Dual antiplatelet therapy (DAPT) using of acetylsalicylic acid and antagonists of platelet’s P2Y12 receptors is included in standards for treatment of patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Clopidogrel, prasugrel, and ticagrelor are the P2Y12 receptor inhibitors used as a component of DAPT. The aim of this review is to determine the most effective and the safest P2Y12 receptor inhibitor for treating patients with an invasive treatment strategy of ACS. The TRITON study compared clopidogrel and pragugrel efficacy and safety had demonstrated a significantly higher efficiency in reducing the risk of reaching the primary endpoint (including cardiovascular death, myocardial infarction and stroke) for prasugrel, but at the same time, the prasugrel group was reliably recorded higher rate of major bleeding. Comparison of the efficacy and safety of clopidogrel and ticagrelor was carried out in the PLATO study, where ticagrelor was shown to be more effective in reducing cardiovascular deaths and myocardial infarction, while the safety of the drugs was comparable. A subsequent ISAR-REACT 5 study proved higher efficacy of prasugrel compared to ticagrelor in reducing the risk of reaching a primary endpoint with comparable safety to the major bleeding risk. Baseline data represents that the most effective drug among P2Y12 receptor inhibitors as a component of DAPT for patients with an invasive treatment strategy is prasugrel, and the safest is clopidogrel, which can be considered in elderly patients.

Objective: to describe a clinical case of polymorphic leukocytoclastic vasculitis (PLCV) associated with renal neoplasia.Materials and methods. Patient K., a man, 67 y. o., was admitted to the surgical department No. 2 of the N. I. Pirogov State Clinical Hospital No. 1 with cardiac complaints and heart failure decompensation symptoms, severe respiratory insufficiency associated right lower lobe pneumonia. Besides cardiac function evaluation and pneumonia managing there was a conducting of differential diagnostic search to clarify the genesis of ulcerative necrotic rashs among systemic vasculitis, paraneoplastic syndrome including hematologic problems and sepsis.Results. It was no data for systemic connective tissue diseases and systemic vasculitis during clinical examination and immunological diagnostics. On contrast-enhanced multispiral computed tomography of abdomen and retroperitoneal space there was latent malignant neoplasia of left kidney Т2аN1M0. PLCV was considered to paraneoplastic syndrome associated with malignancy. Due to the progression of vasculitis and the patient’s refusal of surgical treatment was prescribed GC 0.5 mg / kg / day as a result positive dynamics was noted.Conclusion. This clinical case demonstrates necessity of providing examination aimed at malignancy excluding for early neoplasm’s detecting for patients with vasculitis.

Dual antiplatelet therapy (DAPT) using of acetylsalicylic acid and antagonists of platelet’s P2Y12 receptors is included in standards for treatment of patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Clopidogrel, prasugrel, and ticagrelor are the P2Y12 receptor inhibitors used as a component of DAPT. The aim of this review is to determine the most effective and the safest P2Y12 receptor inhibitor for treating patients with an invasive treatment strategy of ACS. The TRITON study compared clopidogrel and pragugrel efficacy and safety had demonstrated a significantly higher efficiency in reducing the risk of reaching the primary endpoint (including cardiovascular death, myocardial infarction and stroke) for prasugrel, but at the same time, the prasugrel group was reliably recorded higher rate of major bleeding. Comparison of the efficacy and safety of clopidogrel and ticagrelor was carried out in the PLATO study, where ticagrelor was shown to be more effective in reducing cardiovascular deaths and myocardial infarction, while the safety of the drugs was comparable. A subsequent ISAR-REACT 5 study proved higher efficacy of prasugrel compared to ticagrelor in reducing the risk of reaching a primary endpoint with comparable safety to the major bleeding risk. Baseline data represents that the most effective drug among P2Y12 receptor inhibitors as a component of DAPT for patients with an invasive treatment strategy is prasugrel, and the safest is clopidogrel, which can be considered in elderly patients.

