r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/26587947-2023-28-1-54-61r-n-j-396Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSКлинический опыт использования идаруцизумаба у пациентов с фибрилляцией предсердий, принимающих дабигатрана этексилатClinical experience with idarucizumab in patients with atrial fi brillation taking dabigatran etexilatehttps://orcid.org/0000-0001-6824-4114РамазановГ. Р.RamazanovG. R.

Москва

Moscow

ramazanovgr@sklif.mos.ruhttps://orcid.org/0000-0002-8490-1417КовалеваЭ. А.KovalevaE. A.

Москва

Moscow

kovalevaea@sklif.mos.ruhttps://orcid.org/0000-0001-8096-5029АхматхановаЛ. Х.-Б.AkhmatkhanovaL. Kh.-B.

Москва

Akhmatkhanovа Liana Kh.-B.

Moscow

liana.akhmatkhanova@mail.ruhttps://orcid.org/0000-0002-7444-3117ВышловаА. И.VyshlovaA. I.

Москва

Moscow

klychnikova.anna@mail.ruhttps://orcid.org/0000-0002-3349-0451КлычниковаЕ. В.KlychnikovaE. A.

Москва

Moscow

klychnikovaev@sklif.mos.ruhttps://orcid.org/0000-0003-3292-8789ПетриковС. С.PetrikovS. S.

Москва

Moscow

petrikovss@sklif.mos.ruГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health DepartmentRussian Federation2023160320232815461Copyright © Рамазанов Г.Р., Ковалева Э.А., Ахматханова Л.Х., Вышлова А.И., Клычникова Е.В., Петриков С.С., 20232023Рамазанов Г.Р., Ковалева Э.А., Ахматханова Л.Х., Вышлова А.И., Клычникова Е.В., Петриков С.С.Ramazanov G.R., Kovaleva E.A., Akhmatkhanova L.K., Vyshlova A.I., Klychnikova E.A., Petrikov S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/396

Дабигатрана этексилат (ДЭ) — прямой ингибитор тромбина, который показал эффективность и безопасность в отношении предотвращения тромботических событий в целом ряде исследований. В настоящее время с целью незамедлительной инактивации вызванного ДЭ эффекта применяют идаруцизумаб, являющийся моноклональным антителом и антагонистом ДЭ.

Цель работы

Цель работы. Оценка эффективности и безопасности применения идаруцизумаба у пациентов, принимающих ДЭ.

Материал и методы

Материал и методы. 6 пациентов (2 мужчин, 4 женщин) в возрасте от 61 и до 86 лет (средний возраст 72,8 ± 10,6 года), получающих ДЭ, у которых возникла необходимость применения идаруцизумаба с целью возможности выполнения системной тромболитической терапии (сТЛТ) или хирургического вмешательства.

Результаты

Результаты. Ни у одного пациента применение идаруцизумаба не сопровождалось снижением уровня тромбинового времени менее 11 с, что могло бы указывать на явление гиперкоагуляции. До инактивации дабигатрана этексилата тромбиновое время было достоверно выше (р < 0,05), чем после введения препарата. Статистически значимых различий в концентрации D-димера до и после введения идаруцизумаба не выявлено, что указывает на отсутствие прокоагулянтных свойств данного препарата. Ни у одного пациента в течение всего периода госпитализации не развилось клинически значимых артериальных и/или венозных тромботических событий, таких как повторный ишемический инсульт (ИИ), инфаркт миокарда, тромбоз глубоких вен нижних конечностей и тромбоэмболия легочной артерии.

Заключение

Заключение. Применение идаруцизумаба позволяет проводить системную тромболитическую терапию и экстренное оперативное лечение у пациентов, принимающих ДЭ. Идаруцизумаб быстро и безопасно нивелирует оказываемый ДЭ антикоагулянтный эффект и не обладает протромботическим действием.

Dabigatran etexilate (DE) is a direct thrombin inhibitor that has been shown to be eff ective and safe in preventing thrombotic events in a number of studies. Currently idarucizumab, which is a monoclonal antibody and a DE antagonist, is used to immediately inactivate the DE-induced eff ect.

Objective

Objective. Еvaluation of the effi  ciency and safety of idarucizumab in patients receiving DE.

Material and methods

Material and methods. 6 patients (2 men, 4 women) aged 61 to 86 years (mean age 72.8 ± 10.6 years) receiving DE, who are expected to use idarucizumab in achieving the goal of sTLT or surgery.

Results

Results. In none of the patients the use of idarucizumab was accompanied by a decrease in thrombin time of less than 11 seconds which could indicate a hypercoagulable phenomenon. Before inactivation of dabigatran etexilate thrombin time was signifi cantly higher (p < 0.05) than after the administration of the drug. There were no statistically signifi cant diff erences in the concentration of D-dimer before and after the administration of idarucizumab which indicates the absence of procoagulant properties of this drug. None of the patients developed clinically signifi cant arterial and/ or venous thrombotic events such as recurrent IS, myocardial infarction, deep vein thrombosis of the lower extremities and pulmonary embolism, during the entire period of hospitalization.

Conclusion

Conclusion. The use of idarucizumab is allowed for systemic thrombolytic therapy and emergency surgical treatment in patients taking DE. Idarucizumab quickly and safely neutralizes the anticoagulant eff ect of DE and doesn’t have a prothrombotic activity.

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The authors declare that there are no conflicts of interest present.