Approaches to the primary and secondary prevention of cerebral complications in patients with arterial hypertension and multifocal atherosclerosis

Introduction . Patients with arterial hypertension (AH) and multifocal atherosclerosis (MFA) remain at a high risk of recurrent ischemic events. Aim . To show the effectiveness of using dual antithrombotic therapy (acetylsalicylic acid (ASA) 100 mg per day + rivaroxaban 2.5 mg twice daily) in patients with AH and MFA. Materials and methods . The study included 219 patients (mean age 59 ± 8 years) with controlled AH and MFA, 110 of them were stage 1–2 AH (group 1), 109 were stage 3 AH and a history of atherothrombotic ischemic stroke (IS) (group 2). Coagulation hemostasis, high‐sensitivity reactive protein (hs‐CRP) and interleukin‐6 (IL-6) levels were monitored in all patients. Patients were randomized into the main group – ASA 100 mg/day + rivaroxaban 2.5 mg 2 times a day and the comparison group – ASA 100 mg/day. The treatment period was 6 months. Quality of life (QOL) was assessed using the short form of the SF-36 questionnaire before randomization and after 6 months of treatment. After 18 months, the primary endpoints (acute vascular accident, cardiovascular death, hospitalization) were evaluated. Results . The addition of rivaroxaban to ASA led to an improvement in local and global indicators of hemostasis and markers of inflammation, an increase in QOL indicators for physical and mental components, and a reduction in the risk of primary endpoints. When taking rivaroxaban, a low incidence of side effects was recorded: minor bleeding was observed in 4 (3.7%) patients on ASA + rivaroxaban therapy. They were manifested by bleeding from the gums and hemorrhoids and did not require special treatment. No major bleeding has been reported in any patient. Conclusions . The use of dual antiplatelet therapy (ASA + rivaroxaban) leads to an improvement in hemostasis, markers of inflammation and QOL, as well as to a reduction in the risk of cardiovascular complications.