RESUMO
Prasugrel and ticagrelor, new P2Y12-ADP receptor antagonists, are associated with greater pharmacodynamic inhibition and reduction of cardiovascular events in patients with an acute coronary syndrome. However, evidence is lacked about the effects of achieving faster and stronger cyclooxygenase inhibition with intravenous lysine acetylsalicylate (LA) compared to oral aspirin. Recently, we demonstrated in healthy volunteers that the administration of intravenous LA resulted in a significantly reduction of platelet reactivity compared to oral aspirin. Loading dose of LA achieves platelet inhibition faster, and with less variability than aspirin. However, there are no data of this issue in patients with an ST-segment elevation myocardial infarction (STEMI). This is a prospective, randomized, multicenter, open platelet function study conducted in STEMI patients. Subjects were randomly assigned to receive a loading dose (LD) of intravenous LA 450 mg plus oral ticagrelor 180 mg, or LD of aspirin 300 mg plus ticagrelor 180 mg orally. Platelet function was evaluated at baseline, 30 min, 1 h, 4 h and 24 h using multiple electrode aggregometry and vasodilator-stimulated phosphoprotein phosphorylation (VASP). The primary endpoint of the study is the inhibition of platelet aggregation (IPA) after arachidonic acid (AA) 0.5 mM at 30 min. Secondary endpoints were the IPA at 1, 4, and 24 h after AA, and non-AA pathways through the sequence (ADP and TRAP). A total of 32 STEMI patients were randomized (16 LA, 16 aspirin). The inhibition of platelet aggregation after AA 0.5 mM at 30 min was greater in subjects treated with LA compared with aspirin: 166 vs. 412 respectively (p = 0.001). This differential effect was observed at 1 h (p = 0.01), but not at 4 and 24 h. Subjects treated with LA presented less variability and faster inhibition of platelet aggregation wit AA compared with aspirin. The administration of intravenous LA resulted in a significantly reduction of platelet reactivity compared to oral aspirin on ticagrelor inhibited platelets in patients with STEMI. Loading dose of LA achieves an earlier platelet inhibition, and with less variability than aspirin.Trial Registration: Unique identifier: NCT02929888; URL: http://www.clinicaltrials.gov.
Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Ticagrelor , Inibidores da Agregação Plaquetária/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estudos Prospectivos , Aspirina/uso terapêutico , Aspirina/farmacologia , Plaquetas , Cloridrato de Prasugrel/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Resultado do Tratamento , Intervenção Coronária Percutânea/efeitos adversosAssuntos
Equinococose Hepática/complicações , Insuficiência Cardíaca/etiologia , Disfunção Ventricular Direita/etiologia , Idoso , Equinococose Hepática/diagnóstico , Equinococose Hepática/cirurgia , Feminino , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/cirurgiaAssuntos
Anticoagulantes/uso terapêutico , Cardiopatias/tratamento farmacológico , Trombose/tratamento farmacológico , Varfarina/uso terapêutico , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , Resultado do TratamentoAssuntos
Cardiopatias/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , Feminino , Cardiopatias/fisiopatologia , Humanos , Radiografia , Volume Sistólico/fisiologia , Trombose/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
A patient who had been previously diagnosed with congenital complete atrioventricular block (CCAVB) twenty years ago developed atrioventricular (AV) conduction through an accessory pathway (AP). With enhanced sympathetic tone (exercise, isoproterenol), 1:1 conduction down the AP occurred. An electrophysiologic study confirmed a suprahissian AV block and the presence of an AP. The AP was located on the left side and posterior. The absence of retrograde conduction through the AP and also a long conduction time were demonstrated.