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1.
Medicine (Baltimore) ; 100(6): e24366, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578533

RESUMO

BACKGROUND: Pharmacokinetic and pharmacodynamic study showed a lower clopidogrel response when coprescribed with proton pump inhibitors (PPIs). Despite this, PPIs is necessary for patients treated with long term dual antiplatelet therapy (DAPT). Ethnic variance also played a different effect on clopidogrel response. Our study evaluated the effect of concomitant use of DAPT and PPIs and assessed whether ethnic variance exert different effect on clinical outcomes. METHODS: We carefully searched EMBASE, PubMed/Medline databases, and the Cochrane library in April 2019. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) and individual endpoints reported. We also focused on bleeding events. Studies were excluded if the follow-up were <12 months and patients were not treated with clopidogrel after stent implantation. RESULTS: A total of 18 studies were included in the systematic review (involving 79,670 patients). No randomized controlled trials (RCTs) were included. PPIs comedication were associated with increased MACCE (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.28-1.49) while not associated with decreased bleeding risks, such as gastrointestinal bleeding (OR = 1.05; 95% CI = 0.53-2.11). PPIs comedication were associated with increased risk for all endpoints among Caucasian population while not with increased risk for MACE (OR = 1.20; 95% CI = 0.99-1.39), all-cause death (OR = 1.24; 95% CI = 0.74-2.06), cardiac-death (OR = 1.29; 95% CI = 0.64-2.57) among Asian population. CONCLUSION: PPIs comedication were associated with adverse clinical outcomes, and ethnic variance may exert different effect on clinical outcomes. Subgroup analysis indicated that concomitant use of PPI might be suitable for Asian patients after stent implantation.


Assuntos
Implante de Prótese Vascular , Prótese Vascular , Clopidogrel/uso terapêutico , Grupos de Populações Continentais , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Stents , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Clopidogrel/administração & dosagem , Grupos de Populações Continentais/estatística & dados numéricos , Oclusão Coronária/prevenção & controle , Oclusão Coronária/terapia , Quimioterapia Combinada , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Bomba de Prótons/administração & dosagem , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(6): e24481, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578542

RESUMO

ABSTRACT: This study conducts a correlation exploration of CYP2C19 gene polymorphism and clopidogrel resistance in Han Chinese patients with cerebral infarction in Guizhou Region.A total of 270 Han Chinese patients with cerebral infarction, who were hospitalized in our hospital from January 2016 to January 2018, are selected. These patients were divided into 2 groups, clopidogrel resistance group (n = 60) and clopidogrel sensitive group (n = 210). According to the TEG results, the CYP2C19 gene polymorphism detection was carried out by using the PCR-RFLP method, while IL-6 level in the patient's blood was measured by using the ELISA method.The resistance group occupies 22.22%. The platelet inhibition ratio of the resistance group was 23 ±â€Š7%, which was significantly lower than that of the sensitive group (65 ±â€Š13%), and the difference was statistically significant (P < .05). The Logisitic regression analysis revealed that the history of diabetes, history of high blood pressure, increase in low density lipoprotein and CYP2C19 mutant gene were independent risk factors of clopidogrel resistance. After treatment, the serum IL-6 level of patients in the resistance group was 17.21 ±â€Š0.98 ng/L, which was significant higher than that of patients in the sensitive group (11.21 ±â€Š0.68 ng/L), and the difference was statistically significant (P < .05).Patients with cerebral infarction in Guizhou region have a higher occurrence rate of clopidogrel resistance. Clopidogrel resistance not only will weaken the anti-inflammatory action of the drug, but also correlates with the patient's CYP2C19 mutant gene and blood lipid level.


Assuntos
Infarto Cerebral/tratamento farmacológico , Clopidogrel/uso terapêutico , Citocromo P-450 CYP2C19/genética , Polimorfismo Genético/genética , Grupo com Ancestrais do Continente Asiático/genética , China , Clopidogrel/farmacocinética , Resistência a Medicamentos/genética , Feminino , Frequência do Gene/genética , Técnicas de Genotipagem , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real
3.
Ann Intern Med ; 174(2): JC21, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33524286

RESUMO

SOURCE CITATION: Brouwer J, Nijenhuis VJ, Delewi R, et al. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med. 2020;383:1447-57. 32865376.


