Clinically Significant Drug Interactions for Direct Oral Anticoagulants: State of the Art

The article is devoted to modern ideas about the role of drug interactions as a factor affecting the efficacy and safety of the use of direct oral anticoagulants (DOACs) in clinical practice. Data on drug interactions of apixaban, rivaroxaban and dabigatran with the drugs most frequently used in patients with cardiovascular diseases are given. Drug interactions for DOACs, depending on concomitant use of drugs that are inhibitors or inducers of the CYP3A4 enzyme or P-glycoprotein enzymes, are determined by most of the drug interactions of DOACs are considered. The results of studies in which drug interactions of DOACs were assessed by changes in indicators such as the area under the concentration-time curve and the maximum or minimum concentration of drugs in the blood are discussed. The data presented in the article may be useful for accounting for drug interactions in the treatment of patients with DOACs in clinical practice, despite the current lack of reasonable dose adjustment rules depending on the majority of such interactions. The data presented in the article suggest that apixaban has the fewest number of clinically significant interactions among the DOACs available in Russia

Modern Approaches to the Interpretation of the Results of Large Randomized Clinical Trials

Modern approaches to interpreting the results of randomized trials, which can reduce the distortion of information when they are presented to a wide range of doctors, are discussed in the article. Data on the role of taking into account multiple comparisons in the planning and analysis of large randomized clinical trials are given. The validity and approaches to using a hierarchical approach to assessing the statistical significance of indicators (“endpoints”) in cases where, in accordance with a pre-adopted study protocol, several indicators are supposed to be evaluated are considered in detail. Approaches to interpreting the p value as well as 95% confidence intervals are considered. Particular attention is paid to the interpretation of the components of the main combined indicator, since when interpreting just such data, the presentation of the results of the study and the manipulation of doctors' opinions may be distorted. This is especially true for data on mortality and mortality from complications of cardiovascular diseases. Modern approaches to the analysis of research results using methods other than the usual Kaplan-Meier analysis, in particular, the method based on the calculation of the "win ratio" are discussed. Data obtained in modern clinical studies are given as examples

Influence of standard heart failure therapy on readmission rate: opportunities and limitations in modern clinical practice

This review considers the clinical and epidemiological significance of hospitalizations for decompensated heart failure, as well as using it as an indicator of therapy effectiveness. The data on the frequency of using medications that reduce the hospitalization risk in randomized clinical trials and in real practice are presented. The reasons for inadequate prescription of drugs for the treatment of heart failure with reduced ejection fraction and their use in insufficient doses, which include therapeutic inertness and physiological limitations, as well as the need to introduce drugs with alternative mechanisms of action into clinical practice, are iscussed

Therapeutic Options for the Single Pill Combination of Lisinopril, Amlodipine and Rosuvastatin: a Systematic Review

Aim. To evaluate the effect of taking a single pill combination of amlodipine, lisinopril and rosuvastatin on blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) in hypertensive patients with or without severe hypercholesterolemia.Material and methods. Articles published in Russian were selected for analysis. Six articles that met the criteria for inclusion in a systematic review were found by searching the eLibrary database for the keyword "equamer". The results of 5 observational clinical studies were presented in these articles. The effectiveness of the fixed combination of amlodipine, lisinopril and rosuvastatin was assessed mainly by changes in the level of systolic and diastolic blood pressure, the concentration of LDL cholesterol. In addition, the effects of fixed-dose amlodipine, lisinopril, and rosuvastatin on central aortic pressure and its increment index, as well as carotid-femoral pulse wave velocity, were studied in part of the studies. The effect of the fixed combination of amlodipine, lisinopril and rosuvastatin on blood pressure and LDL-C concentration, as well as on these additional indicators, in patients who had a coronavirus infection with severe lung damage was studied in one study.Results. Evidence from a systematic review demonstrates the efficacy of single pill combination amlodipine, lisinopril and rosuvastatin in reducing blood pressure and LDL-C in a wide range of patients with different baseline risk of developing cardiovascular complications and different baseline levels of blood pressure and LDL-C.Conclusion. The data obtained confirm the feasibility of more frequent prescription of the single pill combination of amlodipine, lisinopril and rosuvastatin in clinical practice for the treatment of hypertensive patients with high or moderate risk of developing cardiovascular diseases, including patients with concomitant hypercholesterolemia

THE ROLE OF CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROME AFTER THE EMERGENCE OF MORE POWERFUL INHIBITORS OF P2Y12 RECEPTOR

