The article tells about the current strategy of secondary prevention of venous thrombosis. The benefits and potential risks of oral anticoagulants are evaluated. The possibility of taking acetylsalicylic acid, if new oral anticoagulants  are excluded, is assessed.

The article is an overview of a diagnostic algorithm and capabilities  of different imaging techniques  in the diagnosis of chronic thromboembolic pulmonary  hypertension (CTEPH). The authors touch upon imaging approaches specific for CTEPH and idiopathic pulmonary  hypertension.  The results of comparative studies of diagnostic  accuracy  of multislice computed  tomography,  ventilation/perfusion scintigraphy,  angiography,  and comparative characteristics of the methods, are described. A new method, dual-energy computed  tomography, used in the diagnosis of CTEPH and for determining indications  for surgical treatment, is highlighted.

The review tells about challenges  of antithrombotic  therapy in patients after acute coronary syndrome. The efficacy and safety of long-term administration of anticoagulants (warfarin as well as novel anticoagulants), in addition to standard antiplatelet therapy, is discussed. The focus is on rivaroxaban, low doses of which are officially indicated  for the prevention of cardiovascular  death and myocardial infarction in patients after acute coronary syndrome occurring with increased values of myocardial injury markers. Clinical characteristics of patients feasible for this treatment approach are considered

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Distal coronary artery embolism (DCAE) is a serious complication  of percutancous coronary intervention (PCI).  Distal embolism causes a significant reduction or even blockage of myocardial perfusion, despite the fact that blood flow in the occluded segment of the infarct-related artery is restored. According to various sources, the incidence of distal embolization associated with PCI is about 25%. Various techniques, both invasive and non-invasive, have been developed for identifying distal embolism. DCAE during PCI is prevented with the help of different devices, among which those for thromboextraction are the most reliable. The devices can be divided into manual and rheolytic.

A trial fibrillation is the most common cardiac source of systemic emboli and car-a significant reduction or even blockage of dioembolic stroke. Anticoagulants are recommended for preventing  stroke in patients with non-valvular  atrial fibrillation. Warfarin reduces the risk of stroke in patients with AF by approximately two-thirds. New oral anticoagulants are becoming more common in recent years. Despite this, a number of clinical situations remain where the only possible anticoagulant is warfarin.

The review article updates on the key challenge in the present-day cardiology duration of dual antiplatelet  therapy (DAPT) in patients with a history of acute coronary syndrome. The relevant clinical guidelines are analyzed, and results of the recent clinical trials and meta-analyses  are highlighted. A risk assessment scale for evaluating ischemic and bleeding risks based on the study of DAPT is presented

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The article tells about the experience  with rivaroxaban  for the prevention  of stroke and thromboembolism  not involving the central nervous system vessels in patients with non-valvular  atrial fibrillation in a number of clinical cases. The article demonstrates  that rivaroxaban’s efficacy and safety in everyday medical practice, in general, meets the expectations resulting from the large controlled ROCKET-AF trial.

Safety profiles of the novel oral anticoagulants (NOAC) (rivaroxaban, apixaban, edoxaban,  dabigatran) are better than that of warfarin. However, the risk (including lifethreatening) of bleeding  is no less than 2.3–3.1% per year. Three specific antidotes  to NOAC are currently  in different phases of clinical  trial and implementation. Idarucizumab  is a monoclonal  antibody which immediately and completely  reverses the anticoagulation effect of dabigatran. Andexanet  alfa is a recombinant, modified factor Xa molecule  that binds and inhibits the effects of oral and parenteral factor Xa inhibitors  (rivaroxaban, apixaban,  edoxaban, fondaparinux, heparins).  Andexanet  is already in 3b Phase, and at the end of 2016  — beginning  of 2017 it is expected  to be approved  for clinical  use. Ciraparantag  is a small molecule,  non-covalently binding to factor Xa inhibitors, and dabigatran  (i.e., a universal  antidote).  Recently, promising results of phase 1 trials involving aripazin were published. The article  tells about the practical  aspects of the use of antidotes, treatment  approaches for life-threatening bleeding  during treatment  with NOAC.

A case involving a patient with acute coronary syndrome is described, and a treatment approach is suggested.

Restenosis is a complication of percutaneous coronary interventions which results in the destabilization of coronary heart disease. Presents a clinical case of detection of restenosis using stress Echocardiography one year after percutaneous coronary intervention.

In a question-and-answer format, the most critical issues concerning the safety of therapy and management  of patients taking dabigatran are considered in the article. Particular attention is paid to the prospects of anticoagulant therapy in patients with comorbidities, as well as interactions between novel oral anticoagulants  and other groups of medications, risk assessment of potential complications of therapy.