Assuntos
Aspirina , Substituição da Valva Aórtica Transcateter , Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Quimioterapia Combinada , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos
5.
Clin Appl Thromb Hemost ; 27: 1076029620980067, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33443453

RESUMO

This study aimed to investigate the long-term safety and benefits of antiplatelet therapy in patients with cerebral infarction with thrombocytopenia, as evidence regarding this was limited. This cohort trial assessed patients with acute cerebral infarction with thrombocytopenia treated in the Neurology Department of Shanghai Tenth People's Hospital from January 2016 to December 2018, and enrolled patients were followed up for 9 months. The patients were divided into non-antiplatelet and antiplatelet groups based on the actual intake of antiplatelet drugs. Primary endpoints included hemorrhagic events, recurrence of cerebral infarction, and activity of daily living (ADL) score changes. To balance baseline clinical data, propensity score matching was applied, and there were finally 65 matched patients, including 30 and 35 in the antiplatelet and non-antiplatelet groups, respectively. There were no differences in hemorrhagic and cerebral infarction recurrence rates between the 2 groups. ADL score change was higher in the antiplatelet group than in the non-antiplatelet group (10 vs 5, p = 0.039). In multivariate regression analysis, antiplatelet therapy significantly predicted a positive change in ADL scores [B = 8.381, 95% confidence interval (0.56-16.19)]. In patients with acute cerebral infarction with thrombocytopenia, antiplatelet therapy could the improve the quality of life in the chronic stage.


Assuntos
Infarto Cerebral/complicações , Infarto Cerebral/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Trombocitopenia/complicações , Trombocitopenia/tratamento farmacológico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Aspirina/uso terapêutico , China , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Inibidores da Agregação de Plaquetas/efeitos adversos , Pontuação de Propensão , Qualidade de Vida , Segurança , Resultado do Tratamento
9.
Medicina (Kaunas) ; 57(1)2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-33435185

RESUMO

Effective platelet inhibition is the main goal of the antiplatelet therapy recommended as a standard treatment in the secondary prevention of non-embolic ischemic stroke. Acetylsalicylic acid (aspirin) and clopidogrel are commonly used for this purpose worldwide. A low biological response to antiplatelet agents is a phenomenon that significantly reduces the therapeutic and protective properties of the therapy. The mechanisms leading to high on-treatment platelet reactivity are still unclear and remain multifactorial. The aim of the current review is to establish the background of resistance to antiplatelet agents commonly used in the secondary prevention of ischemic stroke and to explain the possible mechanisms. The most important factors influencing the incidence of a low biological response were demonstrated. The similarities and the differences in resistance to both drugs are emphasized, which may facilitate the selection of the appropriate antiplatelet agent in relation to specific clinical conditions and comorbidities. Despite the lack of indications for the routine assessment of platelet reactivity in stroke subjects, this should be performed in selected patients from the high-risk group. Increasing the detectability of low antiaggregant responders, in light of its negative impact on the prognosis and clinical outcomes, can contribute to a more individualized approach and modification of the antiplatelet therapy to maximize the therapeutic effect in the secondary prevention of stroke.


Assuntos
Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Resistência a Medicamentos/fisiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Disponibilidade Biológica , Interações Medicamentosas , Resistência a Medicamentos/genética , Humanos , Falência Renal Crônica/fisiopatologia , Síndrome Metabólica/fisiopatologia , Variantes Farmacogenômicos/genética , Ativação Plaquetária , Testes de Função Plaquetária , Medição de Risco , Prevenção Secundária , Fumar/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle
10.
Int Heart J ; 62(1): 171-174, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455983

