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Impacto de la terapia médica óptima en el estudio de la terapia antiplaquetaria dual

Charles D Resor1, Ashwin Nathan1, Dean J Kereiakes1

  • 1From Division of Cardiology and Center for Clinical Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston, MA (C.D.R., L.M.); Harvard Clinical Research Institute, Boston, MA (R.W.Y., D.E.C., W.-H.H., L.M.); Harvard Medical School, Boston, MA (R.W.Y., L.M.); Division of Cardiology, University of Pennsylvania Medical Center, Philadelphia (A.N.); Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y., D.E.C.); Department of Biostatistics, Boston University School of Public Heath, MA (J.M.M.); The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, OH (D.J.K.); Université Paris-Diderot, INSERM U-1148, Hôpital Bichat, Département Hospitalo-Universitaire Fibrosis, Inflammation, and Remodeling, Assistance Publique-Hôpitaux de Paris, Paris, France (P.G.S.); and National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, UK (P.G.S.).

Circulation
|September 1, 2016
PubMed
Resumen
Este resumen es generado por máquina.

El tratamiento continuado con tienopiridina redujo significativamente las tasas de infarto de miocardio en pacientes con enfermedad coronaria, independientemente de su estado de terapia médica óptima (OMT). Esta doble estrategia de terapia antiplaquetaria también redujo consistentemente los eventos adversos cardiovasculares importantes y aumentó el riesgo de hemorragia.

Palabras clave:
Agentes antiplaquetariostratamiento médicoLos stents

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Área de la Ciencia:

  • Medicina cardiovascular
  • Ensayos clínicos
  • Farmacología

Sus antecedentes:

  • La terapia médica óptima (OMT) y la terapia antiplaquetaria dual (DAPT) mejoran los resultados en la enfermedad coronaria.
  • El impacto de la OMT en la eficacia del DAPT sigue sin estar claro.

Objetivo del estudio:

  • Investigar si la terapia médica óptima (OMT) modifica el efecto del tratamiento de la terapia antiplaquetaria dual prolongada (DAPT) en pacientes después de la colocación de un stent coronario.
  • Evaluar la eficacia y seguridad de la continuación del tratamiento con tienopiridina frente al placebo en pacientes que reciben o no OMT.

Principales métodos:

  • El estudio DAPT asignó aleatoriamente a 11.648 pacientes a 18 meses de tratamiento continuo con tienopiridina o con placebo después de un año inicial de tratamiento con DAPT.
  • La OMT se definió como el uso simultáneo de estatinas, betabloqueantes y inhibidores de la ECA/ARB.
  • Los resultados incluyeron infarto de miocardio, eventos adversos cardiovasculares importantes y sangrado.

Principales resultados:

  • La administración continua de tienopiridina redujo el infarto de miocardio independientemente del estado de OMT (interacción P=0,103).
  • Las tasas de eventos adversos cardiovasculares y cerebrovasculares importantes se redujeron con la continuación de la tienopiridina, con un efecto significativo observado en pacientes que no recibieron OMT (HR, 0,63; P< 0,001).
  • Las tasas de hemorragia aumentaron con la continuación de la tienopiridina en los pacientes que recibieron OMT (HR, 2,13; P< 0,001), pero no significativamente en los que no recibieron OMT (HR, 1,30; P=0,189).

Conclusiones:

  • El tratamiento continuado con tienopiridina reduce efectivamente las tasas de infarto de miocardio en pacientes con enfermedad coronaria, independientemente de la OMT.
  • Los beneficios de la TDAP extendida en los eventos cardiovasculares adversos importantes y el riesgo de hemorragia asociado deben considerarse en el contexto del uso de OMT.