Modern position of anticoagulants in acute pulmonary embolism: achievements, limitations, prospects

Cover Page

Cite item

Full Text

Abstract

Pulmonary embolism (PE) is the third most common cardiovascular disease after myocardial infarction and stroke, and one of the leading causes of death in Europe.

Aim. Analysis of the modern scientific base concerning the possibilities and limitations of use of anticoagulant therapy (ACT) at different stages of medical care in PE depending on risk stratification. The article reflects the position of modern Clinical guidelines, the results of recent studies and some controversial and unresolved issues of the ACT for PE.

Conclusion. Currently, a sufficient evidence base has been obtained in favor of the fact that the ACT increases the survival rate of patients with past PE even taking into account an increase in the frequency of hemorrhagic complications; the choice of therapy schemes for PE is based on the stratification of the risk of patients; the schemes of the ACT for the acute period, for the subsequent prevention of relapses of PE are developed, the evidence of the expediency of its further prolongation (a study of rivaroxaban at a dose of 10 mg for prolonged therapy) is obtained. Use of direct oral anticoagulants (DOAC) in patients with past PE has a more optimal efficacy/safety profile compared to vitamin K antagonists (VCA). However, not all the issues of the ACT for PE are solved, therefore the prospects for the study and application of the ACT in PE include: reasonability of obtaining substantiated data on use of DOAC after thrombolysis, in patients with reduced renal function, with antiphospholipid syndrome, with neoplastic diseases, and also for determination of exact periods of extended therapy. It is necessary to search for additional prognostic factors for PE, to study and register specific antidotes for DOAC (currently in the Russian Federation a specific antidote to dabigatran – Idarucizumab-registered); to increase the share of DOAC in the ACT as drugs with a proven best profile efficacy/safety compared to VCA.

About the authors

Yuliya V. Terekhovskaya

Ryazan State Medical University

Author for correspondence.
Email: shera_11.11@mail.ru
ORCID iD: 0000-0002-9537-1618
SPIN-code: 4980-9875
ResearcherId: U-7160-2018

Clinical Resident of the Department of Hospital Therapy

Russian Federation, 9, Vysokovoltnaja, Ryazan, 390026

Viktor G. Okorokov

Ryazan State Medical University

Email: shera_11.11@mail.ru
ORCID iD: 0000-0003-3603-5160
SPIN-code: 3971-7108
ResearcherId: Y-8731-2018

MD, PhD, Associate Professor, Associate Professor of the Department of Hospital Therapy

Russian Federation, 9, Vysokovoltnaja, Ryazan, 390026

Natal`ya N. Nikulina

Ryazan State Medical University

Email: shera_11.11@mail.ru
ORCID iD: 0000-0001-8593-3173
SPIN-code: 9486-1801
ResearcherId: A-8594-2017

