Ticagrelor ou Clopidogrel no contexto de síndrome coronariana aguda
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Feb 1, 2023
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Resumo
Objetivo: Comparar o clopidogrel e o ticagrelor no cenário de síndrome coronariana aguda, buscando entender quais os principais benefícios e efeitos adversos das duas drogas, com finalidade de concluir qual medicação possui melhor risco-benefício. Métodos: A metodologia deste trabalho propõe um compilado de buscas feitas no PubMed e Biblioteca Virtual em Saúde; 19 artigos foram selecionados para o estudo dos resultados. Os descritores foram “clopidogrel”, “ticagrelor” e “acute coronary syndrome”, sendo todos presentes no campo “título”. Resultados: Em 11 dos artigos analisados, foi visto uma superioridade do ticagrelor, levando em conta benefícios como revascularização do vaso-alvo e consequente sobrevida. Ademais, efeitos adversos como sangramentos e dispneia também foram analisados, havendo diferença significativa em grupos específicos, como idosos e diabéticos. Com isso, através da análise dos trabalhos, notou-se uma maior eficácia no uso de ticagrelor, atrelado a maior risco de sangramento em determinados casos. Considerações finais: Foi visto no presente estudo uma superioridade do ticagrelor na antiagregação plaquetária, havendo necessidade de ponderar seu uso para alguns grupos, devido a maior chance de efeitos adversos, sendo nesses casos, preferível o uso do clopidogrel.
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Como Citar
SoaresL. R. de O. N., FernandesB. M., & DiasT. S. (2023). Ticagrelor ou Clopidogrel no contexto de síndrome coronariana aguda. Revista Eletrônica Acervo Médico, 23(1), e11821. https://doi.org/10.25248/reamed.e11821.2023
Seção
Revisão Bibliográfica
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Referências
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.