The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press59310.17650/1818-8338-2024-18-1-K704LECTIONЛЕКЦИЯStrategies of anticoagulant therapy in various clinical variants of antiphospholipid syndromeСтратегии антикоагулянтной терапии при различных клинических вариантах антифосфолипидного синдромаhttps://orcid.org/0000-0002-7410-9784KlimenkoA. A.КлименкоА. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997; 8 Leninskiy Avenue, Moscow 119049

Алеся Александровна Клименко 

117997 Москва, ул. Островитянова, 1; 119049 Москва, Ленинский просп., 8

aaklimenko@yandex.ruhttps://orcid.org/0000-0003-4669-1006ShostakN. A.ШостакН. А.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0001-8757-9585GafforovaA. S.ГаффароваA. С.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

N.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииN.I. Pirogov City Clinical Hospital No. 1, Moscow Healthcare DepartmentГБУЗ г. Москвы «Городская клиническая больница № 1 им. Н.И. Пирогова Департамента здравоохранения г. Москвы»1501202418178872406202424062024Copyright ©; 2024, Klimenko A.A., Shostak N.A., Gafforova A.S.Copyright ©; 2024, Клименко А.А., Шостак Н.А., Гаффарова A.С.2024Klimenko A.A., Shostak N.A., Gafforova A.S.Клименко А.А., Шостак Н.А., Гаффарова A.С.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/593

Antiphospholipid syndrome (APS) is a systemic autoimmune pathology characterized by thrombotic manifestation associated with antiphospholipid antibodies (aPL) and phospholipid-binding proteins circulation. Long-term anticoagulant therapy is a cornerstone in the treatment and prevention of relapses and manifestations of APS-associated For high-risk APS phenotypes with arterial thrombosis, microthrombosis and triple aPL-positivity VKA use is the only possible option for anticoagulant therapy. The need for constant monitoring of international normalized relations (INR) for achievement and control of target values, intolerance and variability of INR reduce patient compliance in a certain category of patients, which limits their use in some clinical situations. Use of direct oral anticoagulants (DOAC) is an alternative option for anticoagulant therapy. Despite the benefits of using DOAC according to current international recommendations and guidelines their use is limited by the phenotype of APS with venous thrombosis and monoand double aPL-positivity if the patient is unable or unwilling to take VKA due to need for constant INR monitoring. In the obstetric version of APS during gestation, antithrombotic therapy is performed with aspirin and low molecular-weight heparins. The intensity and duration of antithrombotic prophylaxis determining at high-risk APS is a real challenge for the clinician due to the lack of tools for risk stratification and should be carried out depending on the individual characteristics of the patient and the course of APS.

 

Антифосфолипидный синдром (АфС) – системный аутоиммунный процесс, характеризующийся тромботической манифестацией, ассоциированной с циркуляцией антифосфолипидных антител (афЛ) и фосфолипид-связывающих протеинов. Длительная антикоагулянтная терапия является ведущим направлением в терапии АфС, направленным на профилактику развития и рецидивов тромботических событий и акушерской патологии. Антагонист витамина К (АВК) варфарин на сегодняшний день является наиболее широко используемым рекомендуемым антикоагулянтом. Для фенотипов АфС высокого риска с вовлечением артериального и микроциркуляторного русла и при тройной афЛ-позитивности АВК – единственная возможная опция пероральной антикоагулянтной терапии. Необходимость постоянного контроля международного нормализованного отношения (МНО) с достижением целевых значений, непереносимость и вариабельность МНО у отдельной категории пациентов снижают комплаентность пациентов, что ограничивает использование АВК в отдельных клинических ситуациях. Альтернативным решением проблемы могут стать прямые оральные антикоагулянты (пОАК). Несмотря на удобства применения пОАК, их использование согласно действующим международным рекомендациям и руководствам лимитировано фенотипом АфС с венозными тромбозами и монои двойной афЛ-позитивностью при невозможности или нежелании пациента принимать АВК в связи с необходимостью постоянного мониторинга МНО. при акушерском варианте АфС в период гестации антитромботическая терапия проводится препаратами ацетилсалициловой кислоты и низкомолекулярных гепаринов. Определение интенсивности и продолжительности антитромботической профилактики для АфС высокого риска – это сложная проблема для клинициста в связи с отсутствием инструментов для стратификации риска, и оно должно проводится в зависимости от индивидуальных особенностей пациента и течения АфС.

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