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Aim. To study the features of the appointment of beta-blockers (BB) therapy in the early stages of acute myocardial infarction without ST segment elevation (nonSTEMI) in real clinical practice in the Russian Federation according to the REGION registry, to analyze the frequency and use cases of Intravenous forms (IVF).Material and methods. REGION-IM is a multicenter prospective Russian registry of acute myocardial infarction (AMI). The database records demographic, anamnestic, clinical characteristics of patients, results of laboratory and instrumental examinations. The patient’s recruitment was carried out from 01.11.2020 to 30.06.2023. Overall, 10,884 patients with AMI were included in the MI REGION, of which 3252 patients with non-STEMI and 7631 — with acute myocardial infarction with ST segment elevation (STEMI), information on the appointment or refusal of IV therapy on the first day of hospitalization is present for 7597 patients with STEMI.Results. On the first day after hospitalization, 1.2% (n=91) of patients with STEMI received IVF therapy. In all cases, metoprolol was used at an average daily dose of 4.43 mg. The majority of patients (61.5%, n=56) were transferred to oral administration of BB on the first day, another 33% of patients (n=30) — the next day, 4.4% (n=4) received only intravenous BB, one (1.1%) information is missing due to the transfer to another hospital. The most common relative and absolute contraindications to the appointment of BB — acute heart failure (AHF), including Killip II, and systolic blood pressure less than 120 mmHg. They were observed in less than 20% of all patients with STEMI and in 13% and 12% of patients who received IVF. 74% of patients received oral medications on the first day. Oral forms of BB were used to initiate therapy 61 times more often than IVF of BAB (p

Aim. To analyze the frequency, indications, and outcomes of using glycoprotein IIb/IIIa inhibitors in patients with acute myocardial infarction (AMI) in Russia based on data from a multicenter registry.Material and methods. This work is part of the REGION-MI (Russian Registry of Acute Myocardial Infarction) multicenter retrospective-prospective observational study, which included patients admitted to hospitals in 45 regions of Russia with a diagnosis of AMI from 2020 to 2023. The decision to prescribe glycoprotein IIb/IIIa inhibitors was made by physicians. The observation period was 12 months, the following outcomes were recorded: cardiovascular events (relapse/repeated AMI, stent thrombosis, revascularisation), hemorrhagic complications, and in-hospital and all-cause mortality during the entire observation period. The study is conducted on the "Quinta" platform. Statistical data processing was performed using IBM SPSS Statistics ver.24.Results. A total of 10,884 patients were included in the registry, glycoprotein IIb/IIIa inhibitors were prescribed to 114 patients (1%), all of whom underwent percutaneous coronary intervention (PCI), while among patients with non-ST elevation myocardial infarction, the frequency of IIb/IIIa inhibitors was 0.5%, among ST-segment elevation myocardial infarction patients — 1.3%. Eptifibatide was used most often (67.5%), tirofiban was prescribed in 28.9% of cases, abciximab — 2.6%, framon — 0.9%. The most common indication for prescribing drugs were complications of PCI, in particular — distal embolism. There was a higher incidence of cardiogenic shock and multivessel revascularization in the glycoprotein IIb/IIIa inhibitor group. In-hospital mortality and adverse events within 180 days (death, cardiovascular events) did not differ between patients who did and did not receive glycoprotein IIb/IIIa inhibitors. The use of glycoprotein IIb/IIIa inhibitors in this study was associated with an increased risk of all in-hospital bleeding (odds ratio 9.656, confidence interval 2.859-3,894, p

Aim. To study possible causes of dyspnea in patients with stable coronary artery disease (CAD).Material and methods. 101 patients with stable CAD and paroxysmal dyspnea who underwent inpatient treatment in the cardiology department were included in the observational study. The following parameters were analyzed: presence and severity of dyspnea, angina pectoris, chronic heart failure (CHF), anxiety and/or depression, results of physical examination, electrocardiography,laboratory tests (levels of high sensitive cardiac troponin, natriuretic peptide and thyroid-s timulating hormone in the blood), a 6 minute walk test, multispiral computed tomography or chest X-ray, Holter monitorechocardiography, stress echocardiography with a treadmill load, spirometry with a bronchodilation test, as well as coronary angiography, which was performed in the detection of myocardial ischemia were.Results. Transient myocardial ischemia as a cause of dyspnea was diagnosed in 36 patients (35.6%). At the same time, chest pain during stress echocardiography was noted only in 5% of cases. In addition to myocardial ischemia, the following possible causes of dyspnea were found: CHF with preserved left ventricular ejection fraction (EF) in 76 patients (75.2%), obesity — in 34 (33.7%), anxiety — in 33 (32.7%), valvular pathology — in 28 (27.7%), pulmonary ventilation disorders — in 21 (20.8%), depression — in 20 (19.9%), cardiac rhythm and conduction disorders — in 9 (8,9%), thyroid dysfunction — in 7 (6.9%), CHF with mildly reduced EF — in 7 (6.9%), CHF with reduced EF — in 2 (2.0%), anaemia — in 2 (2.0%). The potential cause of dyspnea was not established in 2 patients (2.0%). One cause of dyspnea was diagnosed in 8.9%, a combination of two causes — in 38.6%, three — in 25.7%, four — in 15.8%, five — in 6.9%, six causes — in 1% of participants. Dyspnea commonly was associated with transient myocardial ischemia combined with CHF with preserved EF (17%), as well as CHF with preserved EF and valvular pathology (13.9%).Conclusion. The obtained results confirm the variety of possible causes of dyspnea in patients with stable CAD, as well as the fact that transient myocardial ischemia is not the most common cause of dyspnea in this category of patients and in many cases is combined with other disorders accompanied by similar symptoms.

The article analyzes the results of the All-Russian competition for general practitioners, family doctors and internists held over five years by the National Medical Research Center for Therapy and Preventive Medicine with the support of the Russian Society for the Prevention of Non communicable Diseases.Aim. To determine the methodological characteristics of managing the academic competition as a type of informal education.Material and methods. To conduct the competition, practice-oriented tasks corresponding to professional tasks of a general practitioner were developed. In addition, we developed an original questionnaire to assess the impact of participation in the academic competition on the professional development. Family doctors and general practitioners with 1-10 years of experience, as well as internists, were included.Results. The methodological characteristics of the academic competition management as a type of informal education were determined: practice-oriented goals aimed at improving the knowledge, skills and abilities, competencies of the participants; the content of tasks based on the theory-practice relationship; compliance of tasks and real situations in the practice of a general practitioner; a systematic approach to competition management. Conclusion. The effectiveness of the academic competition as a type of informal education contributes to the professional development of participants, promotes the development of long-term attitudes towards improving professional knowledge, skills, abilities and competencies necessary for solving professional problems.

