The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press33510.17650/1818-8338-2018-12-1-10-16EDITORIALРЕДАКЦИОННАЯ СТАТЬЯANTIPLATELET THERAPY OF ACUTE CORONARY SYNDROME: CURRENT CAPAB ILITIESАНТИАГРЕГАНТНАЯ ТЕРАПИЯ ОСТРОГО КОРОНАРНОГО СИНДРОМА : СОВРЕМЕННЫЕ ВОЗМОЖНОСТИhttps://orcid.org/0000-0003-4918-3795KonstantinovaE. V.КонстантиноваЕ. В.
Russian Federation

1 Ostrovityanova St., Moscow 117997, 8 Leninskiy prospekt, Moscow 119049

Екатерина Владимировна Константинова

117997 Москва, ул. Островитянова, 1, 117049 Москва, Ленинский проспект, 8

katekons@mail.ruhttps://orcid.org/0000-0002-2870-3301GilyarovМ. Yu.ГиляровМ. Ю.
Russian Federation

8 Leninskiy prospekt, Moscow 119049, 8 Trubetskaya St., Moscow 119991

117049 Москва, Ленинский проспект, 8, 119991 Москва, ул. Трубецкая, 8

https://orcid.org/0000-0003-4669-1006ShostakN. А.ШостакН. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-5610-4819AnichkovD. A.АничковД. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russian FederationФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава РоссииN.I. Pirogov City Clinical Hospital No 1 named of Moscow Healthcare DepartmentГБУЗ г. Москвы «Городская клиническая больница № 1 им. Н. И. Пирогова Департамента здравоохранения г. Москвы»I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russian FederationФГАОУ ВО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава России (Сеченовский Университет)1501201812110161707201817072018Copyright ©; 2018, Konstantinova E.V., Gilyarov М.Y., Shostak N.А., Anichkov D.A.Copyright ©; 2018, Константинова Е.В., Гиляров М.Ю., Шостак Н.А., Аничков Д.А.2018Konstantinova E.V., Gilyarov М.Y., Shostak N.А., Anichkov D.A.Константинова Е.В., Гиляров М.Ю., Шостак Н.А., Аничков Д.А.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/335

Dual antiplatelet therapy (acetylsalicylic acid and platelet P2Y12 receptor antagonist) is a standard component of treatment of any type of acute coronary syndrome, independently of perfusion and the chosen treatment strategy. Due to certain limitations of clopidogrel as the 2nd component of dual antiplatelet therapy in patients with acute coronary syndrome and percutaneous coronary intervention, the possibility of using prasugrel or ticagrelor should be considered first. Their effectiveness is higher than clopidogrel’s, as was demonstrated in large clinical trials. As a result, prasugrel and ticagrelor were included in all major international and Russian guidelines on treatment of this category of patients with the same class and level of evidence. Currently, there’re no data from any finished large randomized clinical trials of sufficient statistical power directly comparing the effectiveness and safety of prasugrel and ticagrelor. Therefore, careful analysis of the accumulated data on the safety and effectiveness of each drug including meta-analyses and registries is necessary for providing the best care for every individual patient.

Двойная антиагрегантная терапия (ацетилсалициловая кислота и блокатор P2Y12-рецепторов тромбоцитов) — стандартный компонент лечения любого типа острого коронарного синдрома, независимо от проведения реперфузии и выбранной лечебной стратегии. В связи с определенными ограничениями в применении клопидогрела в качестве 2-го компонента двойной антиагрегантной терапии у пациентов с острым коронарным синдромом с выполненным чрескожным коронарным вмешательством прежде всего должна быть рассмотрена возможность назначения прасугрела или тикагрелора. Их эффективность, превосходящая эффективность клопидогрела, была доказана в крупных клинических исследованиях, по результатам которых прасугрел и тикагрелор были включены во все основные международные и российские рекомендации по лечению этой категории больных с одинаковым классом и уровнем доказанности. В настоящее время нет данных какого-либо завершившегося крупного рандомизированного клинического исследования достаточной статистической мощности, которое напрямую сравнивало бы эффективность и безопасность прасугрела и тикагрелора, поэтому необходим тщательный анализ всех накопленных по каждому препарату данных о его эффективности и безопасности, включая результаты метаанализов и регистров, для оказания лучшей помощи каждому конкретному пациенту.

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