Assuntos
Síndrome Coronariana Aguda , Aspirina , Terapia Antiplaquetária Dupla , Hemorragia , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária , Stents , Ticagrelor , Humanos , Ticagrelor/uso terapêutico , Ticagrelor/efeitos adversos , Síndrome Coronariana Aguda/terapia , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Inibidores da Agregação Plaquetária/efeitos adversos , Aspirina/uso terapêutico , Aspirina/efeitos adversos , Aspirina/administração & dosagem , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Terapia Antiplaquetária Dupla/métodos , Terapia Antiplaquetária Dupla/efeitos adversos , Stents/efeitos adversos , Resultado do Tratamento , Quimioterapia Combinada , Fatores de TempoAssuntos
Aspirina , Clopidogrel , Ataque Isquêmico Transitório , AVC Isquêmico , Inibidores da Agregação Plaquetária , Recidiva , Prevenção Secundária , Humanos , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Ataque Isquêmico Transitório/tratamento farmacológico , Ataque Isquêmico Transitório/prevenção & controle , AVC Isquêmico/tratamento farmacológico , AVC Isquêmico/prevenção & controle , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Prevenção Secundária/métodos , Prevenção Secundária/normas , Fatores de Tempo , Quimioterapia Combinada , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/etiologia , Fatores de Risco , Resultado do TratamentoAssuntos
Fibrilação Atrial , Doença da Artéria Coronariana , Doença Arterial Periférica , Tromboembolia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Humanos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologiaRESUMO
Therapeutic Strategies in Patients with Stable Coronary Artery Disease: The Role of Coronary Revascularization Abstract. Coronary artery disease is the leading cause of death worldwide. Prevention and optimal treatment of patients with coronary artery disease is therefore crucial. Lifestyle changes, optimal medical therapy and aggressive risk factor control represent key elements in the management of patients with stable coronary artery disease. Coronary revascularization of flow-limiting coronary artery stenoses is indicated to reduce myocardial ischemia and related symptoms. This review summarizes treatment strategies of patients with stable coronary artery disease, focusing on the 2018 European Society of Cardiology (ESC) guidelines of myocardial revascularization.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana , Isquemia Miocárdica , Intervenção Coronária Percutânea , Doença da Artéria Coronariana/cirurgia , Humanos , Revascularização Miocárdica , Fatores de RiscoAssuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Hemostasia/efeitos dos fármacos , Inibidores da Agregação Plaquetária/administração & dosagem , Hemorragia Pós-Operatória/prevenção & controle , Trombose/prevenção & controle , Consenso , Esquema de Medicação , Procedimentos Cirúrgicos Eletivos/efeitos adversos , França , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Fatores de Risco , Trombose/sangue , Resultado do TratamentoRESUMO
Coronary thrombosis remains the leading cause for cardiovascular death in France. Great advances have been made in the knowledge of the basic mechanism involved in coronary thrombogenesis and in antithrombotic treatments. They have led to substantial survival benefit after myocardial infarction and enabled development of tailored therapeutic strategies, especially for high-risk patients. Direct oral anticoagulants have now entered the game for secondary prevention after coronary thrombosis.
Assuntos
Trombose Coronária/tratamento farmacológico , Trombose Coronária/fisiopatologia , Fibrinolíticos/administração & dosagem , Medicina Integrativa , Qualidade de Vida , Administração Oral , Trombose Coronária/mortalidade , Humanos , Fatores de Risco , Resultado do TratamentoRESUMO
Like all antithrombotic drugs, antiplatelet agents expose to a risk of bleeding complications. Clinical research has extensively focused on the efficacy of these drugs to reduce ischemic events. The bleeding risk associated with them was solely considered as an inevitable and acceptable complication. When two new potent P2Y12-receptor inhibitors, prasugrel and ticagrelor, were marketed, the risk of major bleeding increased. These new agents have modified the balance between the absolute risk reduction in ischemic events and the absolute risk increase in bleeding events. This paper is an update on the bleeding risk assessment associated with antiplatelet agents. It discusses the place of platelet function monitoring, and the optimal management of bleeding complications. It addresses the challenging issue of reversal of antiplatelet therapy, focusing especially on ticagrelor, which pharmacodynamics complicate bleeding management.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Hemorragia/induzido quimicamente , Hemorragia/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Adenosina/administração & dosagem , Adenosina/efeitos adversos , Adenosina/análogos & derivados , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Clopidogrel , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Fatores de Risco , Ticagrelor , Ticlopidina/administração & dosagem , Ticlopidina/efeitos adversos , Ticlopidina/análogos & derivadosRESUMO
BACKGROUND: In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome. AIMS: To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD. METHODS: We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing. RESULTS: The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042). CONCLUSIONS: Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.