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Actual Issues of Ischemic and Hemorrhagic Events Risk Management During Antithrombotic Therapy in Patients with Acute Coronary Syndrome

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Today, optimal duration of double antiplatelet (DAPT) and triple antithrombotic therapy (TATT) in patients with acute coronary syndrome (ACS) remains the subject of scientific and practical discussion on possibilities of ischemic and hemorrhagic risks assessment. Good clinical risk metrics is based on validated risk scales. However, actual clinical guidelines do not provide a universal and generally accepted scale for assessing the balance of risks of ischemic events and bleeding. Is very necessary to determine the optimal content and DAPT or TATT duration is the existence of validated risk assessment scales would allow to optimize the accuracy of risk assessment of ischemic and hemorrhagic events in patients after ACS. One of the probable reasons is absence of validation of existing scales for each specific population of patients with ACS. In this regard, the use of «new» risk assessment systems: PRECISE DAPT and DAPT, in addition to the routine risk assessment scales (GRACE, CRUSADE), could become optimal in all ACS patient categories. In order to identify the initial risk of community-acquired hemorrhagic events during the first 12 months all patients with ACS at the inpatient stage of treatment is used the PRECISE DAPT score. In order to determine the need for prolongation of the standard DAPT. It should be used after 12 months of receiving DAPT in survivors of ACS patients without ischemic events, must be used the DAPT score.

About the Authors

R. M. Velieva
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Velieva Rufana Mamed Kyzy - MD, Postgraduate Student, Cardiologist, Research Institute for Complex Issues of Cardiovascular Diseases.
Sosnoviy bulv. 6, Kemerovo, 650002.

T. B. Pecherina
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Pecherina Tamara Borzalievna - MD, PhD, Senior Researcher, Laboratory of Pathophysiology of Multifocal Atherosclerosis; Senior Lecturer, Scientific and Educational Department, Research Institute for Complex Issues of Cardiovascular Diseases.
Sosnoviy bulv. 6, Kemerovo, 650002.

A. S. Vorobiev
Surgut State University
Russian Federation

Vorobyov Anton Sergeevich - MD, PhD, Leading Researcher, Scientific and Educational Department; Associate Professor, Cardiology Chair, Medical Institute, Surgut State University.
Lenina pr. 1, Surgut, 628403.

V. V. Kashtalap
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Kashtalap Vasily Vasilievich - MD, Head of the Laboratory of Pathophysiology of Multifocal Atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases.
Sosnoviy bulv. 6, Kemerovo, 650002.

D. Yu. Sedykh
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

Sedykh Daria Yuryevna - MD, PhD, Researcher, Laboratory of Pathophysiology laboratory of multifocal atherosclerosis, Research Institute for Complex Issues of Cardiovascular Diseases
Sosnoviy bulv. 6, Kemerovo, 650002.


1. Erlikh A.A. Review of the new clinical guidelines of the European Cardiological Society in 2017 on the use of double antiplatelet therapy. Consilium Medicum. 2017;19(12):8-11 (In Russ.)

2. Timmis A., Townsend N., Gale C., et al. Atlas Writing Group. European Society of Cardiology: cardiovascular disease statistics 2017. Eur Heart J. 2018;39(7):508-79. DOI:10.1093/eurheartj/ehx628.

3. Barbarash O.L., Kashtalap V.V. Dual antiplatelet therapy in patients with acute coronary syndrome. Results from real clinical practice. Russian Cardiological Journal. 2018;(10):127-35 (In Russ.). DOI:10.15829/1560-4071-2018-10-127-135.

4. Patrono C., Ciabattoni G., Patrignani P, Pugliese F, Filabozzi P., Catella F, Davi G., Forni L. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation. 1985;72(6):1177-84. DOI:10.1161/01.CIR.72.6.1177.

5. Grosser N., Schroder H. Aspirin qrotects еndothelial oells from oxidant damage via the nitric oxide-cGMP pathway. Arterios Thromb Vasc Biol. 2003;23:1345. DOI:10.1161/01.ATV.0000083296.57581.AE.

6. Mehta S.R., Yusuf S. Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study investigators. CURE trial programme; rationale, design and baseline characteristics including a meta-analysis of the effects of thienopyridines in vascular disease. Eur Heart J. 2000;21(24):2033-41. DOI:10.1053/euhj.2000.2474.

7. Bhatt D.L., Topol E.J. Clopidogrel added to aspirin versus aspirin alone in secondary prevention and high-risk primary prevention: rationale and design of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. Am Heart J. 2004;148(2):263-8. DOI: 10.1016/j.ahj.2004.03.028.

8. Steg P.G., James S., Harrington R.A., et al. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: A Platelet Inhibition and Patient Outcomes (PLATO) trial subgroup analysis. Circulation. 2010;122(21):2131-41. DOI:10.1136/bmj.d3527.

9. Jacobsson F., Swahn E., Wallentin L., Ellborg M. Safety profile and tolerability of intravenous AR-C69931MX, a new antiplatelet drug, in unstable angina pectoris and non-Q-wave myocardial infarction. Clin Ther. 2002;24(5):752-65. DOI:10.1016/S0149-2918(02)85149-9.

10. Kastrati A., Ndrepepa G. Cangrelor - A Champion Lost in Transaction. N Engl J Med. 2009;361(24):2382-4. DOI:10.1056/nejme0910677.

11. Michniewicz E., Mlodawska E, Lopatowska P., et al. Patients with atrial fibrillation and coronary artery disease Double trouble. Adv Med Sci. 2017;63(1):30-5. DOI:10.1016/j.advms.2017.06.005.

12. Valgimigli M., Bueno H., Byrne, R.A., Collet J.P. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213-60. DOI:10.1093/eurheartj/ehx419.

13. Dewilde W.J, Oirbans T., Verheugt F.W., et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an openlabel, randomised, controlled trial. Lancet. 2013;381(9872):1107-15. DOI:10.1016/S0140-6736(12)62177-1.

14. Cannon C.P., Bhatt D.L, Oldgren J., et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med. 2017;377(16):1513-24. DOI:10.1056/NEJMoa1708454.

15. Peterson E.D, Pokorney S.D. New treatment options fail to close the anticoagulation gap in atrial fibrillation. JACC. 2017;69(20):2485-7. DOI:10.1016/j.jacc.2017.03.541.

16. D'Ascenzo F., Biondi-Zoccai G., Moretti C., et al. TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes. Contemp Clin Trials. 2012;33(3):507-14. DOI:10.1016/j.cct.2012. 01.001.

17. Assmann G., Cullen P., Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002;105(3):310-5. DOI:10.1161/hc0302.102575.

18. Barbarash O.L., Karetnikova V.N., Kashtalap V.V. The patient after myocardial infarction: how to reduce a risk of recurrent ischemic event? Cardiosomatics. 2015;6(2):12-9 (In Russ.)

19. Mauri L., Yeh R.W., Kereiakes D.J. Duration of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2015;372(14):1373-4. DOI:10.1056/nejmc1501195.

20. Bonaca M.P., Bhatt D.L., Braunwald E., et al. Design and rationale for the prevention of cardiovascular events in patients with prior heart attack using ticagrelor compared to placebo on a background of aspirin - thrombolysis in myocardial infarction 54 (PEGASUSTIMI 54) trial. Am Heart J. 2014;167(4):437-44. DOI:10.1056/nejmc1501195.

21. Flores-Rios X., Couto-Mallon D., Rodriguez-Garrido J., et al. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI. Eur Heart J Acute Cardiovasc Care. 2013;2(1):19-26. DOI:10.1177/2048872612469885.

22. Costa F., van Klaveren D., James S., et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRE-CISE-DAPT) score: A pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389(10073):1025-34. DOI:10.1016/S0140-6736(17)30397-5.

For citation:

Velieva R.M., Pecherina T.B., Vorobiev A.S., Kashtalap V.V., Sedykh D.Yu. Actual Issues of Ischemic and Hemorrhagic Events Risk Management During Antithrombotic Therapy in Patients with Acute Coronary Syndrome. Rational Pharmacotherapy in Cardiology. 2020;16(6):1024-1030. (In Russ.)

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