MD, PhD, Associate Professor, Professor of the Department of Hospital Therapy

Russian Federation, 9, Vysokovoltnaja, Ryazan, 390026

References

  1. Konstantinides S, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35: 3033-69. doi: 10.1093/eurheartj/ehu283
  2. Barbarash OL, Boytsov SA, Vaysman DSh, et al. Problemy otsenki pokazateley smertnosti ot otdelʹnykh prichin. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy. 2018;7(2):6-9. (In Russ). doi:10/17802/2306-1278-2018-7-2-6-9
  3. Boytsov SA, Nikulina NN, Yakushin SS, et al. Patologo-anatomicheskoe issledovanie v analize smertnosti naseleniya ot serdechno-sosudistykh zabolevaniy. Arkhiv patologii. 2011;73(1):30-3. (In Russ).
  4. Boytsov SA, Nikulina NN, Yakushin SS, et al. Mesto autopsii sredi sovremennykh metodov diagnostiki serdechno-sosudistykh zabolevaniy (po rezulʹtatam rossiyskogo mnogotsentrovogo ehpidemiologicheskogo issledovaniya zabolevaemosti, smertnosti, kachestva diagnostiki i lecheniya ostrykh form IBS «REZONANS»). Serdtse: zhurnal dlya praktikuyushchikh vrachey. 2010;9(4):231-3. (In Russ).
  5. Vertkin AL, Rumyantsev MA, Skotnikov AS. Komorbidnostʹ v Klinicheskoy praktike. Chastʹ 2. Arkhiv vnutrenney meditsiny. 2011;2:20-4. (In Russ).
  6. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease. CHEST Guideline and Expert Panel Report. CHEST. 2016;149(2):315-52. doi: 10.1016/j.chest.2016.08.1442
  7. Witt DM, Nieuwlaat R, Clark N P, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Advances. 2018;2(22):3257-91. doi: 10.1182/bloodad-vances.2018024893
  8. Bokeriya LA, Zatevakhin II, Kiriyenko AI, et al. Rossiyskie klinicheskie rekomendatsii po diagnostike, lecheniyu i profilaktike venoznykh tromboehmbolicheskikh oslozhneniy (VTEHO). Flebologiya. 2015;9(4):2-52. (In Russ).
  9. Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370:1402-14. doi:10. 1056/nejmc1406283
  10. Sharifi M, Bay C, Skrocki L, et al. Moderate pulmonary embolism treated with thrombolysis (from the «MOPETT» Trial). Am J Cardiol. 2013;111(2): 273-7. doi: 10.1016/j.amjcard.2012.09.027
  11. Kropacheva ES, Borovkov NN, Vavilova TV, et al. Bystrye tempy nasyshcheniya varfarinom – prediktor razvitiya chrezmernoy gipokoagulyatsii. Modernizatsiya algoritma podbora dozy varfarina. Aterotromboz. 2015;1:74-86. (In Russ).
  12. Agapov AB, Suchkov IA, Ryabkov AN. Direct oral anticoagulants in patients with deep vein thrombosis of the lower extremities. Science of the Young (Eruditio Juvenium). 2016;2:147-57. (In Russ).
  13. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361 (24):2342-52. doi: 10.1056/nejmoa0906598
  14. Schulman S, Kakkar AK, Goldhaber SZ, et al. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014;129(7):764-72. doi: 10.1161/circulatio-naha.113.004450
  15. Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-510. doi: 10.1056/nejmoa1007903
  16. Buller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287-97. doi: 10.1056/nejmoa1113572
  17. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799-808. doi: 10.1056/nejmoa1302507
  18. Buller HR, Decousus H, Grosso MA, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369 (15):1406-15. doi: 10.1056/NEJMoa1306638
  19. Instruktsiya po meditsinskomu primeneniyu lekarstvennogo preparata Xarelto® 10 mg. Registratsionnyy nomer LSR-009820/09. (In Russ).
  20. Instruktsiya po meditsinskomu primeneniyu lekarstvennogo preparata Xarelto® 15 or 20 mg. Registratsionnyy nomer LP-001457. (In Russ).
  21. Instruktsiya po meditsinskomu primeneniyu lekarstvennogo preparata Eliquis® 2,5 mg. Registratsionnyy nomer LP-001475-030212. (In Russ).
  22. Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39:1330-93. doi:10.1093/ eurheartj/ehy136
  23. Sharifi M, Bay C, Schwartz F, et al. Safe-dose thrombolysis plus rivaroxaban for moderate and severe pulmonary embolism: drip, drug, and discharge. Clin Cardiol. 2014;37(2):78-82. doi: 10.1002/clc.22216
  24. Pengo V, Denas G, Zoppellaro G, et al. Rivaro-xaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018;132(13):1365 -71. doi: 10.1182/blood-2018-04-848333
  25. Carrier M, Prandoni P. Controversies in the management of cancer-associated thrombosis. Expert Rev Hematol. 2017;10:15-22. doi: 10.1080/174740 86.2017.1257935
  26. Young AM, Marshall A, Thirlwall J, et al. Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism: Results of a Randomized Trial (SELECT-D). J Clin Oncol. 2018;36(20):2017-23. doi: 10.1200/JCO.2018.78.8034
  27. Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. N Engl J Med. 2018;378: 615-24. doi: 10.1056/NEJMoa1711948
  28. Khorana AA, Noble S, Lee AYY, et al. Role of direct oral anticoagulants in the treatment of cancer‐associated venous thromboembolism: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16:1891-4. doi: 10.1111/jth.14219
  29. Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123:1794-801. doi:10.1182/ blood-2013-12-512681
  30. Prandoni P, Noventa F, Ghirarduzzi A, et al. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica. 2007;92(2):199-205. doi:10. 3324/haematol.10516
  31. Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med. 2013;368(8):709-18. doi: 10.1056/nejmoa1113697
  32. Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368(8):699-708. doi: 10.1097/sa. 0b013e3182a495a4
  33. Prins MH, Lensing AWA, Prandoni P, et al. Risk of recurrent venous thromboembolism according to baseline risk factor profiles. Blood Advances. 2018; 2:788-96. doi: 10.1182/bloodadvances.2018017160
  34. Instruktsiya po meditsinskomu primeneniyu lekar-stvennogo preparata Warfarin Nycomed ® 2,5 mg. Registratsionnyy nomer LSR-006342/10. (In Russ).
  35. Silva C, Fiumara K, Kachalia A. A Guide to Taking Warfarin. Available at https://www.mghpcs.org/ eed_portal/Documents/AMS/MGHAMSWarfarin
  36. Guide_Russian.pdf Accessed: 15 Jan 2019. (In Russ).
  37. Luk’yanov MM, Boytsov SA, Yakushin SS, et al. Сoncomitant cardiovascular diseases and antihypertensive treatment in outpatient practice. Ratsio-nal’naya farmakoterapiya v kardiologii. 2016; 12(1):4-15. (In Russ).
  38. Bel’diyev SN, Medvedeva IV, Platonov DYu. Drug interactions of new oral anticoagulants: inside and outside the table cells. Ratsional’naya farmakoterapiya v kardiologii. 2017;13(5):716-24. (In Russ). doi: 10.20996/1819-6446-2017-135-716-724
  39. Yakusheva EN, Chernykh IV, Shchul’kin AV, et al. Methods of identification of drugs as P-glyco-protein substrates. I.P. Pavlov Russian Medical
  40. Biological Herald. 2015;23(3):49-53. (In Russ).
  41. Shchul’kin AV, Yakusheva EN, Popova NM. The role of Glycoprotein-P in rational pharmacotherapy in cardiology. Ratsional’naya farmakoterapiya v kardiologii. 2013;9(6):701-7. (In Russ).
  42. Instruktsiya po meditsinskomu primeneniyu lekar-stvennogo preparata Praxbaynd® 2,5 g. Registra-tsionnyy nomer LP-005017. (In Russ).
  43. Khorev NG, Momot AP, Konʹkova VO. Antidotes to novel direct oral anticoagulants. Angiology and Vascular Surgery. 2016;22:177-83. (In Russ).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Schemes of anticoagulant therapy of PE according to Clinical guidelines of ESC (2014) [1]

Download (332KB)
Indexing metadata

Copyright (c) 2019 Terekhovskaya Y.V., Okorokov V.G., Nikulina N.N.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies