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Aumento de la mortalidad con los antagonistas orales de la glicoproteína plaquetaria IIb/IIIa: un metanálisis de los
1Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Circulation
|February 24, 2001
Resumen
Los inhibidores orales de la glicoproteína IIb / IIIa en el manejo de la enfermedad arterial coronaria aumentaron el riesgo de mortalidad, a pesar de reducir las necesidades urgentes de revascularización. Se necesita más investigación para comprender este mayor riesgo de mortalidad asociado con estos agentes antiplaquetarios.
Área de la Ciencia:
- Cardiología Cardiología.
- Farmacología Farmacología.
- Los ensayos clínicos son ensayos clínicos.
Sus antecedentes:
- Los inhibidores intravenosos de la glicoproteína IIb/IIIa son beneficiosos para la enfermedad de las arterias coronarias.
- Los antagonistas orales de la glicoproteína IIb/IIIa no han mostrado beneficios comparables en ensayos a gran escala.
- La inhibición de la agregación plaquetaria por agentes orales no se ha traducido en una reducción de los eventos isquémicos.
Objetivo del estudio:
- Evaluar la seguridad y eficacia de los inhibidores orales de la glicoproteína IIb/IIIa.
- Para analizar los resultados de ensayos a gran escala, controlados con placebo, de antagonistas orales de la glicoproteína IIb/IIIa.
- Investigar el impacto de estos agentes en la mortalidad, el infarto de miocardio y la revascularización.
Principales métodos:
- Análisis combinado de 4 ensayos aleatorizados, controlados con placebo y a gran escala.
- Inclusión de 33.326 pacientes con seguimiento >30 días.
- Cálculo y estratificación de los odds ratios (ORs) para los puntos finales clínicos clave, incluida la mortalidad, el infarto de miocardio, la revascularización urgente y el sangrado mayor, por dosis de terapia y uso de aspirina.
Principales resultados:
- Se observó un aumento estadísticamente significativo en la mortalidad con la terapia oral de glicoproteína IIb/IIIa (OR, 1.37; P:=0.001).
- Este aumento del riesgo de mortalidad fue consistente en diferentes agentes, dosis y con o sin aspirina.
- Se observó una reducción en la revascularización urgente, pero no se detectó un aumento significativo en el infarto de miocardio.
Conclusiones:
- Los inhibidores orales de la glicoproteína IIb/IIIa se asocian con un aumento significativo de la mortalidad.
- El aumento de la mortalidad observado puede indicar un efecto tóxico directo en lugar de un mecanismo protrombótico.
- Se justifica una investigación adicional para determinar la causa del mayor riesgo de mortalidad con estos agentes.
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