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

Aim. To evaluate the long-term impact of endovascular left atrial appendage occlusion (LAAO) on heart failure (HF) course in patients with atrial fibrillation (AF).Materials and Methods: The prospective cohort study included patients with AF, HF, and a high risk of thromboembolic events, of which 39,6% underwent LAAO, 60,4% — received standard preventive therapy for cardioembolic events. Changes in BNP levels in the LAAO and control groups were analyzed throughout the observation period. The incidence of unfavorable HF outcomes (decompensated HF, hospitalizations related to HF, worsening HF class) was compared using the Cox-regression analysis with the log-rank test. A univariate analysis using Cox regression was conducted to identify independent predictors of endpoint achievement, involving all clinical and historical factors. Subsequently, a multivariate analysis was carried out, with predictors selected through the Wald exclusion test from those factors with a p-value less than 0.2 in the univariate analysis. Each factor was found to be a statistically significant independent predictor of the endpoint, with the overall model significance of p

Many patients and some doctors associate the worsening of cardiovascular diseases with meteoropathy (changes in atmospheric pressure and air temperature). Opinion about lack of weather influence on the increase in overall morbidity and the lack of related research data indicate the need to study the relationship between cardiovascular diseases and meteorological conditions.Aim. To assess the prevalence of hospitalizations with symptomatic increases in blood pressure (BP), atrial fibrillation (AF), and decompensated heart failure (HF) in a Moscow hospital depending on meteorological conditions.Material and methods. This retrospective analysis of the number of emergency hospitalizations of patients with symptomatic increases in blood pressure, AF, and decompensated HF in Moscow City Clinical Hospital № 24 was carried out in the period from October 1, 2018 to September 30, 2019. Information from the website www.weather.com was used as a source of meteorological data. The following indicators were assessed daily: daytime air temperature (t), nighttime air temperature, maximum diurnal air temperature variation, atmospheric pressure, maximum diurnal atmospheric pressure variation, amount of precipitation. To assess statistical significance, the Mann-Whitney and Kruskal-Wallis tests were used. A correlation analysis was carried out, and a prognostic model was created using multiple linear regression.Results. During the period from October 1, 2018 to September 30, 2019, 4354 patients were hospitalized at City Clinical Hospital № 24 with symptomatic BP increase and/or AF and/or decompensated HF. The highest number of hospitalizations occurred in November, December and January. The median number of admissions per day was 12 patients. When comparing the mean number of patients admitted to the hospital per day, depending on day- and nighttime air temperature, following statistically significant differences were obtained (p

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Aim. To study the relationship between the presence and size of microvascular obstruction (MVO) and the prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) within one year.Material and methods. The study included 50 patients with a first STEMI who underwent PPCI on the infarct-related artery. After 3-7 days and 12 months, contrast-enhanced cardiac magnetic resonance imaging was performed to assess left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and MVOs. After 12 months, patients were rehospitalized and prognosis was assessed based on data on cardiovascular events.Results. Patients with MVO had a significantly lower LVEF in the acute period of MI (44,1±10,6%) compared to patients without MVO (52,9±10,5%), p=0,0209, as well as during reassessment after a year (44,8±11,1%) compared with patients without MVO (58,9±8,0%), p=0,0004. A significant inverse correlation was found between LVEF in the initial and repeat examination and MVO size in the initial examination as follows: ρ=-0,42 (95% confidence interval (CI): -0,66 — -0,12, p=0,008) and ρ=-0,61 (95% CI: -0,78 — -0,34, p=0,0001). There was also a significant inverse correlation between LVEF and MVO size at reassessment, ρ=-0,40 (95% CI: -0,65 — -0,07, p=0,0205). A significant direct correlation was identified between MVO size in the acute MI period and LVEDV one year later, ρ=0,35 (95% CI: 0,02-0,62, p=0,0409). The development of a left ventricular (LV) aneurysm was registered in 40% of patients with MVO during the initial study and was not registered among patients without MVO (p=0,0039).Conclusion. MVOs was associated with post-infarction LV aneurysm. An increase in MVO size correlated with a decrease in LVEF and an increase in LVEDV both in the acute period and one year after MI.

Arterial involvement in atherosclerosis is systemic in nature and is not limited to a single vessel causing ischemic symptoms. Atherosclerotic plaques at various stages of development are simultaneously present in arteries of a patient with atherosclerosis, and many of them undergo cycles of rupture and repair without any clinical manifestations. The chronic use of antithrombotic drugs is one of the ways to prevent the development of clinically significant thrombosis after atherosclerotic plaque destabilization. For this purpose antiplatelet agents, are used in patients with diseases caused by atherosclerosis, who do not have indications for long-term use of high (therapeutic) doses of anticoagulants. At present, acetylsalicylic acid maintains a leading position of the main antithrombotic drug in monotherapy and a must component of composite antithrombotic therapy. Recent studies have limited its role only in certain clinical settings: (1) a prolonged (more than 1 month) use after coronary stenting in patients requiring a long-term use of high (therapeutic) doses of oral anticoagulants; (2) a long-term use after coronary stenting in some patients receiving acetylsalicylic acid combined with ticagrelor; (3) use as first-line drug monotherapy in patients with symptomatic atherosclerosis of arteries of the lower extremities; (4) a long-term use as first-line drug monotherapy after ischemic non-cardioembolic stroke. The use of acetylsalicylic acid requires adequate patient adherence to treatment and sufficient bioavailability of the active substance. When there are doubts on proper bioavailability, it is reasonable to use nonenteric-coated dosage forms of acetylsalicylic acid.

