into account the results of DOACs pivotal studies, it can be said that apixaban does not significantly affect the risk of gastrointestinal bleeding. An interesting aspect of the clinical pharmacology of DOACs and, in the first place, apixaban is also the absence of a negative effect on the processes of osteogenesis and mineralization of bone tissue, which, as is known, is present in vitamin Kantagonists. Additional evidence of the optimal profile of the effectiveness and safety of apixaban in the presence of comorbidities is the inclusion of this drug in international clinical guidelines and consensus documents for the management of patients with concomitant diseases.

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About the authors

Olga D. Ostroumova

Russian Medical Academy of Continuous Professional Education; I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: ostroumova.olga@mail.ru
Dr. Sci. (Med.), Professor, Department of Therapy and Polymorbid Pathology Moscow 125993, Russian Federation

A. I Kochetkov

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

S. V Batyukina

Russian Medical Academy of Continuous Professional Education

Moscow, Russia

N. L Lyakhova

S.P. Botkin Municipal Clinical Hospital

Moscow, Russia

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