The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701).
Dabigatran is highly effective oral anticoagulant used in patients with atrial fibrillation, venous thrombosis, pulmonary embolism, orthopedic surgery. The most important role in activation and transport of dabigatran play hepatic carboxylesterase-1 (CES-1) and P-glycoprotein. To date were studied different polymorphisms that affect the pharmacokinetics of dabigatran such as rs2244613 (C > A), rs8192935 (T > C) и rs71647871 (G > A), rs1128503 (1236 C > T), rs2032582 (2677 G > T), rs1045642 (3435 C > T) и rs4148738 (G > A) and others. At the same time, there is no need of dabigatran pharmacogenetics testing in routine care. On the other side, existing literature data is often controversial, that’s why future studies are needed to answer the above-mentioned question.
Фибрилляция предсердий (ФП) при открытых опе-рациях на сердце встречается с частотой от 18 до 40%. Она определяет дальнейший прогноз пациентов с ишемической болезнью сердца (ИБС), поскольку увеличивает риск инсульта, способствует возникнове-нию и прогрессированию сердечной недостаточности [1][2][3]. Патофизиологические механизмы, лежащие в ос-нове развития ФП, активно изучаются. Большинство ис-следований показывают многофакторность послеопе-рационной аритмии [1,4,5]. В последнее время ряд ра-бот подчеркивают важную роль воспаления в возник-новении ФП после коронарного шунтирования (КШ) [1,5]. Ингибиторы 3-гидрокси-3-метилглютарил-коэн-зим А-редуктазы (ГМГ-Коа-редуктазы) -группа пре-паратов, известная своим антиоксидантным и проти-вовоспалительным действием, применяющаяся у па-циентов с ИБС, в том числе при дислипидемиях. Пред-операционное назначение статинов, в том числе в ко-роткие сроки до КШ, способствует уменьшению новых случаев ФП [1,4,5]. Представляется интересным из-учение показателей, провоцирующих развитие нару-шения ритма после реконструктивных операций, на фоне гиполипидемической терапии.Цель исследования: изучить эффективность терапии аторвастатином в профилактике ФП у больных ИБС, под-вергающихся операции КШ, с оценкой факторов вос- Aim. To evaluate the efficacy of atorvastatin therapy in prevention of atrial fibrillation (AF) development after coronary artery bypass graft (CABG) surgery in patients with ischemic heart disease (IHD) with the assessment of inflammation, sheer stress and myocardial injury indicators. Material and methods. The study included 105 patients with IHD who were divided into two groups: patients of group 1 were treated with atorvastatin (59 patients, 81% males, mean age 62.1±7.5 years); patients of group 2 received no HMG-CoA reductase inhibitors (46 patients, 89% males, and mean age 61.7±8.1 years).Results. Postoperative AF occurred more often in patients of group 2 (41.3% vs 16.9%; р=0.047). Laboratory analysis revealed the following: the levels of total leukocytes, interleukin-8, interleukin-10, C-reactive protein, fibrinogen, superoxide dismutase and troponin did not different significantly among the patients of two groups. Interleukin-6 level in pre-and postoperative period was significantly higher in patients of group 2 (35.4±28.5 pg/ml vs 24.1±14.8 pg/ml, р=0.03; 63.7±54.8 pg/ml vs 50.7±40.8 pg/ml, р=0.04, respectively). Conclusion. Our study has shown that atorvastatin therapy contributed to the reduction of number of new cases of AF after CABG in patients with IHD. At that, the efficacy of atorvastatin therapy correlated with the size of left atrium and the severity of inflammatory response. Patients with atorvastatin therapy had significantly lower interleukin-6 level, as a proinflammatory marker, in pre-and postoperational period as compared with the patients without such treatment.
Aim. To evaluate the influence of combination of omega-3 polyunsaturated fatty acids and atorvastatin on the risk of atrial fibrillation (AF) after coronary bypass surgery (CBS). Material and methods. The study included 114 patients divided into 2 groups, one comprised of 59 ones (75,6% men of mean age 62,0±7,3 yr given conventional medication), the other including 55 patients (80,0% men of mean age 59,4±6,7 yr given omega-3 polyunsaturated fatty acids 5 days before (2 g/d) and during 3 weeks after CBS (1 g/d)). All patients were treated with atorvastatin at the outpatient stage. IL-6,8, 10 and C-reactive protein (CRP), fibrinogen, troponin, NT-proBNP, superoxide dismutase (SOD), and myeloperoxidase were measured at admittance and on day 3.7±1.4 after surgery. Results. AF developed on day 5.9±4.9 (mean) after surgery. Patients of group 2 tended to have fewer new episodes of arrhythmia although no significant difference between the groups was documented (9,1% vs 18,6%, р=0,12). Group 2 included more smokers (74,5% vs 45,8%, р=0,002) and patients with atherosclerosis of lower limb arteries (87,3% vs 71,2%, р=0,03) but fewer those consuming nitrates (39,0% vs 18,2%, р=0,01) and Ca antagonists (45,8% vs 21,8%, р=0,006).Mean dose of atorvastatin given to patients of groups 1 and 2 was 24.7±12.5 and 25.1±10.5 mg/d respectively (р=0,2), duration of its intake 14.6±12.7 and 21.5±19.3 months (р<0,001). There. was no significant difference between leukocyte count, leukogram, IL-8, IL-10, NT-proBNP, and troponin levels before and after CBS. Surgical myocardial revascularization caused a rise in leukocyte count, shifted the leukogram toward predominance of stab and segmented cells, increased IL-8, IL-10, fibrinogen, NT-proBNP, CRP, and troponin levels in both groups. IL-8 and IL-10 levels remained normal before and after surgery. Preoperative IL-6 level in group 1 was significantly higher than in group 2 (21,7±13,0 vs 2.5±2,2 pg/ml, р<0,001). Postoperatively, the difference was absent. The CRP level before surgery was high in both groups (3122.7±2175.8 vs 3670.8±2490.0 U/g) but decreased after CBS although remained higher in group 1 (1957.6±1660.3 vs 1069.8±630.2 U/g, р<0,001). Myeloperoxidase level increased postoperatively in both groups but the difference was insignificant. Fibrinogen and CRP in the postoperative period increased more significantly in group 2 than in group 1 (4,9±1,4 vs 4,4±1,1 g/l, р=0,02 and 8,6±2,2 vs 5,4±2,3 mg/l respectively, р<0,001). Conclusion. The study revealed an insignificant decrease in the number of AF episodes in the early post-CDS period in patients treated with omega-3 polyunsaturated fatty acids and atorvastatin compared with those given the latter medication alone. Also, fibrinogen and CRP levels as markers of inflammation increased while SOD antioxidative activity decreased.
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