Aim. To compare different scores in assessment of risk of left atrial or its appendage thrombosis (LAAT) in patients with non-valvular atrial fibrillation (AF) or atrial flutter (AFL) undergoing transesophageal echocardiography before catheter ablation (CA) or cardioversion (CV).Material and methods. In retrospective, single-center, case-control study medical records of 1994 patients with non-valvular AF or AF from the period 2014-2019, who underwent transesophageal echocardiography before CA or elective CV, were analyzed. LAAT was detected in 33 of them. For the control group, 167 patients without LAAT were randomly selected from this database. CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were evaluated and compared as potential predictors of LAAT.Results. Mean age of studied patients (n=200) was 60.3±10.9, 55% of them were males. Most of patients had non-valvular AF (87,5%) and were assessed before CA (84,0%). All risk scores were associated with LAAT and CHA2DS2-VASc-RAF score was most informative [AUC 0.84; 95% confidence interval (CI) 0.76-0.91]. According to multivariate analysis in a logistic regression model among studied risk scores CHA2DS2-VASc-RAF score was the single independent predictor of LAAT [odds ratio (OR) 1.37; 95% CI 1.21-1.55; p=0.004). OR of LAAT among patients with CHA2DS2-VASc-RAF >3 was 12.8 (95% CI 3.75-43.9; p˂0.0001) with sensitivity, specificity, positive and negative predicting values 90.6%, 57.1%, 30.2% and 96.7% respectively.Conclusion. In the studied group of patients with non-valvular AF or AFL, without severe structural heart disease and severe concomitant diseases CHADS2, CHA2DS2-VASc, R2CHADS2, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc, CHA2DS2-VASc-AFR, ATRIA scores were associated with LAAT. CHA2DS2-VASc-RAF score was the most informative.

Due to the continued risk of recurrence after a first episode of proximal deep vein thrombosis (DVT) of the lower extremities and/ or pulmonary embolism (PE) occurring without major transient risk factors, long-term use of anticoagulants is indicated in many cases. One attractive way to individualize the duration of treatment in these cases appears to be the assessment of blood D-dimer concentration. However, according to the prospective studies PROLONG, PROLONG II and REVERSE II, even persistent normalization of blood D-dimer concentration does not guarantee the absence of relapse. The available evidence also does not allow a differentiated approach to the assessment of the role of D-dimer for cases where proximal DVT and/or PE occurs in patients without identifiable risk factors or with minor risk factors. An attempt to clarify some of these uncertainties was made in the prospective APIDULCIS study, which included 732 patients who first had proximal DVT and/or PE, with symptoms occurring in the absence of obvious provoking factors (75.6% of cases) or associated with minor (weak) and transient risk factors (24.4%). The prerequisites included a normal blood D-dimer concentration. Patients were discontinued anticoagulants and blood D-dimer concentration measurements were repeated after 15, 30, and 60 days. If it remained low, the anticoagulant was not resumed (39.1% of cases), and when it first increased, apixaban was administered in a dose of 2.5 mg twice daily. The APIDULCIS study confirmed that anticoagulants cannot be discontinued after 1 year of use after the first unprovoked episode of proximal DVT and/or PE, even with persistent normal blood D-dimer concentration; it was shown that recurrence rate after the first episode of proximal DVT and/or PE, provoked by a minor transient risk factor, is high enough even after at least 1 year of anticoagulant treatment and at stable normal blood D-dimer concentration after their cancellation; comfirmed the effectiveness and safety of a reduced dose of apixaban (2.5 mg 2 times a day) during prolonged treatment of the first episode of proximal DVT and/or PE.

Aim. In patients with acute thrombophlebitis of the great saphenous vein and/or large tributaries, compare the effectiveness and safety of 1,5-month fondaparinux sodium therapy and endovenous laser ablation in the area of the saphenofemoral junction in combination with shortterm anticoagulation or without anticoagulant therapy.Material and methods. This prospective, single-center, randomized, open-label clinical trial included 105 patients with acute great saphenous vein thrombophlebitis at a distance of at least 5 cm from the saphenofemoral junction. Thirty-four patients were randomized into the group of endovenous laser ablation in the area of the saphenofemoral junction without the anticoagulant therapy. The group of endovenous laser ablation in combination with 7-day fondaparinux sodium included 35 patients, while the group of 1,5-month treatment with fondaparinux sodium — 36. In all cases, class 2 compression stockings were used for 1,5 months. Clinical manifestations of venous thrombosis and its prevalence according to compression ultrasonography were assessed in the first 45±2 days from the start of treatment.Results. The mean age of patients was 49,1±13,7 years. There were more women (73,3%). The prevalence of risk factors for the occurrence and progression of venous thrombosis was low. Previous episodes of thrombophlebitis were observed in 3 (2,9%) patients. External factors that could provoke venous thrombosis were identified in 21 (20,0%) patients. Thrombosis was located in the great saphenous vein in 97,1% of patients, while large tributaries were involved in 25,7% of cases. The median distance from the proximal thrombus to the saphenofemoral junction was 45,2 cm. Patients randomized to the pharmacotherapy group were significantly older (mean age 49,1±13,7, 45,9±13,3 and 53,8±13,2 years, respectively; p=0,032), had slightly less pain and swelling. In all patients, after endovascular laser obliteration, a stable flow cessation at the intervention site was achieved. There were no cases of progression of venous thrombosis. After 7±2 days, in all groups there was a significant decrease in the proportion of patients with clinical manifestations of venous thrombosis, as well as the severity of persistent clinical manifestations. After 45±2 days, clinical manifestations were observed in a few patients and their severity was minimal. However, in the drug treatment group, a more frequent persistence of edema was noted both after 7±2 days (26,5, 20,0 and 47,7%, respectively; p=0,036) and after 45±2 days, (0, 2,9 and 16,7%, respectively; p=0,01). Hematomas and bruises were exclusive hemorrhagic complications. Hematomas were revealed in groups with endovenous laser ablation only. All hemorrhagic complication were minor according to World Society of Thrombosis and Hemostasis (ISTH) and type 1 according to Academic Research Consortium (BARC) classifications.Conclusion. In outpatients with low risk of recurrence and mainly distal localization of acute thrombophlebitis of the great saphenous vein and/ or large inflows, endovenous laser ablation close to saphenous vein junction without anticoagulation or with 7 days of anticoagulation and medical treatment with 1,5-month anticoagulation had comparable efficacy and invasive treatment was sufficiently safe.

