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Ticagrelor comparado con clopidogrel en pacientes con revascularización anterior de las extremidades inferiores por

W Schuyler Jones¹, Iris Baumgartner¹, William R Hiatt¹

¹From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).

|November 15, 2016

Resumen

En pacientes con enfermedad arterial periférica que se sometieron previamente a revascularización, el ticagrelor y el clopidogrel mostraron resultados similares de eficacia y seguridad. Sin embargo, este grupo experimentó tasas más altas de infarto de miocardio e isquemia aguda de las extremidades en comparación con los incluidos según los criterios del índice tobillo-braquial.

Área de la Ciencia:

Cardiología
Medicina vascular
Farmacología

Sus antecedentes:

No se ha determinado la terapia antitrombótica óptima para los pacientes con enfermedad arterial periférica sintomática (EAP) con revascularización previa de las extremidades.
El ensayo EUCLID investigó el ticagrelor frente al clopidogrel en pacientes con EAP.
Este análisis examinó específicamente los resultados en pacientes incluidos debido a una revascularización previa de las extremidades inferiores.

Objetivo del estudio:

Comparar la eficacia y la seguridad de ticagrelor frente a clopidogrel en pacientes con EAP con antecedentes de revascularización de las extremidades.
Evaluar el riesgo de eventos cardiovasculares y hemorragias en este subgrupo específico de pacientes.

Principales métodos:

En el ensayo EUCLID se asignó al azar a 13.885 pacientes con EAP el tratamiento con ticagrelor o clopidogrel.
Este subestudio se centró en 7.875 pacientes incluidos en base a una revascularización previa de las extremidades inferiores (índice tobillo-braquial ≤0,80 excluido).
Los criterios de exclusión incluyeron la revascularización reciente (< 30 días) y la necesidad de un tratamiento antiplaquetario dual.

Principales resultados:

Los pacientes con revascularización previa tuvieron tasas más altas de infarto de miocardio (HR 1.29) e isquemia aguda de las extremidades (HR 4.23) en comparación con los incluidos en los criterios de ABI.
No se observaron diferencias significativas entre ticagrelor y clopidogrel en el criterio de valoración primario de eficacia (mortalidad cardiovascular compuesta, infarto de miocardio, accidente cerebrovascular), mortalidad por cualquier causa, isquemia aguda de las extremidades o hemorragia mayor.
La mediana de seguimiento fue de aproximadamente 30 meses.

Conclusiones:

Los pacientes con enfermedad arterial periférica con revascularización previa presentan un mayor riesgo de infarto de miocardio e isquemia aguda de las extremidades.
Ticagrelor y clopidogrel demostraron una eficacia y un perfil de seguridad comparables en esta población de pacientes.
Puede ser necesaria más investigación para optimizar las estrategias antitrombóticas en pacientes con EAP con antecedentes de revascularización.

Palabras clave:

revascularización de las extremidades inferiores Enfermedad arterial periférica y el ticagrelor Intervención vascular

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