Ticagrelor o Clopidogrel en el contexto del síndrome coronario agudo
##plugins.themes.bootstrap3.article.sidebar##
Publicado
Feb 1, 2023
##plugins.themes.bootstrap3.article.main##
Resumen
Objetivo: Comparar el clopidogrel y el ticagrelor en el contexto del síndrome coronario agudo, buscando comprender los principales beneficios y efectos adversos de los dos fármacos, con el fin de concluir qué medicamento tiene la mejor relación riesgo-benefício. Métodos: La metodología de este trabajo propone una recopilación de búsquedas realizadas en PubMed y la Biblioteca Virtual en Salud; se seleccionaron 19 artículos para el estudio de resultados. Los descriptores fueron “clopidogrel”, “ticagrelor” y “síndrome coronario agudo”, todos presentes en el campo “título”. Resultados: En 11 de los artículos analizados, ticagrelor fue superior, teniendo en cuenta beneficios como la revascularización del vaso diana y la consecuente supervivencia. También se analizaron efectos adversos como sangrado y disnea, con diferencia significativa en grupos específicos, como ancianos y diabéticos. Así, a través del análisis de los estudios, se observó una mayor efectividad en el uso de ticagrelor, ligado a un mayor riesgo de sangrado en determinados casos. Consideraciones finales: En el presente estudio se observó la superioridad del ticagrelor en la antiagregación plaquetaria, existiendo la necesidad de considerar su uso para algunos grupos, debido a una mayor posibilidad de efectos adversos, en cuyo caso, el uso de clopidogrel es preferible.
##plugins.themes.bootstrap3.article.details##
Cómo citar
SoaresL. R. de O. N., FernandesB. M., & DiasT. S. (2023). Ticagrelor o Clopidogrel en el contexto del síndrome coronario agudo. Revista Eletrônica Acervo Médico, 23(1), e11821. https://doi.org/10.25248/reamed.e11821.2023
Número
Sección
Revisão Bibliográfica
Copyright © | Todos los derechos reservados.
La revista posee los derechos de autor exclusivos para la publicación de este artículo en los términos de la ley brasileña 9610/98.
Reproducción parcial
El uso de partes de los textos, figuras y cuestionario del artículo es libre, siendo obligatoria la citación de los autores y revista.
Reproducción total
Está expresamente prohibido y debe ser autorizado por la revista.
Citas
1. ARORA S, et al. Premature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVD, Journal of the American College of Cardiology, 2019; 73(19): 2454–2464.
2. BHATT D, et al. REVERSE-IT: Effect of Bentracimab on Platelet Inhibition and Hemostasis in Patients on Ticagrelor with Major Bleeding or Requiring Urgent Procedures on Behalf of the REVERSE-IT Investigators. Disponível em: https://www.acc.org/-/media/Clinical/PDF-Files/Approved-PDFs/2021/11/01/AHA21/15Nov/1130amET-REVERSE-IT-aha-2021.pdf. Acessado em: 15 de Outubro de 2022.
3. BONOW R. Braynwald Tratado de Doenças Cardiovasculares. 10ª ed. Rio de Janeiro: Guanabara Koogan, 2017; 53.
4. CAIAZZO G, et al. Administration of a loading dose has no additive effect on platelet aggregation during the switch from ongoing clopidogrel treatment to ticagrelor in patients with acute coronary syndrome, Circ Cardiovasc Interv, 2014; 104-12.
5. CHEN I-CHIH, et al. Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study, Journal of the Chinese Medical Association, 2016; 79(10): 521–530.
6. CHEN Z. M, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet (London, England), 2005; 366(9497): 1607–21.
7. CHO JY, et al. Factors Related to Major Bleeding After Ticagrelor Therapy: Results from the TICO Trial, Journal of the American Heart Association, 2021; 10: 7.
8. GIMBEL M, et al. Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial, The Lancet, 2020; 395(10233): 1374–1381.
9. GOTO S, et al. Ticagrelor vs. Clopidogrel in Japanese, Korean and Taiwanese Patients with Acute Coronary Syndrome – Randomized, Double-Blind, Phase III PHILO Study –, Circulation Journal, 2015; 79(11): 2452–2460.
10. HE P, et al. Clinical Outcome between Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndrome and Diabetes, Cardiovascular Therapeutics, 2021; 2021: 1–9.