RESUMO

A 41-year-old woman with chest pain for 6 hours was admitted to our chest pain center, presenting with acute myocardial infarction. Coronary angiography showed acute total occlusion in the proximal left anterior descending artery due to late stent thrombosis. After thrombus aspiration and intracoronary administration of 0.5 mg tirofiban, repeated angiography showed that no obvious residual stenosis remained. The patient underwent drug-coated balloon angioplasty 69 days ago and was then administered dual antiplatelet treatment (aspirin and clopidogrel) uninterruptedly. Genetic testing found that both cytochrome P450 2C19 (CYP2C19) (G681A) and glycoprotein Ia (GPIa) (C807T, G873A) were hybrid mutant types, demonstrating that the patient was possibly resistant to clopidogrel and aspirin simultaneously. Thus, clopidogrel was replaced by ticagrelor and no more cardiovascular adverse events occurred during the 2-year follow-up.


Assuntos
Oclusão Coronária/etiologia , Reestenose Coronária/etiologia , Infarto do Miocárdio/diagnóstico , Doença Aguda , Adulto , Assistência ao Convalescente , Angioplastia Coronária com Balão/métodos , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Clopidogrel/administração & dosagem , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico por imagem , Reestenose Coronária/terapia , Citocromo P-450 CYP2C19/genética , Terapia Antiplaquetária Dupla/efeitos adversos , Terapia Antiplaquetária Dupla/métodos , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Humanos , Integrina alfa2/genética , Mutação/genética , Infarto do Miocárdio/etiologia , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Stents/efeitos adversos , Trombectomia/métodos , Trombose/terapia , Ticagrelor/administração & dosagem , Ticagrelor/uso terapêutico , Tirofibana/administração & dosagem , Tirofibana/uso terapêutico , Resultado do Tratamento
12.
Yonsei Med J ; 62(1): 75-85, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381937

RESUMO

PURPOSE: Antiplatelet drugs are essential in patients with cardiovascular disease who undergo stent placement. We hypothesized that risks of mortality would differ according to adherence to antiplatelet agents, number of antiplatelet agents, and antiplatelet regimens in patients undergoing stent placement or angioplasty. MATERIALS AND METHODS: Between 2002 and 2013, we initially enrolled 8671 subjects who underwent stent placement or angioplasty in the National Health Insurance Service-National Sample Cohort in Korea. Using the International Classification of Diseases, 10th revision, the incidence of all-cause death, including cardiovascular disease, cerebrovascular disease, and cancer, was defined. Using a nested case-control study design, controls were matched to cases at a ratio of 4:1, and a total of 5415 subjects were eligible for this study. RESULTS: During a median follow-up period of 3.51 years, the incidence rate of all-cause death was 40 per 1000 person-years. We found that adherence to antiplatelet monotherapy significantly decreased risk of death by cerebro-cardiovascular disease, compared with discontinuation of antiplatelets [adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) (0.41-0.96)]. Compared with dual antiplatelet therapy (DAPT), aspirin and clopidogrel monotherapy significantly reduced death by cerebro-cardiovascular disease [adjusted OR 0.65, 95% CI (0.44-0.95) and adjusted OR 0.58, 95% CI (0.35-0.96), respectively]. There was no significant difference of mortality between aspirin monotherapy and clopidogrel monotherapy. CONCLUSION: Our study demonstrated that adherence to antiplatelet therapy and antiplatelet monotherapy, compared with DAPT, in patients with stent placement or angioplasty may have a beneficial effect on mortality in cerebro-cardiovascular disease.


Assuntos
Angioplastia/efeitos adversos , Stents Farmacológicos/efeitos adversos , Inibidores da Agregação de Plaquetas/farmacologia , Idoso , Angioplastia/mortalidade , Aspirina/uso terapêutico , Estudos de Casos e Controles , Clopidogrel/efeitos adversos , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Resultado do Tratamento
15.
PLoS One ; 15(12): e0236260, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370281

