O uso correto de antiagregantes plaquetários após intervenção coronária percutânea: uma revisão comparativa
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Resumo
Objetivo: Debater sobre o uso mais efetivo da antiagregação plaquetária após intervenção coronária percutânea. Métodos: A abordagem metodológica deste trabalho se propõe a um compilado de pesquisa bibliográfica de abordagem qualitativa e caráter descritivo por meio de uma revisão integrativa da literatura nas bases de dados PubMed e Biblioteca Virtual em Saúde. Os descritores utilizados foram Platelet Aggregation Inhibitors, Clopidogrel, Ticagrelor e Percutaneous Coronary Intervention. Os critérios de inclusão foram ensaio clínico, ensaio clínico controlado e teste controlado aleatório, publicados em inglês, português e espanhol, no intervalo de 2017 a agosto de 2022. Os fármacos abordados foram clopidogrel, ticagrelor, aspirina e prasugrel. Resultados: Houve um total de nove artigos concluindo uma maior efetividade do clopidogrel em relação ao ticagrelor, sendo que em apenas um o ticagrelor se mostrou superior. Além disso, também foi visto a eficácia do prasugrel em casos de eventos coronarianos adversos maiores em comparação ao clopidogrel. Considerações finais: Assim, pode-se enfatizar que o ticagrelor não é o fármaco mais eficaz para ser usado como antiagregante plaquetário padrão na ICP, como prega a diretriz, devendo dar lugar ao clopidogrel, salvo em casos especiais específicos, podendo variar também para o uso de prasugrel.
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Referências
2. ALAAMRI S e DALBHI SA. Risk of bleeding with ticagrelor in elderly patients over 75 years old: A systematic review and meta-analysis. Medicine, 2021; e27398–e27398.
3. BUTT JH, et al. Ticagrelor and the risk of Staphylococcus aureus bacteraemia and other infections. Eur Heart J Cardiovasc Pharmacother, 2022; 13–19.
4. EIKELBOOM JW, et al. Antiplatelet Drugs. Chest, 2012; 141(2): e89S-e119S.
5. FERES F, et al. Diretriz da sociedade brasileira de cardiologia e da sociedade brasileira de hemodinâmica e cardiologia intervencionista sobre intervenção coronária percutânea. Arquivos Brasileiros de Cardiologia, 2017; 109(1).
6. HAHN J-Y, et al. 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial. Lancet, 2018; 391(10127): 1274–1284.
7. KIM CJ, et al. Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial. The Lancet, 2021; 398(10308): 1305–1316.
8. KOO B-K, et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Lancet, 2021; 397(10293): 2487–2496.
9. LI J, et al. Efficacy and safety of ticagrelor and clopidogrel in East Asian patients with coronary artery disease undergoing percutaneous coronary intervention. Curr Med Res Opin, 2020; 36(11): 1739–1745.
10. LI X-Y, et al. Switching from ticagrelor to clopidogrel in patients with ST-segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real-world China: Occurrences, reasons, and long-term clinical outcomes. Clin Cardiol, 2018; 41(11): 1446–1454.
11. LI Y-S, et al. Comparison of effectiveness and safety between ticagrelor and clopidogrel in patients with acute coronary syndrome and on dialysis in Taiwan. Br J Clin Pharmacol, 2022; 145–154.
12. LINDER M e ANDERSEN M. Patient characteristics and safety outcomes in new users of ticagrelor and clopidogrel-An observational cohort study in Sweden. Pharmacoepidemiol Drug Saf, 2022; 235–246.
13. MOON H, et al. Comparison of ticagrelor with clopidogrel on quality of life in patients with acute coronary syndrome. Health Qual Life Outcomes, 2021; 242–242.
14. PAN Y, et al. Clopidogrel-induced neutropenia in an 80-year-old patient with chronic kidney disease who underwent percutaneous coronary intervention: a case report and literature review. BMC Cardiovasc Disord, 2022; 40–40.
15. PARK D-W, et al. Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management: A Randomized Clinical Trial. Circulation, 2019; 140(23): 1865–1877.
16. PEREIRA NL, et al. Effect of Genotype-Guided Oral P2Y12 Inhibitor Selection vs Conventional Clopidogrel Therapy on Ischemic Outcomes After Percutaneous Coronary Intervention: The TAILOR-PCI Randomized Clinical Trial. JAMA, 2020; 324(8): 761–771.
17. RODRIGUEZ-ARIAS JJ, et al. Long-Term Vascular Function in CTO Recanalization: A Randomized Clinical Trial of Ticagrelor vs. Clopidogrel. Cardiovasc Revasc Med, 2022; 61–67.
18. SHAHID I, et al. Efficacy and Safety of Oral P2Y12 Inhibitors in Older Patients with Acute Coronary Syndrome: A Frequentist Network Meta-Analysis. Drugs Aging, 2021; 1003–1016.
19. SIBBING D, et al. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial. Lancet, 2017; 390(10104): 1747–1757.
20. SILVAIN J, et al. Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial. Lancet, 2020; 396(10264):1737–1744.
21. SILVERTHORN D. Fisiologia Humana: Uma Abordagem Integrada, 7ª Edição, Artmed, 2017.
22. TURGEON RD, et al. Association of Ticagrelor vs Clopidogrel With Major Adverse Coronary Events in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. JAMA Intern Med, 2020; 180(3): 420–428.
23. VRANCKX P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet, 2018; 392(10151): 940–949.
24. WALLENTIN L, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med, 2009; 361(11):1045–1057.
25. YING L, et al. Intensified antiplatelet therapy in patients after percutaneous coronary intervention with high on‐treatment platelet reactivity: the OPTImal Management of Antithrombotic Agents (OPTIMA)‐2 Trial. Br J Haematol, 2022; 196(2): 424–432.