Klinicist (Oct 2015)


  • M. Yu. Gilyarov,
  • E. V. Konstantinova,
  • A. I. Trukhin

Journal volume & issue
Vol. 9, no. 3
pp. 15 – 21


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Clinical medicine develops towards increasingly more specialization; however, there are diseases faced by physicians of different specialties. The most common cardiac arrhythmia after extrasystoles is atrial fibrillation (AF) that increases the risk of cardiac embolism, primarily ischemic stroke, by several times. Identification of the causes of stroke and systemic embolisms has given rise to the creation of clinical scales to assess the risk of their development. According to current guidelines, the long­term use of oral anticoagulants (for an indefinite time) is the best way to prevent cardiac embolic complications with medications in AF. This approach outperforms both monotherapy with acetyl­-salicylic acid alone and in combination with clopidogrel. The administration of anticoagulants is warranted in patients having risk factors for stroke, no matter what the clinical type of AF (paroxysmal, constant, or persistent). Until quite recently, oral anticoagulant therapy has implied the use of drugs from a group of vitamin K antagonists (VKAs), among which warfarin is at the forefront; however, the pharmacodynamic and pharmacokinetic features of the drug substantially complicate its practical application. The results of a number of large randomized controlled trials have shown that novel oral anticoagulants (NOACs) may be used along with VKAs in patients with non­valvular AF (i. e. in the absence of mitral stenosis or mechanical cardiac valvular prostheses). As com­ pared with warfarin, NOACs have advantages: a much less interaction with foods and drugs and no need for continuous monitoring using coagulation tests and for drug dose adjustment (although the dose should be corrected in renal dysfunctions). When prescribing therapy with VKAs or NOACs, a risk for hemorrhagic complications should be defined. The patient should be informed of the advantages and disadvantages of each therapy option in order to take into account the real possibilities of safely maintaining the persistent coagulation level and the patients, choices. Prognosis and quality of life may be effectively influenced in an AF patient where physicians of all specialties understand each other well and know general approaches to treating these patents. A general practitioner plays a key role in the coordination of all actions.