Avaliação da duração e do risco de sangramento entre diferentes estratégias de dupla antiagregação plaquetária administradas após a intervenção coronária percutânea: uma revisão de escopo

Autores

DOI:

https://doi.org/10.33448/rsd-v12i8.42867

Palavras-chave:

Terapia antiplaquetária dupla; Inibidores da agregação plaquetária; Hemorragia.

Resumo

Pacientes portadores Síndrome Coronariana Aguda (SCA) necessitam de implante de stent farmacológico após a intervenção coronária percutânea (ICP), associado à administração de dupla terapia antiplaquetária (TDAP) para a redução do risco trombótico. Considerando a avaliação entre a proteção isquêmica e a chance de eventos hemorrágicos, novas estratégias de TDAP têm sido utilizadas, permitindo-se a prevenção de possíveis desfechos deletérios. O presente estudo objetiva avaliar a duração e o risco de sangramento entre diferentes estratégias de TDAP administradas após a ICP. Para essa revisão de escopo, realizada através das plataformas PubMed e ScienceDirect, entre os anos de 2020 e 2023, os descritores eleitos foram: '’Platelet Aggregation Inhibitors'', ‘’Percutaneous Coronary Intervention’’ e ‘’Hemorrhage’’. Os critérios de inclusão consistiram em (1) avaliação da duração e do risco de sangramento em distintas estratégias de TDAP (2) análise entre diferentes tipos de antiagregantes plaquetários (3) estudos que abordaram o seguimento e o manejo clínico (4) artigos em inglês e português. Os critérios de exclusão consistiram em inadequações ao tema, relatos de casos, editoriais, revisões simples, estudos com animais, além de textos fora do limite temporal. Regimes de TDAP prolongada e de longa duração apresentaram maior proteção isquêmica e maior risco de sangramento. Regimes de curta ou curtíssima duração estiveram associados à redução das taxas de sangramento maior, sendo benéficos aos pacientes idosos ou trombocitopênicos. O manejo de casos com alto risco trombótico e hemorrágico, assim como a utilização de escores preditivos permanecem como tópicos controversos a serem elucidados através de novos estudos.

Referências

Abusnina, W., Baral, N., Seri, A., Ben-Dor, I., Alkhouli, M., Monteleone, P., & Paul, T. K. (2022). Safety and Efficacy of Ultra Short-Duration Dual Antiplatelet Therapy After Percutaneous Coronary Interventions: A Meta analysis of Randomized Controlled Trials. Curr Probl Cardiol, 101295.

Al-Abdouh, A., Barbarawi, M., Abusnina, W., Amr, M., Zhao, D., Savji, N., & Michos, E. D. (2020). Prasugrel v s Ticagrelor for DAPT in Patients with ACS Undergoing PCI: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cardiovasc Revasc Med., 21(12), 1613-1618.

Apostolos, A., Chlorogiannis, D., Vasilagkos, G., Katsanos, K., Toutouzas, K., Aminian, A., & Tsigkas, G. (2023). Safety and efficacy of shortened dual antiplatelet therapy after complex percutaneous coronary intervention: A systematic review and meta-analysis. Hell. J. Cardiol.

Bajraktari, G., Bytyçi, I., Bajraktari, A., & Henein, M. Y. (2022). Non-inferiority of 1 month versus longer dual antiplatelet therapy in patients undergoing PCI with drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials. Ther. Adv. Chronic Dis., 13, 20406223221093758.

Benenati, S., Galli, M., De Marzo, V., Pescetelli, F., Toma, M., Andreotti, F., & Porto, I. (2021). Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. Euro Heart J Cardiovasc Pharmacother., 7(2), 86-93.

Bhattarai, M., Ibrahim, A. M., Salih, M., Tandan, N., Al-Akchar, M., Ayan, M., & Hafiz, A. M. (2020). Comprehensive Outcomes Evaluation After Percutaneous Coronary Intervention in Stable Ischemic Heart Disease and Acute Coronary Syndrome for Short-Versus Standard-Term Dual Antiplatelet Therapy: A Systematic Review and Meta-analysis of Randomized Control Trials. J Cardiovasc Pharmacol., 76(5), 574-583.

Bianco, M., D'ascenzo, F., Roubin, S. R., Kinnaird, T., Peyracchia, M., Ariza-Solé, A., & Valgimigli, M. (2020). Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor. Int. J. Cardiol., 301, 200-206.

Boudreau, R., Fu, A. Y., Barry, Q. S., Clifford, C. R., Chow, A., Tran, U., & CAPITAL Investigators. (2021). Outcomes in Patients Stratified by PRECISE-DAPT Versus DAPT Scores After Percutaneous Coronary Interventions. Am. J. Cardiol., 161, 19-25.

Brant, L. C., & Passaglia, L. G. (Eds.). (2022). Alta Mortalidade por Infarto Agudo do Miocárdio na América Latina e Caribe: Defendendo a Implementação de Linha de Cuidado no Brasil. Arq. Bras. Cardiol., 119(6), 979-980.

Cesaro, A., Gragnano, F., Calabrò, P., Moscarella, E., Santelli, F., Fimiani, F., & Gugliemini, G. (2021). Prevalence and clinical implications of eligibility criteria for prolonged dual antithrombotic therapy in patients with PEGASUS and COMPASS phenotypes: Insights from the START-ANTIPLATELET registry. Int. J. Cardiol., 345, 7-13.