Aim. To study the outcomes frequency and structure in patients with atrial fibrillation (AF) depending on the cardioembolic events preventing method: left atrial appendage (LAA) isolation, direct oral anticoagulants (DOACs) or warfarin.Material and methods. A prospective observational study included patients with AF and high risk of cardioembolic complications and without contraindications to anticoagulants. Patients who refused long-term oral anticoagulants taking underwent LAA isolation, the rest of the patients received DOACs or warfarin. The observation period was 3 years. Mortality, cardioembolic complications and major bleeding (according to GARFIELD criteria) cumulative incidence was assessed.Results. We included 245 patients: 46 patients were treated with LAA isolation, 100 with warfarin, and 99 with DOACs. Multivariate regression analysis demonstrated a statistically significant advantage of LAA occluder in terms of combined endpoint achieving frequency compared to warfarin (hazard ratio [HR] 3.10; 95% confidence interval [CI] 1.01-9.54; p=0.049), and to DOACs (HR 3.44, 95% CI 1.15-10.29; p=0.027). A similar result was obtained for all-cause mortality (HR 5.24; 95% CI 1.12-24.55; p=0.036 and HR 5.58; 95% CI 1.22-25.49; p=0.027, respectively). There were no significant differences in bleeding rates between the groups.Conclusion. This observational study demonstrates the superiority of LAA isolation as a first-line therapy over DOACs and warfarin in patients with AF and high risk of cardioembolic complications. Randomized trials are required to confirm these observations.

Parenteral administration of high (therapeutic) doses of anticoagulants is a mandatory component of the initial treatment of acute coronary syndrome (ACS) unless contraindicated. In ACS, intravenous administration of unfractionated heparin, the use of low molecular weight heparin enoxaparin, selective antagonist of activated X clotting factor fondaparinux sodium and direct thrombin antagonist bivalirudin are possible. The review presents current approaches to the choice of drugs and the specifics of parenteral anticoagulant use depending on ACS variant (with or without persistent ST-segment elevations on ECG), approaches to myocardial revascularization, previous use of oral anticoagulants, renal function, risk of major bleeding, presented in current versions of European Society of Cardiology and Russian Society of Cardiology guidelines, approved by the Russian Ministry of Health. It is shown that, according to the results of randomized controlled trials and expert opinion, for most ACS treatment scenarios (streptokinase thrombolytic therapy or no reperfusion therapy in ACS with persistent ST elevation on ECG, ACS without persistent ST elevation) the optimal approach is parenteral administration of sodium fondaparinux. Exceptions include primary percutaneous coronary intervention and very early invasive treatment of ACS without persistent ST-segment elevation, but initial treatment with sodium fondaparinux does not prevent these approaches. Additional advantages of sodium fondaparinux are the absence of the need to monitor the coagulation system, a fixed dose, as well as the possibility of use in patients with significant thrombocytopenia. If short-term use of parenteral anticoagulant is expected (in early invasive treatment of ACS), there are contraindications or limitations to the use of sodium fondaparinux and sodium enoxaparin, the means of choice for most cases is intravenous administration of unfractionated heparin.

Aim. To study the potential of predicting thrombosis of the left atrium (LA) and/or LA appendage (LAA) before catheter ablation (CA) or elective cardioversion in patients with nonvalvular atrial fibrillation (NAF) or atrial flutter (AFL) using indicators available in routine practice.Material and methods. In this single-center retrospective study, the medical records of 1994 patients with nAF or AFL for the period 2014-2019 were analyzed, who underwent transesophageal echocardiography before CA or elective CV. LA/LAA thrombus was found in 33 (1,6%) patients. For the comparison group, 167 patients were randomly selected without LA/LAA thrombosis. Demographic, anamnestic, clinical, laboratory data, results of transthoracic echocardiography, as well as the CHA2DS2-VASc-RAF (CHA2DS2-VASc plus 2 points for an estimated glomerular filtration rate 7 days), 10 points for persistent AF).Results. The mean age of the patients was 60,3±10,9 years (men, 55%). There were more patients with NAF (87,5%), hospitalized for CV (84,0%). Multivariate analysis revealed that the severity of symptoms associated with arrhythmia was associated with the detection of a LA/LAA thrombus (odds ratio (OR) for EHRA class 3-4 14,29 at 95% confidence interval (CI): 3,3-61,8; p3 was 12,8 (95% CI: 3,8-43,9; p8 was 25,8 (95% CI: 5,9-112,3; p

This article presents a critical analysis of the results of three prospective randomized controlled trials of anticoagulant use in patients with superficial vein thrombosis of lower limbs CALISTO using fondaparinux sodium, STEFLUX using different doses of parnaparin sodium, and SURPRISE comparing the effectiveness and safety of fondaparinux sodium and the preventive dose of the oral anticoagulant rivaroxaban.Evidence from these clinical trials suggests that low-dose anticoagulants should be used for at least 1.5 months in superficial vein thrombosis of lower limbs with thrombus localization beyond 3 cm from the saphenofemoral and/or saphenopopliteal junction. However, anticoagulant treatment does not appear to prevent the progression of venous thrombosis after withdrawal, so in patients with persisting risk factors, it is reasonable to consider extended treatment. This seems to apply primarily to patients with superficial thrombophlebitis a history of superficial or deep venous thrombosis in the lower extremities, a family history of venous thromboembolic complications, and possibly a broader contingent of high-risk patients, not represented in the CALISTO and STEFLUX studies (with active malignancy, ongoing anticancer therapy, severe chronic heart or respiratory failure, inability to withdraw hormone replacement therapy, autoimmune disease). According to the accumulated evidence, subcutaneous injections of fondaparinux sodium, intermediate doses of low molecular weight heparin, and direct oral anticoagulant rivaroxaban in the dose of 10 mg once a day are effective and sufficiently safe in the treatment of superficial vein thrombosis of lower limbs with localization beyond 3 cm from the saphenofemoral and/or saphenopopliteal junction. Questions about the feasibility of increasing the doses of anticoagulants to further reduce the rate of superficial thrombophlebitis - progression during treatment and the optimal duration of their use remain open.