RESUMO

BACKGROUND: Antiplatelet therapy is a cornerstone of secondary stroke prevention, but the responsiveness to antiplatelet medication varies among patients. Clopidogrel is a pro-drug that requires hepatic transformation to reach its active metabolite. Single nucleotide polymorphisms (SNPs) in key enzymes or the target adenosine diphosphate (ADP) receptor on the platelet surface are believed to be involved in clopidogrel-mediated platelet inhibition and decreased antiplatelet effect with high-on-treatment platelet reactivity (HTPR). OBJECTIVE: This study investigated whether specific SNPs in key hepatic enzymes (CYP2C19*2, *3, *17, CYP3A4*1G, and NR1I2) or the ADP receptor (PR2Y12) are associated with HTPR to clopidogrel. PATIENTS & METHODS: This observational study included patients with ischemic stroke (IS) and transient ischemic attacks (TIAs) receiving clopidogrel at a dose of 75 mg/day. Patients were genotyped for eight different SNPs in the genes encoding CYP2C19, CYP3A4, NR1I2, and the P2Y12 receptor. RESULTS: Of the 103 patients that were included, 30.7% carried the CYP2C19*2 allele and had higher platelet reaction unit (PRU) values than non-carriers, but no patients showed HTPR. Carriers of the *17 allele had higher platelet inhibition but showed no difference in PRU values compared with non-carriers. The remaining SNPs were neither associated with PRU nor with platelet inhibition. CONCLUSIONS: Patients with IS and TIAs treated with 75 mg clopidogrel/day do not have HTPR. A genetic analysis of CYP2C19*2, *3, *17, CYP3A4*1G, and NR1I2 revealed no associations with clopidogrel HTPR. CYP2C19*2 carriers and patients with HTPR in the acute phase after ischemic stroke or transient ischemic attacks exhibit higher PRU values, but not long-term treatment HTPR.


Assuntos
Clopidogrel/uso terapêutico , Citocromo P-450 CYP2C19/genética , Inibidores da Agregação de Plaquetas/uso terapêutico , Polimorfismo de Nucleotídeo Único , Idoso , Alelos , Dinamarca , Feminino , Frequência do Gene , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária
16.
J Clin Neurosci ; 82(Pt A): 128-133, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317720

RESUMO

PURPOSE: To reduce procedural thromboembolisms, tailored antiplatelet drug preparation has been used according to antiplatelet resistance for endovascular coiling of unruptured aneurysms. We compared an aspirin plus clopidogrel group with a ticagrelor group using diffusion-weighted imaging (DWI) after stent-assisted coiling for unruptured aneurysms. METHODS: From October 2018 to April 2019, 72 patients with 78 aneurysms underwent stent-assisted coiling, with aspirin plus clopidogrel (n = 20 patients with 22 aneurysms) or ticagrelor (n = 52 patients with 56 aneurysms) as an antiplatelet preparation, and were enrolled in our study. All patients were evaluated using DWI 2 h after coiling to detect procedural thromboembolisms. RESULTS: Postprocedure infarction was observed on DWI in 37 procedures (47.4%), and symptomatic infarction occurred in 1 procedure (1.28%). Postprocedure infarction was significantly lower in the aspirin plus clopidogrel than in ticagrelor group (27.3% vs. 55.4%, p = 0.043). Postprocedure infarction was associated with aneurysm type (sidewall aneurysm (30.8%) vs. aneurysm with incorporated branches (64.1%), p = 0.006) and guiding catheter type (single (23.8%) vs. double (56.1%), p = 0.020). Multivariable logistic regression analysis demonstrated that postprocedure infarction was related to aneurysm type (adjusted odds ratio (OR); 3.317, confidence interval (CI); 1.223-8.991, p = 0.018), guiding catheter type (adjusted OR; 2.783, CI; 0.828-9.353, p = 0.098), and antiplatelet medication (adjusted OR; 1.295, CI; 0.969-1.730, p = 0.080). CONCLUSIONS: Postprocedure infarction was observed on DWI after stent-assisted coiling for unruptured aneurysms more frequently in the ticagrelor group than in the aspirin plus clopidogrel group. However, our study suggests that postprocedure infarction is more associated with aneurysm type than antiplatelet medication.