11. JAMES S, et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial, European heart journal, 2010; 31(24): 3006–16.
12. JEONG YJ, et al. Comparison between ticagrelor and clopidogrel on myocardial blood flow in patients with acute coronary syndrome, using 13 N-ammonia positron emission tomography, American Heart Journal, 2020; 222: 121–130.
13. KANG HJ, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial, American Heart Journal, 2015; 169(6): 899-905.e1.
14. LINDHOLM D, et al. Ticagrelor vs. clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization: results from the PLATO trial, European Heart Journal, 2014; 35(31): 2083–2093.
15. LIU GZ, et al. Half-dose ticagrelor versus high-dose clopidogrel in reducing platelet reactivity in acute coronary syndrome patients with high on-clopidogrel platelet reactivity, European Journal of Clinical Pharmacology, 2019; 1059-1068.
16. MARIAN M. J, et al. Effects of Crushed Ticagrelor Versus Eptifibatide Bolus Plus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Clinical Trial. J of the American Heart Association, 2019; 8(23): e012844.
17. MOON H, et al. Comparison of ticagrelor with clopidogrel on quality of life in patients with acute coronary syndrome, Health and Quality of Life Outcomes, 2021; 19: 1.
18. NICOLAU JC, et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST, Arq. Bras. Cardiol, 2021; 117(1): 181-264.
19. PARK K, et al. Comparison of the Effects of Ticagrelor and Clopidogrel on Microvascular Dysfunction in Patients With Acute Coronary Syndrome Using Invasive Physiologic Indices, Circulation. Cardiovascular Interventions, 2019; 12(10): e008105.
20. PATEL M. R, et al. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: Data from the PLATO Trial, European Journal of Preventive Cardiology, 2015; 22(6): 734–742.
21. QADERDAN K, et al. Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70years and older—rationale and design of the POPular AGE study, American Heart Journal, 2015; 170(5): 981-985.e1.
22. SABATINE M. S. et al. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation, New England Journal of Medicine, 2005; 352(12): 1179–1189.
23. SCHNORBUS B, et al. Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study, European Heart Journal, 2020.
24. SCHNORBUS B, et al. Effects of Clopidogrel, Prasugrel and Ticagrelor on Microvascular Function and Platelet Reactivity in Patients with Acute Coronary Syndrome Undergoing Coronary Artery Stenting. A Randomized, Blinded, Parallel Group Trial. Frontiers in Cardiovascular Medicine, 2021; 8: 780605.
25. UNVERDORBEN M, et al. Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics, International Journal of Cardiology, 2016; 202: 167–173.
26. WALLENTIN L, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes, New England Journal of Medicine, 2009; 361(11): 1045–1057.
27. WALLENTIN, L, et al. Biomarkers in Relation to the Effects of Ticagrelor in Comparison with Clopidogrel in Non–ST-Elevation Acute Coronary Syndrome Patients Managed with or Without In-Hospital Revascularization, Circulation, 2014; 129(3): 293–303.
28. WOLF D e LEY K. Immunity and Inflammation in Atherosclerosis. Circulation Research, 2019; 124(2): 315–327.
29. YAO Y, et al. Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease, Chinese Medical Journal, 2019; 132(19): 2292–2299.
30. YUSUF S, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation, The New England Journal of Medicine, 2001; 345(7): 494-502.
2. BHATT D, et al. REVERSE-IT: Effect of Bentracimab on Platelet Inhibition and Hemostasis in Patients on Ticagrelor with Major Bleeding or Requiring Urgent Procedures on Behalf of the REVERSE-IT Investigators. Disponível em: https://www.acc.org/-/media/Clinical/PDF-Files/Approved-PDFs/2021/11/01/AHA21/15Nov/1130amET-REVERSE-IT-aha-2021.pdf. Acessado em: 15 de Outubro de 2022.
3. BONOW R. Braynwald Tratado de Doenças Cardiovasculares. 10ª ed. Rio de Janeiro: Guanabara Koogan, 2017; 53.
4. CAIAZZO G, et al. Administration of a loading dose has no additive effect on platelet aggregation during the switch from ongoing clopidogrel treatment to ticagrelor in patients with acute coronary syndrome, Circ Cardiovasc Interv, 2014; 104-12.
5. CHEN I-CHIH, et al. Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study, Journal of the Chinese Medical Association, 2016; 79(10): 521–530.