Objective: to assess the relationship between hematological manifestations of systemic lupus erythematosus (SLE) in the early stage of the disease and development of other syndromes and symptoms of the disease, as well as the nature and severity of internal organs damage during the subsequent five-year period.Subjects and methods. The analysis of data of examination of 89 patients with SLE during the five-year period was carried out. The frequency of clinical manifestations of SLE, the level of antinuclear and antiphospholipid antibodies, SLICC/ACR damage index (SDI) depending on the presence of hematological manifestations of SLE in the onset of the disease including leukopenia (LP), thrombocytopenia (TP) and autoimmune hemolytic anemia (AGA) were studied.Results and discussion. In the onset of SLE LP was observed in 21.3%, TP – in 26.9%, AGA – in 8.9% of patients. The presence of LP was associated with an increase of antibodies to SSA frequency, and TP – with more frequent detection of antibodies to Ro-52, cardiolipin and β-2-glycoprotein (p<0.05). Patients with TP in the onset of SLE compared with patients without hematological manifestations, had an increase (p<0.05) of the cumulative incidence of nephritis (83.3 and 42.9%), central nervous system lesions (70.8 and 26.5%), vasculitis (45.8 and 10.2%) and Libman-Sachs endocarditis (20.8 and 6.1%, respectively), which was accompanied by an increase of SDI values (median was 2.09 [2, 1.82; 2.21] and 1.12 [0.81; 1.32], p<0.05). In patients with LP, the cumulative incidence of pneumonitis and Sjogren's syndrome was increased in the onset of SLE compared with patients without hematological manifestations (15.8 vs 6.1% and 15.7 vs 2.0%, respectively, p<0.05).Conclusion. Presence of TP in the onset of SLE is a predictor of kidneys, central nervous system, peripheral vessels and heart valves damage during the next 5 years.

BackgroundThe impairment of hip joints has significant prognostic value on functional status of patients with Ankylosing spondylitis (AS) [1]. One of possible yearly marker of hip joints structure damage in patients with AS may be changing in volume of hyaline cartilage [2]. Objectives.ObjectivesTo investigate changes in width of hyaline cartilage and synovial layer of hip joints in patients with coxitis, associated with AS under treatment with adalimumab (ADA) during 2 years.MethodsThe 28 patients with AS and clinical, ultrasound and radiographic signs of coxitis (21 male, 7 female, average age is 35.4 years old, duration of disease is 12-132 month) were included into study. All patients were being treated by NSAIDs at least 3 months before they started to take ADA (40 mg subcutaneously every 2 weeks). Treatment with ADA was continued during 24 months. Patients were observed at month 0, 12 and 24 months of treatment including measurements of pain visual analog scale (VAS) in hip movements, maximal distance between ankles, pelvic X-ray and sonography of hip joints by 10-18 MHz probe. BASRI-Hips index was applied for radiographic estimation of structural damage of hip joints [3]. During sonography width of hip joint capsule and hyaline cartilage were measured. The Mann-Whitney-U test was used for comparison of changes in clinical and sonographic data between two groups of patients.ResultsIt was determined that pain VAS at hip movements was decreased (23.1 [12.3; 32.3] mm at month 12 and 19.7 [11.8; 32.9] mm at month 24 vs 73.7 [59.5; 82.6] mm at month 0, p<0.05) and maximal distance between ankles was increased (112.5 [94.7; 122.2] mm at month 12 and 116.2 [91.2; 125.0] mm at month 24 vs 78.7 [63.4; 98.5] mm at month 0, p<0.05) in observed patients under treatment with ADA. It was also found that ultrasound measured width of hip joint capsule was decreased from 11.8 [10.3; 12.7] mm at month 0 to 8.7 [8.1; 9.4] mm at month 12 (p<0.05) and 7.5 [6.6; 8.5] mm at month 24 (p<0.05). The ultrasound measured width of hyalinic cartilage in observed patients was increased from 0.8 [0.6; 1.1] mm at month 0 to 1.0 [0.8; 1.2] mm at month 12 (p>0.1) and 1.2 [1.0; 1.7] mm at month 24 (p<0.05) under treatment with ADA. The BASRI-Hips index had not changed in observed patients at the end of 24-months period. The differences in changes of hip cartilage width between patients with joint capsule width at month 24 less than 9 mm and more than 9 mm was determined (p<0.05): +0.6 [0.3; 0.8] mm vs +0,1 [-0.1; 0.2] mm.ConclusionTreatment with ADA leads to decrease of clinical and sonographic signs of coxitis in patients with AS and improves of hyaline cartilage structure. The increase of width of hip hyalinic cartilage was observed in patients with absence of ultrasound signs of hip joints synovial inflammation in patients with AS. MRI-controlled studies are needed to confirm ability of THFα inhibitors to restore cartilage volume in patients with coxitis, associated with AS.References[1] Baraliakos X., Braun J. Hip involvement in ankylosing...