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Consenso internacional de expertos sobre el cambio de las terapias inhibidoras de los receptores P2Y

Dominick J Angiolillo¹, Fabiana Rollini², Robert F Storey³

¹Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A., F.R., F.F.). dominick.angiolillo@jax.ufl.edu.

|November 1, 2017

Resumen

El cambio de inhibidores de P2Y12, incluidos los agentes orales como el clopidogrel, el prasugrel, el ticagrelor y el cangrelor intravenoso, es común, pero carece de orientación clara. Este consenso de expertos aborda las preocupaciones de seguridad y proporciona recomendaciones para el cambio de tratamiento en la práctica clínica.

Área de la Ciencia:

Cardiología
Farmacología
La trombosis

Sus antecedentes:

La doble terapia antiplaquetaria (DAPT) con aspirina y un inhibidor de P2Y12 es estándar para los síndromes coronarios agudos y las intervenciones coronarias percutáneas.
Existen múltiples inhibidores orales de P2Y12 (clopidogrel, prasugrel, ticagrelor) y una opción intravenosa (cangrelor), lo que lleva a cambios frecuentes en el tratamiento.
La práctica clínica a menudo implica el cambio de inhibidores de P2Y12 debido a varios factores, pero persisten las preocupaciones de seguridad y la falta de claridad de las directrices.

Objetivo del estudio:

Proporcionar un consenso de expertos sobre la farmacología, las modalidades y la seguridad del cambio entre inhibidores de P2Y12.
Ofrecer orientación a los médicos sobre cuándo y cómo cambiar las terapias con inhibidores de P2Y12.
Abordar las recomendaciones limitadas en las directrices de práctica actuales con respecto al cambio de inhibidor de P2Y12.

Principales métodos:

Desarrollo de un documento de consenso de expertos por parte de destacados expertos norteamericanos y europeos.
Revisión de la farmacología de los inhibidores de P2Y12 disponibles.
Análisis de la literatura existente sobre estrategias de cambio y datos de seguridad.

Principales resultados:

El documento describe las definiciones y modalidades de cambio de inhibidores de la P2Y12.
Presenta una visión general de la farmacología de los inhibidores de P2Y12 relevantes para el cambio.
Se proporcionan recomendaciones para estrategias de cambio seguras y efectivas basadas en la evidencia disponible y en el dictamen de expertos.

Conclusiones:

El cambio de inhibidores de la P2Y12 es un escenario clínico complejo que requiere una cuidadosa consideración.
Este documento de consenso tiene por objeto llenar el vacío de las directrices actuales ofreciendo recomendaciones prácticas.
La adhesión al consenso de los expertos puede mejorar la seguridad del paciente y optimizar el tratamiento antiplaquetario.

Palabras clave:

Inhibidores de los receptores P2Y12 Interacciones farmacológicas hemorragia en el cuerpo farmacodinámica Inhibidores de la agregación plaquetaria Trombosis

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