This review discusses reasons for prolonged use of anticoagulants after discharge of patients with COVID-19 without additional indication for anticoagulation. Data regarding rate of thrombotic and thromboembolic complications in patients with COVID-19 after discharge from the hospital are presented. Large randomized controlled trials EXCLAIM, ADOPT, MAGELLAN, APEX and MARINER with prolonged use of anticoagulants in patients hospitalized with acute nonsurgical diseases before pandemia of COVID-19 are discussed. The first prospective randomized controlled trial MICHELLE with direct oral anticoagulant rivaroxaban in a dose 10 mg once daily after discharge of patients with COVID-19 with high risk at least venous thromboembolism are analyzed. It seems that the most relevant approach for the determination of indications for prolonged use of anticoagulants in doses dedicated for primary prevention of venous thromboembolism after discharge of patients with COVID-19 without apparent indication for anticoagulation is a modified IMPROVE VTE risk score with the addition of elevated in-hospital D-dimer level. And the most well-studied approach for anticoagulation in these patients is a direct peroral anticoagulant rivaroxaban 10 mg once daily for 35 (and possibly up to 45) days after discharge.

Aim. To determine the incidence of left atrial (LA) and/or LA appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation (AF) (NAF) or atrial flutter (AFL) on transesophageal echocardiography (TEE) before elective catheter ablation (CA) or cardioversion (CV) and characterize the predictors of LA/LAA thrombosis among the indicators available in the routine practice of cardiologists and general practitioners.Material and methods. In this retrospective, single-center, casecontrol study, the medical records of 1994 patients with NAF or AFL for the period 2014-2019, who underwent TEE before CA or elective CV, were analyzed. A thrombus in the LA/LAA was detected in 33 (1,6%) of them. For the comparison group, 167 patients were randomly selected without LA/LAA thrombosis. Demographic, anamnestic and clinical parameters, transthoracic echocardiography data, and laboratory results were analyzed as potential predictors of LA/LAA thrombosis.Results. Patients with LA/LAA thrombosis were older (mean age, 64,8±1,6 vs 59,4±10,8 (p=0,01), more often had persistent or longstanding persistent AF, hypertension, heart failure, enlarged LA, lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate, as well as more severe symptoms according to the modified European Heart Rhythm Association (EHRA) score and a higher CHA2DS2-VASc score (median, 4,0 vs 2,0; p=0,0001). Oral anticoagulants were taken by 88% of patients; there were no significant differences in the presence and composition of anticoagulant therapy between the groups. Functional class (FC) according to the modified EHRA score (odds ratio (OR), 5,4; 95% confidence interval (CI): 1,9814,96; p=0,001) and LVEF were independent predictors of LA/LAA thrombosis (OR, 0,87; 95% CI: 0,80-0,95; p=0,002). For EHRA class 3-4, the OR was 5,1; 95% CI: 2,3-11,4 (p

Thrombophlebitis of the superficial lower limb veins is one of the most common complications of chronic vein disease. Nowadays a long-term (at least 45 days) subcutaneous injection of fondaparinux sodium or heparin in combination with elastic compression of the limb is recommended for treatment of superficial vein thrombosis with a moderate risk of thrombus propagation to deep venous system. However, long-term use of anticoagulants is not always possible and sometimes contraindicated. Endovenous laser ablation (EVLA) around thrombus-free junction of great or small saphenous veins without subsequent long-term use of anticoagulants seems to be a promising intervention for treatment of acute thrombophlebitis of varicose superficial veins.The prospective single-center randomized open-label clinical trial was dedicated for comparison the efficacy and safety of three following treatments options for patients with acute thrombosis of the varicose great saphenous vein and location of thrombi in the trunk and/ or its large inflows: EVLA close to saphenous vein junction without anticoagulation, EVLA and 7 days of anticoagulation and noninvasive treatment with anticoagulation for 45 days (subcutaneous injections of the fondaparinux 2,5 mg). Class 2 compression stockings are used in all patients. Adverse outcomes are recorded at 7, 45 and 90 days after randomization. These include the progression of superficial vein thrombosis, recurrent superficial vein thrombosis, thrombosis involvement of the superficial segment of the perforating vein up to the fascia, deep vein thrombosis according to compression ultrasound, and pulmonary embolism with symptoms. Bleedings according to the World Society of Thrombosis and Hemostasis and the Academic Research Consortium classification as well other complications are also recorded. The first 30 patients included in the study have a low incidence of venous thrombosis risk factors and localization of the thrombus relatively far from the saphenofemoral junction. EVLA resulted in persistent cessation of venous blood flow at the intervention site. New episodes of venous thrombosis were noted only in the group of medical treatment — deep vein thrombosis of the contralateral tibia 5 days after stopping of 45-day treatment with fondaparinux and thrombus in the recanalized inflow of the great saphenous vein without involving its trunk at the 21st day after stopping of 45-day injection of fondaparinux. There were no complications in the area of intervention and bleedings.

The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Shortness of breath is a common debilitating and limiting the quality of life symptom, which leads to frequent requests for medical help. The review summarizes data on the causes of shortness of breath in stable patients with suspected coronary heart disease (CHD), with an established diagnosis of CHD, as well as in patients with other cardiovascular diseases. PubMed, Science Direct, Google Scholar, and eLibrary search platforms were used for the selection of publications, the review includes publications from 2009 to 2021. Patients with suspected coronary artery disease complaining of shortness of breath, in addition to myocardial ischemia, not always associated with stenosing atherosclerosis of the coronary arteries. The following causes of shortness of breath are described: bronchial obstruction, psychogenic hyperventilation, and depression. When studying patients with other cardiovascular diseases, the causes of shortness of breath turned out to be even more diverse: transient myocardial ischemia (including in cases where the cause of shortness of breath initially appears to be non-ischemic), chronic heart failure, cardiac arrhythmias, pathology of the heart valves, thyroid dysfunction, lung diseases, obesity, anemia, etc. Thus, despite the limited evidence, it is obvious that in the presence of paroxysmal dyspnea in patients with stable coronary heart disease, its causes are more diverse than transient myocardial ischemia.