6. CHEN Z. M, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet (London, England), 2005; 366(9497): 1607–21.
7. CHO JY, et al. Factors Related to Major Bleeding After Ticagrelor Therapy: Results from the TICO Trial, Journal of the American Heart Association, 2021; 10: 7.
8. GIMBEL M, et al. Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial, The Lancet, 2020; 395(10233): 1374–1381.
9. GOTO S, et al. Ticagrelor vs. Clopidogrel in Japanese, Korean and Taiwanese Patients with Acute Coronary Syndrome – Randomized, Double-Blind, Phase III PHILO Study –, Circulation Journal, 2015; 79(11): 2452–2460.
10. HE P, et al. Clinical Outcome between Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndrome and Diabetes, Cardiovascular Therapeutics, 2021; 2021: 1–9.
11. JAMES S, et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial, European heart journal, 2010; 31(24): 3006–16.
12. JEONG YJ, et al. Comparison between ticagrelor and clopidogrel on myocardial blood flow in patients with acute coronary syndrome, using 13 N-ammonia positron emission tomography, American Heart Journal, 2020; 222: 121–130.
13. KANG HJ, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial, American Heart Journal, 2015; 169(6): 899-905.e1.
14. LINDHOLM D, et al. Ticagrelor vs. clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization: results from the PLATO trial, European Heart Journal, 2014; 35(31): 2083–2093.
15. LIU GZ, et al. Half-dose ticagrelor versus high-dose clopidogrel in reducing platelet reactivity in acute coronary syndrome patients with high on-clopidogrel platelet reactivity, European Journal of Clinical Pharmacology, 2019; 1059-1068.
16. MARIAN M. J, et al. Effects of Crushed Ticagrelor Versus Eptifibatide Bolus Plus Clopidogrel in Troponin-Negative Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Clinical Trial. J of the American Heart Association, 2019; 8(23): e012844.
17. MOON H, et al. Comparison of ticagrelor with clopidogrel on quality of life in patients with acute coronary syndrome, Health and Quality of Life Outcomes, 2021; 19: 1.
18. NICOLAU JC, et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST, Arq. Bras. Cardiol, 2021; 117(1): 181-264.
19. PARK K, et al. Comparison of the Effects of Ticagrelor and Clopidogrel on Microvascular Dysfunction in Patients With Acute Coronary Syndrome Using Invasive Physiologic Indices, Circulation. Cardiovascular Interventions, 2019; 12(10): e008105.
20. PATEL M. R, et al. Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: Data from the PLATO Trial, European Journal of Preventive Cardiology, 2015; 22(6): 734–742.
21. QADERDAN K, et al. Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients 70years and older—rationale and design of the POPular AGE study, American Heart Journal, 2015; 170(5): 981-985.e1.
22. SABATINE M. S. et al. Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation, New England Journal of Medicine, 2005; 352(12): 1179–1189.
23. SCHNORBUS B, et al. Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study, European Heart Journal, 2020.
24. SCHNORBUS B, et al. Effects of Clopidogrel, Prasugrel and Ticagrelor on Microvascular Function and Platelet Reactivity in Patients with Acute Coronary Syndrome Undergoing Coronary Artery Stenting. A Randomized, Blinded, Parallel Group Trial. Frontiers in Cardiovascular Medicine, 2021; 8: 780605.
25. UNVERDORBEN M, et al. Dyspnea related to reversibly-binding P2Y12 inhibitors: A review of the pathophysiology, clinical presentation and diagnostics, International Journal of Cardiology, 2016; 202: 167–173.
26. WALLENTIN L, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes, New England Journal of Medicine, 2009; 361(11): 1045–1057.
27. WALLENTIN, L, et al. Biomarkers in Relation to the Effects of Ticagrelor in Comparison with Clopidogrel in Non–ST-Elevation Acute Coronary Syndrome Patients Managed with or Without In-Hospital Revascularization, Circulation, 2014; 129(3): 293–303.
28. WOLF D e LEY K. Immunity and Inflammation in Atherosclerosis. Circulation Research, 2019; 124(2): 315–327.
29. YAO Y, et al. Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease, Chinese Medical Journal, 2019; 132(19): 2292–2299.
30. YUSUF S, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation, The New England Journal of Medicine, 2001; 345(7): 494-502.