Assuntos
Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Tromboembolia/tratamento farmacológico , Ticagrelor/uso terapêutico , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética , Embolização Terapêutica , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Stents
17.
PLoS One ; 15(12): e0242466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370282

RESUMO

BACKGROUND: In real-world practice settings, there is insufficient evidence on the efficacy of antiplatelet drugs, including clopidogrel, aspirin, and ticlopidine, in stroke prevention. PURPOSE: To compare the efficacies between aspirin and clopidogrel and aspirin and ticlopidine in stroke prevention. METHODS: This population-based case-cohort study utilized the data obtained from a randomized sample of one million subjects in the Taiwan National Health Insurance Research Database. Patients who were hospitalized owing to the primary diagnosis of ischemic stroke from January 1, 2000 to December 31, 2010 and treated with aspirin, ticlopidine, or clopidogrel were included in the study. Propensity score matching with a 1:4 ratio was performed to compare aspirin with ticlopidine and clopidogrel. The criteria for inclusion were the use of one of the three antiplatelet drugs for more than 14 days within the first month after the stroke and then continued use of the antiplatelet drugs until the study endpoint of recurrent stroke. RESULTS: During the 3-year follow-up period, the recurrent stroke rates were 1.62% (42/2585), 1.48% (3/203), and 2.55% (8/314) in the aspirin, ticlopidine, and clopidogrel groups, respectively. Compared with the patients treated with aspirin, those treated with clopidogrel and ticlopidine showed competing risk-adjusted hazard ratios of recurrent stroke of 2.27 (1.02-5.07) and 0.62 (0.08-4.86), respectively. CONCLUSION: Compared with the patients treated with aspirin, those treated with clopidogrel were at a higher risk of recurrent stroke. For stroke prevention, aspirin was superior to clopidogrel whereas ticlopidine was not inferior to aspirin.


Assuntos
Aspirina/uso terapêutico , Isquemia Encefálica/prevenção & controle , Clopidogrel/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Ticlopidina/uso terapêutico , Adulto , Idoso , Isquemia Encefálica/sangue , Isquemia Encefálica/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Recidiva , Prevenção Secundária/métodos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/fisiopatologia , Taiwan
18.
Medicine (Baltimore) ; 99(50): e23695, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327360

RESUMO

BACKGROUND: Randomized trials and observation studies have revealed conflicting results regarding the interaction between clopidogrel and proton pump inhibitors (PPIs). The aim of our study was to provide laboratory evidence regarding whether PPIs blunt the antiplatelet reactivity of clopidogrel. METHODS: We included records of Asian patients who received clopidogrel treatment for cardiovascular or cerebrovascular events and the VerifyNow P2Y12 assay for platelet reactivity monitoring. The responsiveness of antiplatelet effect to clopidogrel was analyzed according to 3 criteria:Results: Patients treated without PPIs did not differ significantly from those concomitantly treated with PPIs in terms of levels of PI (25.7% ± 24.3% vs 23.0 ± 25.3%, P = .4315), PRU (187.3 ± 74.0 vs 197.4 ±â€Š77.3, P = .3373), or responsiveness to antiplatelet (adjusted absolute risk, 3.5%; 95% confidence interval, - 10.7 to 17.7%; P = .6297). Patients treated with lansoprazole, esomeprazole, pantoprazole, and rabeprazole exhibited no significant differences in PRU or PI levels compared with those treated without PPIs. By contrast, patients treated with dexlansoprazole exhibited a significantly decreased level of PI (25.7% ±â€Š24.3% vs 14.0% ±â€Š21.6%, P = .0297) and responsiveness to clopidogrel under the criterion PI > 20% (adjusted absolute risk: 10.5%; 95% confidence interval: 2.6% to 43.6%; P = .0274). CONCLUSION: No robust interaction between clopidogrel and PPIs was found, but caution should be exercised in the concomitant use of dexlansoprazole and clopidogrel in Asians.