The incidence of atrial fibrillation (AF) and coronary heart disease (CHD) increases with age. Obviously, this is largely due to the coincidence of risk factors for the occurrence and progression of AF and risk factors for the occurrence and progression of atherosclerosis, including coronary atherosclerosis. Vitamin K antagonists, which are necessary for stroke prevention in patients with AF, are also reported to be able to prevent thrombotic complications of coronary atherosclerosis. No studies specifically designed to compare direct oral anticoagulants (DOACs) and vitamin K antagonists in the prevention of coronary thrombosis have been conducted, However, analysis of the results of randomized controlled trials ARISTOTLE, AUGUSTUS, PIONEER AF-PCI, REDUAL PCI, RE-LY and ROCKET AF indicates that in general DOACs are not inferior to warfarin in the ability to protect patients with AF from myocardial infarction and stent thrombosis. Accordingly, in stable patients with non-valvular AF (who have not suffered an acute coronary syndrome in the next 1 year or planned coronary stenting in the next 6 months) they can be used as monotherapy, without simultaneous administration of antiaggregants. Taking into account the data obtained in patients with sinus rhythm who recently had acute coronary syndrome in the randomized controlled trial ATLAS-ACS 2, as well as with stable atherosclerotic disease in the randomized controlled trial COMPASS, the greatest evidence base in the prevention of coronary complications has been accumulated with rivaroxaban. At the same time, the results of the COMPASS study, as well as analysis of daily medical practice indicate its additional benefits in patients with peripheral atherosclerosis.

The review presents up-to-date information on the physiological and pathophysiological aspects of short-term middle-altitude adaptation in healthy individuals and patients with various chronic diseases. Unlike acute mountain sickness, which develops going to ≥3000, the physiological aspects of human adaptation to 2000-2500 m remain insufficiently studied. However, these altitudes are the most visited among tourist groups and individually.

Стандартные протоколы ультразвукового исследования включают исследования всех сосудов анализируемой области, во всех режимах сканирования, с полным набором измерений, и требуют высокой квалификации специалистов и больших временных затрат. Однако для ряда клинических задач достаточно выполнения фокусированного протокола ультразвукового исследования, т.е. ориентированного на решение конкретной проблемы и, следовательно, сокращенного по времени, тем самым позволяющего увеличить число обследуемых. Оценка сердечно-сосудистого риска с помощью выявления атеросклеротических бляшек в сонных и бедренных артериях, скрининг на наличие аневризмы аорты, выявление проксимального тромбоза глубоких вен нижних конечностей – это те направления в медицине, где фокусированные протоколы ультразвукового исследования могут повысить долю обследуемых и способствовать своевременной диагностике и профилактике заболеваний. Доступность фокусированного ультразвукового исследования и развитие образовательных структур позволят расширить круг специалистов, способных выполнять подобные исследования (кардиологи, терапевты, врачи общей практики, сосудистые хирурги). Сегодня существует много вопросов по организации проведения фокусированных протоколов в клинической практике. Данный консенсусный документ направлен на повышение информированности широкого круга специалистов о задачах, принципах проведения и применении фокусированного УЗИ.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

In case of early invasive approach to the treatment of acute coronary syndrome in patients without indications forlong-term anticoagulants, double antithrombocytic therapy is recommended - a combination of acetylsalicylic acid with one of the blockers of P2Y12 platelet receptor (clopidogrel, prasugrel or ticagrelor). In this case, patients who do not have an excessively high risk of bleeding, there is evidence in favor of the choice of prasugrel or ticagrelor. Which of them is preferable in cases where in the first hours after hospitalization it is planned to perform coronary stenting is not fully clarified.The drawbacks of the randomized open PRAGUE-18 study do not allow us to judge the comparative effectiveness and safety of prasugrel and ticagrelor in primary percutaneous coronary intervention.ц The ISAR-REACT 5 study was relatively small and has its strengths as well as weaknesses. However, the European expert community considers the results to be sufficient to change the practical approaches to acute coronary syndrome treatment. Thus, according to the recommendations of the European Society of Cardiology for the treatment of acute coronary syndrome without stable ST segment elevations on ECG, which were updated in September 2020, prasugrel is proposed to be considered as a preferred treatment for ticagrelor in cases where the patient is directed to percutaneous coronary intervention (class IIa recommendation, degree of evidence B).

This review presents data on the frequency of bleeding in direct comparison of apixaban and vitamin K antagonists in the context of prospective randomized controlled trials. According to ARISTOTLE, AUGUSTUS and AMPLIFY studies, Apixaban has an advantage over vitamin K antagonists in terms of safety regardless of the indications (prevention of cardioembolic complications in nonvalvular atrial fibrillation, treatment of venous thromboembolic complications), which applies to all categories of patients studied, including those with increased risk of bleeding (elderly and old age, chronic renal failure, low body weight, arterial hypertension, the need for simultaneous use of one or two antiagregants, 3 or more points on the HAS-BLED scale). Moreover, the course of the accumulation curves of clinically significant bleedings indicates a constant increase in the number of patients who can prevent bleeding with prolonged use of apixaban instead of vitamin K antagonists.Prospective randomized clinical trials AMPLIFY and CARAVAGGIO show that in early treatment of proximal deep vein thrombosis of the lower limbs and/or thromboembolism of pulmonary arteries in patients without malignant tumors apixaban is safer than low-molecular-weight heparin enoxaparin, In long-term treatment of venous thromboembolic complications in patients with malignant tumors is not worse in safety than low-molecular-weight heparin dalteparin. Additional evidence for the safety of apixaban was obtained by comparing it with placebo in the prolonged treatment of venous thromboembolic complications in patients with low risk of serious bleeding in a prospective randomized controlled trial AMPLIFY-EXT.

