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Clinical Significance of Thrombin Blockade with Low Doses (2.5 mg) of Rivaroxaban in Ischemic Heart Disease Patients

https://doi.org/10.20996/1819-6446-2020-01-03

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Abstract

Arterial thrombosis is a result of complex interaction between blood cells, soluble coagulation factors in plasma and vessel wall. Antiplatelet drugs do not always provide the necessary antithrombotic effect of sufficient strength, because their influence does not extend to all three factors involved in this process. Low doses of direct oral inhibitors of thrombin are able to potentiate antithrombotic effect of antiplatelet therapy. The combination of rivaroxaban in a dose of 2.5 mg and standard double antiplatelet therapy turned out to be the most promising for clinical use, since studies with dabigatran and apixaban at the II and III stages of the trials were found to be unsuccessful due to the unacceptably high frequency of bleeding. Studies of the combination of rivaroxaban at a dose of 2.5 mg and standard antiplatelet therapy conducted in previous years among patients with acute myocardial infarction showed a decrease in the frequency of complications of atherothrombosis associated with their ischemic nature, while at the same time there was a slight increase in hemorrhagic complications. In the COMPASS study the combination of rivaroxaban (2.5 mg) plus aspirin reduced the risk of the primary endpoint (myocardial infarction, ischemic stroke, cardiovascular death) more significantly than aspirin alone in patients with stable ischemic heart disease and ischemic brain disease. The pathophysiological rationales for the use of low doses of rivaroxaban when added to dual antiplatelet therapy are considered, and the significance of recent studies in patients with acute coronary syndrome, stable ischemic heart disease and in the prevention of ischemic stroke is discussed.

About the Authors

A. B. Sumarokov
National Medical Research Center of Cardiology
Russian Federation

Alexander B. Sumarokov – MD, PhD, Senior Researcher, Institute of Clinical Cardiology named after A.L. Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



L. I. Buryachkovskaya
National Medical Research Center of Cardiology
Russian Federation

Liudmila I. Buryachkovskaya – PhD (Biology), Leading Researcher, Institute of Experimental Cardiology

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



Y. V. Docenko
National Medical Research Center of Cardiology
Russian Federation

Yulia V. Docenko – MD, PhD, Junior Researcher, Institute of Clinical Cardiology named аfter A.L. Myasnikov

Tretya Cherepkovskaya ul. 15A, Moscow, 121552



M. S. Kurochkin
Central Clinical Hospital of the Presidential Administration of the Russian Federation
Russian Federation

Michail S. Kurochkin – MD, Physician (Resuscitator), Department of Intensive Cardiology

Marshala Timoshenko ul. 15, Moscow, 121359



N. V. Lomakin
Central Clinical Hospital of the Presidential Administration of the Russian Federation
Russian Federation

Nikita V. Lomakin – MD, PhD, Head of Department of Intensive Cardiology

Marshala Timoshenko ul. 15, Moscow, 121359



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For citation:


Sumarokov A.B., Buryachkovskaya L.I., Docenko Y.V., Kurochkin M.S., Lomakin N.V. Clinical Significance of Thrombin Blockade with Low Doses (2.5 mg) of Rivaroxaban in Ischemic Heart Disease Patients. Rational Pharmacotherapy in Cardiology. 2020;16(1):99-107. (In Russ.) https://doi.org/10.20996/1819-6446-2020-01-03

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