arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2015-21-5-536-544arthyper-327Research ArticleЛЕКЦИЯLECTUREНекоторые вопросы назначения ацетилсалициловой кислоты в клинической практикеSome issues of administering acetylsalicylic acid in clinical practiceОрловаЯ. А.OrlovaYa. A.

доктор медицинских наук, заместитель директора Медицинского научно-образовательного центра,

Ломоносовский пр., д. 27, корп. 10, Москва, 119192; 5163002@bk.ru

MD, PhD, Deputy Director, 

27/10 Lomonosovsky avenue, Moscow, 119192, 5163002@bk.ru

YAOrlova@mc.msu.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный университет имени М.В. Ломоносова»РоссияClinic of M.V. Lomonosov Moscow State UniversityRussian Federation201522122015215536544Copyright © Орлова Я.А., 20152015Орлова Я.А.Orlova Y.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/327

Данная статья посвящена долгосрочному назначению ацетилсалициловой кислоты (АСК) для первичной и вторичной профилактики сердечно-сосудистых заболеваний (ССЗ). В этой работе не рассматриваются подходы к антиагрегантной терапии при остром коронарном синдроме и вмешательствах на коронарных артериях. Возможности использования АСК в первичной профилактике сердечно-сосудистых осложнений (ССО) представлены на основе имеющихся данных и рекомендаций, включая последние исследования, демонстрирующие протективное влияние АСК на риск развития рака. Другие антитромбоцитарные препараты (например, клопидогрел) не обсуждались, так как не используются в первичной профилактике. Последние рекомендации предполагают обязательное использование оценки 10‑летнего риска развития ССО перед принятием решения о назначении АСК. Обосновывается необходимость использования малых доз АСК у пациентов с высоким риском развития ССЗ. Известно, что пациенты с сахарным диабетом (СД) имеют более высокий риск развития ССО. АСК рекомендуется для вторичной профилактики у больных СД, а для первичной профилактики может рассматриваться у пациентов с СД и высоким сердечно- сосудистым риском. Дезагрегантная терапия является обязательным компонентом лечения ишемической болезни сердца и ишемического инсульта. Однако она ассоциирована с повышенным риском развития кровотечений. В статье обсуждаются вопросы совместного назначения АСК и ингибиторов протонной помпы для снижения риска развития геморрагических осложнений.

This article reviews some issues related to the long-term administration of antithrombotic drugs for primary and secondary cardiovascular prevention. It does not address initial management of acute coronary syndromes or periprocedural use of antithrombotic therapies. We review the pros and cons regarding acetylsalicylic acid (ASA) therapy in primary prevention based on the available evidence, including recent data linking ASA with cancer protection. We do not include other antiplatelet therapies (e. g., clopidogrel alone or in combination with aspirin) or oral anticoagulation (e. g., warfarin), because they are not likely to be used in primary prevention setting. Recent guidelines depend on the accurate assessment of cardiovascular risk as part of decision-making process. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to use low-dose ASAin primary cardiovascular prevention and discussits use in patients at high cardiovascular risk. Patients with diabetes mellitus are known to have an increased risk of cardiovascular events. Low dose ASA is recommended for secondary prevention, as for primary prevention it can be prescribed in patients with diabetes mellitus and at high cardiovascular risk. Antiplatelet therapy is the standard of care for the secondary prevention of coronary artery disease and ischemic stroke. However, it is associated with increased risk of bleeding, first of all gastrointestinal bleeding. Prescription of proton pump inhibitors along with antiplatelet therapy reduces the risk of upper gastro-intestinal bleeding.

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