The review presents data on the feasibility of using laboratory findings to predict the presence of left atrium (LA) and/or left atrial appendage (LAA) thrombus in non-valvular atrial fibrillation (NvAF). It describes the relationship between the presence of a blood clot in the LA/LAA and a blood group, certain parameters of peripheral blood, blood brain natriuretic peptide levels, homocysteine, asymmetric D-methylarginine, uric acid and D-dimer.The authors presented data of studies to show a relationship between the presence of LA/LAA trombus and individual parameters obtained during transthoracic echocardiography: left ventricular mass index, left atrial volume index, LvEF/left atrial volume index ratio, E/e' ratio, peak systolic deformity of the left atrium.The capabilities of different scales in assessing the likelihood of the presence of LA/LAA thrombus in NvAF are evaluated. insufficient information capacity of the CHADS2 and CHA2DS2-vASc scales is demonstrated. The article described attempts to improve the scales by adding other risk factors (CHA2DS2-VASc-MS, CHA2DS2VASc-AFR, CHA2DS2VASc-RAF scales, as well as the possible role of additional consideration of blood brain natriuretic peptide levels). It is shown that it is feasible to add information on the duration of NvAF paroxysm and glomerular filtration rate to the CHA2DS2-VASc scale. in addition, consideration of the presence of metabolic syndrome may be beneficial. Overall, approaches with addition of information on the duration of NvAF paroxysm and glomerular filtration rate to the CHA2DS2-VASc scale proved to be most successful.The authors presented the shortcomings of accumulated evidence base regarding the relationship between the studied parameters and the presence of LA/LAA thrombus, including a small number of examined patients, usually a retrospective character of the study, a search of LA/LAA thrombus before the planned catheter ablation or electropulse therapy. As a result, it is not known to what extent the studied predictors and scales may be applied to a wider contingent of patients with NvAF. In addition, most studies have been performed on the Asian population and it is unclear whether their results can be extrapolated to other ethnic groups. It was shown that thrombi do not disappear under pressure of anticoagulant therapy in at least one-third of patients.

In the article, a review is given of the facts that determined contemporary views of the role of clopidogrel in the treatment of acute coronary syndrome. The author described a history of the clinical studies of clopidogrel in acute coronary syndrome (ACS), analysed its role in the current approaches to the treatment of the disease during the widespread use of other platelet P2Y12 receptor antagonists (ticagrelor and prasugrel).The article discusses circumstances, when clopidogrel may have additional advantages, particularly the role of adherence to prolonged double antiplatelet therapy, as well as situations, when sever suppression of platelet function can be decreased (treatment de-escalation). According to a prospective randomized open-label PoPular Age study, clopidogrel combined with acetylsalicylic acid in patients with ACS without persistent ST segment elevations at the age of ≥70 years showed better adherence to treatment over the coming year as compared with clopidogrel combined with ticagrelor or prasugrel. As a result, these two approaches had comparable efficacy. Today, treatment de-escalation is a necessary measure to extend the double antiplatelet therapy in cases, when continued administration of prasugrel or ticagrelor appears unacceptable. There is insufficient evidence for the routine implementation of de-escalation in stented patients with ACS, although a small prospective, one-centre randomized open-label ToPIC study shows that this approach is safe.The author provides a review of the results of recently presented prospective studies on the choice of a platelet P2Y12 receptor antagonist for long-term treatment of acute coronary syndrome, taking into account the residual platelet reactivity and cytochrome p450 2c19 genetic polymorphisms. Among them are multicenter open randomized clinical TRoPICAL-ACS study, multicenter randomized open-label PoPular Genetics and TAILoR PCI studies. According to the study results, the long-term outcomes in stented patients with ACS with a good response to clopidogrel assessed by the residual functional activity of platelets or by studying cytochrome p450 2c19 genetic polymorphisms may not be worse than those during use of prasugrel or ticagrelor.

Aim. To analyze the contribution of cardiac causes to all-cause mortality, to characterize the differences in standardized mortality rates (SMRs) in Russian regions, as well as to identify promising directions for improving establishment of cardiovascular death and its coding.Material and methods. We used the Federal State Statistics Service (Rosstat) data on the mortality rate and the average annual population in one-year age groups for 2019. To calculate the SMR, the European Standard Population was used. For each cardiac death, the SMR from 23 causes was calculated, which were combined into 4 groups, and for each of these groups, the regional mean and standard deviation of SMR in Russian regions were estimated.Results. In 2019, the cardiac SMR in Russian regions was 301,02±77,67, which corresponded to 30,5±5,8% of all death causes. At the same time, the coefficient of variation of regional cardiac SMR was 25,8%. In general, in 60,9±13,8% of cases, the cause of cardiac death was chronic diseases, mainly related to atherosclerosis. The proportion of deaths from acute types of coronary artery disease was 17,3±9,7%, deaths not associated with atherosclerosis (heart defects, myocardial diseases, etc.) — 17,5±8,2%, deaths associated with hypertension — 4,2±5,2%. The coefficient of variation of regional SMR was 34,66, 64,47, 50,99 and 122,7, respectively.Conclusion. Significant regional differences in SMR from certain cardiac causes and groups of causes, as well as their contribution to mortality pattern, were revealed. It is necessary to continue the research on the methodology of statistical recording of certain cardiovascular diseases.

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices.

The review presents data on the frequency of thrombosis detection in the left atrium (LA and/or its appendage (LAA) in patients with non-valvular atrial fibrillation (NVAF), characterizes their connection with antithrombotic therapy and the presence of cardiovascular risk factors. It was demonstrated that thrombosis in LA/LAA is detected in 4-19% of cases. At the same time, data on thrombus frequency in LA/LAA were obtained by examination of small cohorts of patients with AF, who were subjected to transesophageal echocardiography before catheter isolation of pulmonary vein ostia, cardioversion, installation of occluders in LAA. Information about thrombosis frequency in the LA/LAA without these procedures is extremely limited. The frequency of thrombus detection in LA/LAA varies depending on the population studied, the presence of cardiovascular risk factors (diabetes mellitus, metabolic syndrome, arterial hypertension, chronic kidney disease, chronic heart failure) and peculiarities of anticoagulant therapy. CHADS2 and CHA2DS2-VASc scales do not sufficiently predict the presence of thrombus in LA/LAA. For example, at least 50% of patients with LA/LAA thrombus may have a low score on these scales and therefore the risk of heart thromboembolism will be underestimated. According to the facts, adequate anticoagulant therapy does not guarantee the absence of a thrombus in the LA/LAA. Approximately 40% of thrombotic formation cases in LA/LAA do not disappear after 1 year of antithrombotic treatment.