Assuntos
Clopidogrel/farmacocinética , Inibidores da Agregação de Plaquetas/farmacocinética , Inibidores da Bomba de Prótons/farmacologia , Receptores Purinérgicos P2Y12/efeitos dos fármacos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Comorbidade , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária/efeitos dos fármacos , Fatores Sexuais
19.
Arq. bras. cardiol ; 115(5): 830-839, nov. 2020. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP | ID: biblio-1142260

RESUMO

Resumo Fundamentos: Poucos estudos discutiram causas para o subtratamento medicamentoso na SCA. Objetivos: Avaliar a não-administração e suspensão de medicamentos durante o tratamento intra-hospitalar da SCA na Estratégia de Registro de Síndrome Coronariana Aguda (estudo ERICO). Métodos: Analisamos prontuários de 563 participantes ERICO para avaliar a frequência e motivos da não administração e/ou suspensão de medicamentos. Construímos modelos de regressão logística para avaliar se sexo, idade ≥65 anos, nível educacional ou subtipo de SCA estavam associados com (a) não administração de ≥1 medicamentos; e (b) não administração ou suspensão de ≥1 medicamentos. O nível de significância foi 5%. Resultados: A amostra é composta por 58,1% de homens e com idade mediana de 62 anos. Em 183 (32,5%) participantes ≥1 medicamentos não foram administrados e 288 (51,2%) apresentaram ≥1 medicamentos não administrados ou suspensos. As causas mais frequentes foram risco de sangramento (aspirina, clopidogrel e heparina), insuficiência cardíaca (betabloqueadores) e hipotensão (inibidores da enzima conversora da angiotensina e bloqueadores dos receptores da angiotensina). Indivíduos com idade ≥65 anos (razão de chances [RC]:1,51; intervalo de confiança de 95% [IC95%]:1,05-2,19) e com angina instável (RC:1,72; IC95%:1,07-2,75) tiveram maior chance de não-administração. Considerando apenas pacientes com infarto do miocárdio, idade ≥65 anos foi associada tanto à não administração quanto à não administração ou suspensão. Conclusões: A não administração ou suspensão de ≥1 medicamento não foi rara no estudo ERICO. Indivíduos com idade ≥65 anos ou com angina instável tiveram maior chance de não administração e podem ser subtratados nesse cenário.


Abstract Background: Few studies have discussed the reasons for pharmacological undertreatment of Acute Coronary Syndrome (ACS). Objectives: To determine the frequency and reasons for the non-administration and suspension of medications during in-hospital treatments of ACS in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods: The present study analyzed the medical charts of the 563 participants in the ERICO study to evaluate the frequency and reasons for the non-administration and/or suspension of medications. Logistic regression models were built to analyze if sex, age ≥65 years of age, educational level, or ACS subtype were associated with (a) the non-administration of ≥1 medications; and (b) the non-administration or suspension of ≥1 medications. The significance level was set at 5%. Results: This study's sample included 58.1% males, with a median of 62 years of age. In 183 (32.5%) participants, ≥1 medications were not administered, while in 288 (51.2%), ≥1 medications were not administered or were suspended. The most common reasons were the risk of bleeding (aspirin, clopidogrel, and heparin), heart failure (beta blockers), and hypotension (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers). Individuals aged ≥65 (odds ratio [OR]:1.51; 95% confidence interval [95% CI]:1.05-2.19) and those with unstable angina (OR:1.72; 95% CI:1.07-2.75) showed a higher probability for the non-administration of ≥1 medication. Considering only patients with myocardial infarction, being ≥65 years of age was associated with both the non-administration and the non-administration or suspension of ≥1 medication. Conclusions: Non-administration or suspension of ≥1 medication proved to be common in this ERICO study. Individuals of ≥65 years of age or with unstable angina showed a higher probability of the non-administration of ≥1 medication and may be undertreated in this scenario. (Arq Bras Cardiol. 2020; 115(5):830-839)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Preparações Farmacêuticas , Síndrome Coronariana Aguda/tratamento farmacológico , Inibidores da Enzima Conversora de Angiotensina , Inibidores da Agregação de Plaquetas , Aspirina , Clopidogrel
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