The role of P2Y12 receptor blocker clopidogrel after the introduction into clinical practice of new, more powerful and stable operating drugs belonging to this class of antiplatelet agents is discussed. The advantages and disadvantages of each of the currently used antiplatelet drugs that block the receptor P2Y12 are reviewed. On the basis of the analysis concludes that, despite the emergence of new antiplatelet agents clopidogrel, appears to be widely used for a long time in the treatment of patients with acute coronary syndrome and / or after coronary stenting. This is primarily due to the presence of large evidence base, and confirmation of safety of long-term therapy clopidogrel.</p

Анемия у больных с хронической сердечной недостаточностью: современное состояние проблемы

The article reports the modern tactics of treating patients with chronic heart failure and concomitant anemia. The results of the most important randomized clinical trials that are the basis for developing approaches to the treatment of anemia in such cases are discussed. Attention is also paid to unresolved problems in the treatment of anemia in patients with heart failure. The data on the intravenous administration of iron preparations as the most effective approach to the treatment of anemia in patients with heart failure in the presence of iron defciency are given. The main provisions of modern clinical guidelines on the management of patients with heart failure and anemia are considered.В статье рассмотрена современная тактика лечения больных с хронической сердечной недостаточностью и сопутствующей анемией. Обсуждаются результаты наиболее важных рандомизированных клинических исследований, которые стали основанием для разработки подходов к лечению анемии в таких случаях. Уделяется внимание и нерешенным проблемам лечения анемии у больных с сердечной недостаточностью (СН). Приводятся данные о внутривенном введении препаратов железа как наиболее эффективном подходе к лечению анемии у больных с сердечной недостаточностью при наличии дефицита железа. Рассматриваются основные положения современных клинических рекомендаций по тактике ведения больных с СН и анемией

РАЗВИТИЕ ОСТРОГО ИНФАРКТА МИОКАРДА ЗА СЧЕТ СДАВЛЕНИЯ СТВОЛА ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ ОПУХОЛЬЮ СЕРДЦА: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

We report the clinical observation of acute myocardial infarction development associated with the compression of the left coronary artery trunk and discuss etiological role of primary and secondary cardiac tumors in the development of acute coronary syndrome.В статье приводится описание клинического наблюдения развития острого инфаркта миокарда, обусловленного сдавлением ствола левой коронарной артерии. Обсуждается этиологическая роль первичных и вторичных опухолей сердца в развитии острого коронарного синдрома. 

РАЗРЫВЫ МЕЖЖЕЛУДОЧКОВОЙ ПЕРЕГОРОДКИ В ОСТРОМ ПЕРИОДЕ ИНФАРКТА МИОКАРДА: ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННЫЕ КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

The rupture of the interventricular septum (ivs) remains a severe complication of acute myocardial infarction. In this article, we discuss optimal treatment tactics for patients with internal heart ruptures in acute myocardial infarction. We consider minimally invasive interventions in the optimally early periods of acute myocardial infarction as an alternative to surgical treatment using artificial circulation. It remains urgent to improve measures preventing complications in acute myocardial infarction, as well as its early diagnosis and the specifics of managing such patients.Разрыв межжелудочковой перегородки остается грозным осложнением острого инфаркта миокарда. В статье обсуждается проблема оптимальной тактики лечения больных с внутренними разрывами сердца при остром инфаркте миокарда. Рассматриваются малоинвазивные вмешательства в оптимально ранние сроки острого инфаркта миокарда как альтернатива хирургическому лечению с использованием искусственного кровообращения. Остается актуальным совершенствование профилактических мероприятий, направленных на предотвращение осложнений при остром инфаркте миокарда, а также ранней их диагностики и особенности ведения таких пациентов

Empagliflozin in patients hospitalized for acute decompensated heart failure: an expert resolution on the discussion of the EMPULSE trial

An online expert meeting held on November 17, 2021 reviewed the results of the randomized, double-blind, multinational, parallel-group EMPULSE trial, evaluating the clinical benefit and safety of the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin compared with placebo in patients hospitalized with acute decompensated heart failure (ADHF). Patients were included in the study regardless of ejection fraction (EF) and the presence of diabetes and randomized during hospitalization after stabilization. In addition, the EMPULSE trial used a composite result analyzed using a stratified benefit ratio — Win Ratio analysis. There is evidence of clinical benefit of empagliflozin in hospitalized patients with preserved and reduced LVEF, as well as in patients with newly diagnosed ADHF or with acute decompensation of chronic heart failure (CHF) compared with placebo, regardless of type 2 diabetes presence. The importance of the favorable results of the EMPULSE trial and its significance for clinical practice, which implies the early administration of empagliflozin for inpatients, is noted. A number of proposals have been adopted to accelerate the introduction of empagliflozin into clinical practice for patients with ADHF

2020 Clinical practice guidelines for Myocarditis in adults

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federatio