¿Cuáles son las limitaciones de los nuevos antiagregantes?
TIMI Major Bleeding TRITON-TIMI 38 versus PLATO Clopidogrel Prasugrel Wiviott SD et al., N Engl J Med 2007; Wallentin L et al., N Engl J Med 2009 P = TRITONPLATO Ticagrelor P = Rate of non CABG bleeds (%)
0.512 OVERALL Prasugrel BetterClopidogrel Better No Yes Prior Stroke / TIA P int = <75 ≥75 Age P int = 0.18 ≥60 kg <60 kg Weight P int = – Accessed on July 16, 2008 Contraindication with history of cerebro-vascular event Hazard Ratio for net clinical outcome TRITON-TIMI 38
1° efficacy endpoint 1° safety endpoint Previous non-hemorh. CVA No Yes Age Group < 75 years > 75 years Weight group < 60 kg > 60 kg ticagrelor betterclopidogrel better ticagrelor betterclopidogrel better No contraindication for ticagrelor with previous stroke Wallentin L et al., N Engl J Med 2009 PLATO
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. Circulation 2012;125:2914–2921. %
European NSTE ACS Summit September 18 th / 19 th 2013 Brussels
European NSTE ACS Summit September 18 th / 19 th 2013 Brussels
European NSTE ACS Summit September 18 th / 19 th 2013 Brussels
European NSTE ACS Summit September 18 th / 19 th 2013 Brussels
¿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? Nuevos antiagregantes ¿a quién?: preguntas