urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.24.3.139OHCAOUurmj-1906Research ArticleЛитературные обзоры | Literature reviewsLiterature reviewsКлиническая и генетическая характеристика резистентности антитромбоцитарной терапии после ишемического инсульта (литературный обзор)Clinical and Genetic Characteristics of Antiplatelet Therapy Resistance After Ischemic Stroke (Literature Review)https://orcid.org/0009-0003-5058-063XБатеньковаТ. Ю.BatenkovaT. Yu.

Батенькова Татьяна Юрьевна — невролог неврологического отделения, консультативно-диагностическая поликлиника.

Екатеринбург

Tatiana Yu. Batenkova — Neurologist of the Neurological Unit, Consultative and Diagnostic Polyclinic, Sverdlovsk Regional Clinical Hospital No. 1.

Ekaterinburg

tyubatenkova@yandex.ruhttps://orcid.org/0000-0002-2478-727XВолковаЛ. И.VolkovaL. I.

Волкова Лариса Ивановна — доктор медицинских наук, профессор, профессор кафедры неврологии и нейрохирургии, институт клинической медицины, УГМУ; невролог, научный руководитель неврологической клиники, Свердловская ОКБ № 1.

Екатеринбург

Larisa I. Volkova — Doctor of Sciences (Medicine), Professor, Professor of the Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Ural State Medical University; Neurologist, Scientific Supervisor of the Neurological Clinic, Sverdlovsk Regional Clinical Hospital No. 1.

Ekaterinburg

lar-volkova@mail.ruhttps://orcid.org/0000-0003-2797-1926КудрявцеваЕ. В.KudryavtsevaE. V.

Кудрявцева Елена Владимировна — доктор медицинских наук, доцент, генетик отделения медико-генетического консультирования, КДЦ «Охрана здоровья матери и ребенка»; профессор кафедры акушерства и гинекологии, Уральский институт управления здравоохранением им. А.Б. Блохина.

Екатеринбург

Elena V. Kudryavtseva — Doctor of Sciences (Medicine), Associate Professor, Geneticist of the Medical and Genetic Counseling Unit, Clinical and Diagnostic Center “Health Care of Mother and Child”; Professor of the Department of Obstetrics and Gynecology, Ural Institute of Public Health Management named after A.B. Blokhin.

Ekaterinburg

elenavladpopova@yandex.ruСвердловская областная клиническая больница № 1РоссияSverdlovsk Regional Clinical Hospital No. 1Russian FederationСвердловская областная клиническая больница № 1; Уральский государственный медицинский университетРоссияSverdlovsk Regional Clinical Hospital No. 1; Ural State Medical UniversityRussian FederationКлинико-диагностический центр «Охрана здоровья матери и ребенка»; Уральский институт управления здравоохранением имени А.Б. БлохинаРоссияClinical and Diagnostic Center “Health Care of Mother and Child”; Ural Institute of Public Health Management named after A.B. BlokhinRussian Federation202506072025243139–156Copyright © Батенькова Т.Ю., Волкова Л.И., Кудрявцева Е.В., 20252025Батенькова Т.Ю., Волкова Л.И., Кудрявцева Е.В.Batenkova T.Y., Volkova L.I., Kudryavtseva E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1906

Ежегодно среди всех ишемических инсультов 20 % являются повторными, характеризуются тяжелым течением и высокими показателями летальности и инвалидизации. На предотвращение повторной мозговой катастрофы направлены меры вторичной профилактики, что приводит к уменьшению риска развития повторного острого нарушения мозгового кровообращения на 20–30 %. Одним из направлений терапии является назначение антитромбоцитарных препаратов. В настоящее время в России широко используются ацетилсалициловая кислота и клопидогрел. Эффективное ингибирование тромбоцитов путем назначения этих антиагрегантов является одной из приоритетных задач в лечении атеротромботического ишемического инсульта. При этом у ряда пациентов развивается резистентность к антиагрегантам, что связано со множеством факторов, например, взаимодействием лекарств, наличием сопутствующих заболеваний и генетической предрасположенностью. Для контроля за формированием лабораторной резистентности разработано несколько методов оценки функции тромбоцитов. Например, оптическая агрегатометрия по Борну, тромбоэластограмма, проточная цитометрия. В настоящее время нет «золотого стандарта» для определения высокой остаточной активности тромбоцитов, поскольку у каждого метода есть преимущества и недостатки. В работе рассмотрены методы выявления лабораторной резистентности и факторы, влияющие на ее развитие, в зависимости от назначенного антитромбоцитарного препарата.

Every year, 20 % of all ischemic strokes are recurrent, characterized by severe course and high mortality and disability rates. Secondary prevention measures are aimed at preventing repeated brain catastrophes, which leads to a 20–30 % reduction in the risk of recurrent stroke. One of the directions of therapy is the appointment of antiplatelet drugs. Currently, acetylsalicylic acid and clopidogrel are widely used in the Russia. Effective platelet inhibition by prescribing these antiplatelet agents is one of the priorities in the treatment of atherothrombotic ischemic stroke. At the same time, a number of patients develop resistance to antiplatelet agents, which is associated with a variety of factors, such as drug interactions, concomitant diseases, and genetic predisposition. In order to control the formation of laboratory resistance, several methods for assessing platelet function have been developed. For example, optical Born aggregatometry, thromboelastogram, flow cytometry. Currently, there is no “golden method” for determining the high residual activity of platelets, since none of them has achieved a significant advantage. This article discusses methods for detecting laboratory resistance and factors influencing its development, depending on the prescribed antiplatelet drug.

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