AIM. Within the framework of outpatient and hospital registers of REGION (REGIster of patients who have undergone acute cerebrovascular accident) to carry out a comparative assessment of demographic and clinical-anamnestical characteristics, medical treatment and outcomes in clinical practice in patients with a combination of undergone acute cerebrovascular accident (ACVA) and atrial fibrillation (AF) in the presence or absence of myocardial infarction (MI) in the medical history.MATERIAL AND METHODS. Outpatient registers REGION (Ryazan) and hospital register REGION (Moscow) included 1886 patients who have undergone ACVA (age 70.6 ± 12.5 years, 41.9% of men), of them 516 (27.4%) people with AF. Comparison groups included 152 (8.1%) patients with a combination of ACVA, AF and MI in medical history (ACVA + AF + MI group) and 364 (19.3%) patients with ACVA, AF without MI (ACVA + AF without MI group). The presence of cardiovascular diseases (CVD), concomitant diseases, drug therapy and outcomes were analyzed.RESULTS. In the group of ACVA + AF + MI patients, compared to the ACVA + AF without MI group, the share of patients with AH (100% and 97.2%), IHD (100% and 87.1%), CHD (68.4% and 57.1%), repeated ACVA (36.9% and 23.9%), diabetes mellitus in women (39.5% and 20.4%) was statistically significantly higher. In the comparison groups, the share of smokers (13.3% and 15.5%), patients with burdened heredity of early development of CVDs (2.1% and 1.1%) and hypercholesterolemia (41.1% and 50.0%) did not differ significantly, however, in the group of ACVA + AF + MI, in comparison with the group of ACVA + AF without MI, there was a higher risk on the CHA2DS2-VASc scale (5.26 ± 1.32 and 4.09 ± 1.44; p < 0.001) and HAS-BLED scale (1.91 ± 0.76 and 1.62 ± 0.79; p < 0.01). Patients with AF of REGION register, both with and without MI, had insufficient frequency of proper medical prescriptions for CVDs (46.6% and 38.9% on average), especially prescription of anticoagulants (19.1% and 21.4%), statins in case of IHD (33.6% and 27.4%) and beta-adrenoblockers in case of CHD (39.4% and 35.6%). During the four-year period of observation, in comparison with post-stroke patients without a history of MI, the mortality rate for all causes was 1.5 times higher (56.6% and 37.6%, p = 0.0001), the incidence of non-fatal MI was higher (2.0% and 0.3%,p = 0.04). CONCLUSION. Patients with a combination of ACVA, AF and MI history are a very high risk group for adverse outcomes observed on an outpatient stage. For these patients it is very important to improve the quality of drug therapy and the effectiveness of secondary prophylaxis.

Aim. To assess age and gender characteristics and determine comorbidity, medication, and outcomes in young ambulatory patients with cardiovascular diseases (CVD) within the framework of an ambulatory prospective registry.Material and methods. The study included 3690 patients with hypertension (HTN), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), and combinations thereof, which applied to 3 Ryazan hospitals. Younger CVD patients (criterion 1 — the age of 18-49 years, criterion 2 — the age of men 18-54 years old and women 18-64 years old) were compared with older representatives. The presence of CVD and comorbidities, medication, and outcomes over 6 year follow-up were analyzed.Results. The age groups of 18-49 years old and >50 years old included 347 (9,4%) and 3343 (90,6%) patients, respectively (men — 144 (41,5%) and 902 (27,0%), p2 CVDs was 41%; according to criterion 2 — 62% (p

The conclusion of the Expert Council reports an agreement on the place of the P2Y12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

The review analyzes data on the detection rate of and the abilities to predict and prevent non-cardioembolic strokes in non-valvular atrial fibrillation. According to accumulated facts, vitamin K antagonists in non-valvular atrial fibrillation are noted to be inferior to antiplatelet drugs in efficiency in preventing non-cardioembolic (atherothrombotic in particular) strokes, and the widespread use of oral anticoagulants in combination with antiplatelet drugs does not generally reduce the incidence of poor outcomes, markedly increasing the risk of serious bleeding. Nevertheless, it is conceivable that this combination antithrombotic therapy may be useful for certain categories of patients at the highest risk for atherothrombotic stroke and at relatively low risk for hemorrhagic complications. Cohorts of patients, to whom such an approach should be reasonable considered to be applied, have not yet been identified.

See: Shalnova S. A., Drapkina O. M., Kontsevaya A. V., Yarovaya E. B., Kutsenko V. A., Metelskaya V. A., Kapustina A. V., Balanova Yu. A., Litinskaya O. A., Pokrovskaya M. S. Pilot project to study the association of troponin I with cardiovascular events in the population of Russian region in Original articles, pp. 185-192.

В данном документе обсуждаются особенности АТТ у лиц пожилого и старческого возраста в различных клинических ситуациях.

On February 25, 2021, an expert round table was held, which considered the problem of interdisciplinary discussion of a coronavirus disease 2019 (COVID-19) and the development of joint actions for management of patients with chronic noncommunicable diseases during a pandemic.

This review describes the results of randomized, controlled clinical trials comparing the outcomes of stable coronary artery disease after myocardial revascularization and non-invasive treatment, including the recently published results of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA). New potentials for improving the prognosis in stable coronary artery disease with the help of drug treatment are characterized, the role of which has not yet been evaluated in studies comparing the effectiveness of invasive and conservative approaches to the management of such patients.

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

In this review changes of hemostatic parameters in patients with COVID19 and their practical value are discussed. Current approaches to prevention and treatment of thrombotic/thromboembolic complications in patients with COVID-19 are considered.

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

The growing population of elderly people is the main «antithrombotic drugs consumer» because there is higher prevalence of thromboembolic diseases (acute coronary syndrome, venous thromboembolism, atrial fibrillation) among them than among younger people. Elderly people have high risks of both thromboembolic and bleeding complications associated with antithrombotic drugs using. Antithrombotic drug choice is based on individual careful estimation of the «risk/benefit» ratio. Sometimes real clinical practice gives us problems and questions, having no answers in any guidelines. Such a difficult clinical case of elderly patient management is presented in this article.

Practical approaches to use of oral anticoagulants for prevention and treatment of thrombotic and thromboembolic complications in patients with atrial fibrillation, venous thromboembolism and coronary heart disease are considered. Comparison of main pharmacologic properties of DOACs and warfarin as well as their efficacy and safety in prospective randomized controlled trials are present. Clinical situations with minimal or no evidence for use of DOACs are specified.