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¿Cuáles son las limitaciones de los nuevos antiagregantes?

¿Cuáles son las limitaciones de los nuevos antiagregantes?. TIMI Major Bleeding TRITON-TIMI 38 versus PLATO. Rate of non CABG bleeds (%). P = 0.03. 3. Clopidogrel. P = 0.03. 2.8. Prasugrel. 2.4. Ticagrelor. 2. 2.2. 1.8. 1. 0. TRITON. PLATO.

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¿Cuáles son las limitaciones de los nuevos antiagregantes?

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  1. ¿Cuáles son las limitaciones de los nuevos antiagregantes?

  2. TIMI Major Bleeding TRITON-TIMI 38 versus PLATO Rate of non CABG bleeds (%) P = 0.03 3 Clopidogrel P = 0.03 2.8 Prasugrel 2.4 Ticagrelor 2 2.2 1.8 1 0 TRITON PLATO Wiviott SD et al., N Engl J Med 2007; Wallentin L et al., N Engl J Med 2009

  3. Yes Prior Stroke / TIA No Pint = 0.006 ≥75 Age <75 Pint = 0.18 <60 kg Weight ≥60 kg Pint = 0.36 OVERALL Contraindication with history of cerebro-vascular event TRITON-TIMI 38 Hazard Ratio for net clinical outcome 0.5 1 2 Prasugrel Better Clopidogrel Better www.timi.org – Accessed on July 16, 2008

  4. PLATO No contraindication for ticagrelor with previous stroke 1° safety endpoint 1° efficacy endpoint Previous non-hemorh. CVA No Yes Age Group < 75 years > 75 years Weight group < 60 kg > 60 kg ticagrelor better clopidogrel better ticagrelor better clopidogrel better Wallentin L et al., N Engl J Med 2009

  5. Age and primary efficacy outomes in PLATO Husted et al 2011, ACC

  6. PLATO: total mortality according to prior history of stroke/TIA % James S, et al. Circulation2012;125:2914–2921.

  7. Nuevos antiagregantes ¿a quién?: preguntas • ¿a quién no debo administrar prasugrel? • ¿a quién no de administrar ticagrelor? • ¿a quién no debo administrar clopidogrel? • ¿Cuánto debo esperar para operar tras suspender el tratamiento?

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