Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health.

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Introduction.Upper gastrointestinal (UGI) bleeding is a common complication of antiplatelet therapy. Data from real clinical practice that characterize the range of risk factors for UGI bleeding, prophylactic proton pump inhibitors (PPIs) therapy, bleeding frequency and their long-term effects in patients with stable coronary artery disease (CAD) are limited. Aim.To identify predictors of UGI bleeding in patients with stable CAD, to assess the role of PPI in the prevention of bleeding and the long-term prognosis of patients after bleeding. Materials and methods.934 patients with stable CAD (median age 61 [5368] years, 78.6% men) were included in the single institution prospective REGistry of Long-term AnTithrombotic TherApy (REGATTA). Atherosclerosis of peripheral arteries (APA) and abdominal aortic aneurysm (AAA) screening was performed by doctor decision, as well as esophagogastroduodenoscopy. 76% of patients received dual antiplatelet therapy for 612 months after elective PCI. PPIs were prescribed in 28.3% of cases. Results.The median follow-up was 2.5 [1.15.1] years. The frequency of overt UGI bleeding was 1.9 per 100 patients per year. Anamnesis of peptic ulcer disease (OR 4.7; 95% CI 1.911.8;p=0.001), erosion of the upper gastrointestinal tract (OR 6.7; 2.716.6;p=0.00004 ), as well as concomitant diseases associated with a decrease in blood supply to the mucosa, such as heart failure HF (OR 6.1; 2.316.0;p=0.0002), AAA (OR 9.3; 2.534.2;p=0.0008) and APA (OR 2.3; 0.985.5;p=0.05) turned out to be independent predictors of UGI bleeding. The frequency of AAA among those who underwent UGI bleeding was 19.6% (in patients without bleeding 1.4%;p0.001). 90.2% of patients with UGI bleeding received PPI; the frequency of UGI bleeding in patients receiving pantoprazole and omeprazole did not differ significantly. After UGI bleeding, rebleeding rate was 7.8%, thrombotic events (TE) rate 31.4%, mortality rate 17.7% for 30 days, 19.4% for 1 year and 35.3% for the entire observation period. The predictors of deaths were AAA (OR 92.5; 7.7107.9;p0.0001), APA (OR 4.2; 1.0317.2;p=0.045) and HF (OR 34.5; 8.5140.6;p0.0001). The worst prognosis was expected for patients who underwent UGI bleeding and thrombotic events: 2/3 of these patients died. Conclusion.In a prospective analysis of patients with stable CAD, we identified UGI bleeding was a significant risk factor for late thromboembolism and death, compared with patients without bleeding. Predictors of UGI bleeding and poor prognosis are factors that indicate atherothrombotic burden abdominal aortic aneurysm, peripheral atherosclerosis and HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04347200.

Обзор посвящён тестированию функции тромбоцитов у больных ибс, получа-ющих антиагрегантные препараты. Приведены результаты основных крупных исследований, продемонстрировавших связь уровня остаточной реактивно-сти тромбоцитов с развитием ишемических и геморрагических осложнений. Проведен анализ возможных причин недостаточного подавления функции тромбоцитов в ответ на прием клопидогрела. Рассмотрены предложения меж-дународных экспертных организаций по оценке чувствительности к антиагре-гантам и возможной модификации антитромбоцитарного лечения. PLATELET FUNCTION TEST FOR THE ASSESSMENT OF THROMBOSIS AND BLEEDING RISK IN CHD PATIENTS TAKING ANTIPLATELET MEDICATIONSKomarov A. L., Panchenko E. P. the review concerns on the testing of platelet function in Chd patients receiving antiplatelet medications. the results are shown of the main large-scale studies demonstrating the relationship of the residual platelet activity level with the development of ishemic and hemorrhagic complications. the analysis is done of the causes of insufficient suppressing of platelet function as the response to clopidogrel. the guidelines of major international expert organizations are discussed on problem of sensitivity to aggregants testing and possible modification of antiplatelet treatment. Russ

This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

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аВК-антагонисты витамина К, аГ-артериальная гипертония, ад-артериальное давление, аСК-ацетилсалициловая кислота, атП-антитромботические препараты, атт-антитромботическая терапия, ВОз-Всемирная организация здравоохранения, ВтЭО-венозные тромбоэмболические осложнения, ГП-гликопротеин, датт-двойная антитромботическая терапия, ди-доверительный интервал, жКК-желудочно-кишечное кровотечение, иБС-ишемическая болезнь сердца, иМ-инфаркт миокарда, иПП-ингибиторы протонной помпы, КК-клиренс креатинина, КШ-коронарное шунтирование, лС-лекарственные средства, МНО-международное нормализованное отношение, НМГ-низкомолекулярный гепарин, НОаК-новые пероральные антикоагулянты, НПВП-нестероидные противовоспалительные препараты, НФГ-нефракционированный гепарин, ОКС-острый коронарный синдром, ОКС↑ST-острый коронарный синдром с подъемом сегмента ST, ОКС↓ST-острый коронарный синдром без подъема сегмента ST, ОР-относительный риск, ПОаК-пероральные антикоагулянты, Сд-сахарный диабет, ССз-сердечно-сосудистые заболевания, ССО-сердечно-сосудистые осложнения, тГВ-тромбоз глубоких вен, тиа-транзиторная ишемическая атака, тлт-тромболитическая терапия, тЭла-тромбоэмболия легочной артерии, ФП-фибрилляция предсердий, ФР-факторы риска, ХБП-хроническая болезнь почек, чКВ-чрескожное коронарное вмешательство.