Cho, S., Kang, D. Y., Kim, J. S., Park, D. W., Kim, I. S., Kang, T. S., & Park, S. J. (2023). Dual antiplatelet therapy after percutaneous coronary intervention for left main coronary artery disease. Rev Esp Cardiol., 76(4), 245-252.

Clifford, C. R., Boudreau, R., Visintini, S., Orr, N., Fu, A. Y., Malhotra, N., & So, D. Y. (2022). The association of PRECISE-DAPT score with ischaemic outcomes in patients taking dual antiplatelet therapy following percutaneous coronary intervention: a meta-analysis. Euro Heart J Cardiovasc Pharmacother, 8(5), 511-518.

Costa, F., Montalto, C., Branca, M., Hong, S. J., Watanabe, H., Franzone, A., & Valgimigli, M. (2023). Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials. Euro Heart J, 44(11), 954-968.

Costa, F., van Klaveren, D., Colombo, A., Feres, F., Räber, L., Pilgrim, T., & PRECISE-DAPT Study Investigators. (2020). A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making. Am. Heart J., 223, 44-47.

Elliott, J., Kelly, S. E., Bai, Z., Skidmore, B., Boucher, M., So, D., & Wells, G. A. (2023). Extended dual antiplatelet therapy following percutaneous coronary intervention in clinically important patient subgroups: a systematic review and meta-analysis. Can. Med. Assoc. J., 11(1), E118-E130.

Garg, A., Rout, A., Farhan, S., Waxman, S., Giustino, G., Tayal, R., & Rao, S. V. (2022). Dual antiplatelet therapy duration after percutaneous coronary intervention using drug eluting stents in high bleeding risk patients: A systematic review and meta-analysis. Am. Heart J., 250, 1-10.

Guan, J., Song, W., He, P., Fan, S., Zhi, H., & Wang, L. (2020). Comparative Efficacy and Safety of Duration of Dual Antiplatelet Therapy in Patients with CAD Undergoing Drug-eluting Stent Implantation: A Systematic Review and Network Meta-analysis. Curr. Pharm. Des., 26(44), 5739-5745.

Han, Y., Yuan, X., Hu, X., Fang, Y., Jiang, M., Feng, H., & Gao, L. (2022). Dual antiplatelet therapy after percutaneous coronary intervention in patients at high bleeding risk: A systematic review and meta-analysis. Cardiol. J..

Hu, X., Zhao, W., Zhang, Q., Hu, H., & Luo, S. (2021). Efficacy and Safety of Aspirin Combined with Low-Dose P2Y12 Receptor Antagonists in East Asian Patients Undergoing PCI A Meta-Analysis. Int. Heart J., 62(4), 742-751.

Kedhi, E., Verdoia, M., Suryapranata, H., Damen, S., Camaro, C., Benit, E., & De Luca, G. (2021). Impact of age on the comparison between short-term vs 12-month dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-Year follow-up results of the REDUCE trial. Atherosclerosis., 321, 39-44.

Khan, S. U., Singh, M., Valavoor, S., Khan, M. U., Lone, A. N., Khan, M. Z., & Bhatt, D. L. (2020). Dual antiplatelet therapy after percutaneous coronary intervention and drug-eluting stents: a systematic review and network meta-analysis. Circ., 142(15), 1425-1436

Kheiri, B., Simpson, T. F., Osman, M., Golwala, H., Radaideh, Q., Kumar, K., & Zahr, F. (2020). Safety and efficacy of short-term (1 to 3 months) dual antiplatelet therapy in patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. J. Thromb. Thrombolysis, 50, 867-873.

Kuno, T., Ueyama, H., Takagi, H., Fox, J., & Bangalore, S. (2021). Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome: insights from a network meta-analysis of randomized trials. Cardiovasc. Revascularization Med., 28, 50-56.

Kwok, C. S., Wong, C. W., Nagaraja, V., & Mamas, M. A. (2020). A systematic review of the studies that evaluate the performance of the DAPT score. Int. J. Clin. Pract., 74(10), e13591.

Landi, A., Heg, D., Frigoli, E., Vranckx, P., Windecker, S., Siegrist, P., & MASTER DAPT Investigators. (2023). Abbreviated or standard antiplatelet therapy in HBR patients: final 15-month results of the MASTER-DAPT trial. Cardiovasc. Interv., 16(7), 798-812.

Li, J., Qiu, H., Yan, L., Guo, T., Wang, Y., Li, Y., & Gao, R. (2020). Efficacy and safety of ticagrelor and clopidogrel in East Asian patients with coronary artery disease undergoing percutaneous coronary intervention. Curr. Med. Res. Opin., 36(11), 1739-1745.

Liu, D., Li, Y. Z., Wu, H., Yang, J., Yang, J., Ding, J. W., & Yang, C. J. (2020). Duration of dual antiplatelet therapy after percutaneous coronary intervention with implantation of second-generation drug-eluting stent: A meta-analysis of randomized controlled trials. Int. J. Pharm. Sci., 75(4), 113-117.

Long, M., Ye, Z., Zheng, J., Chen, W., & Li, L. (2020). Dual anti-platelet therapy following percutaneous coronary intervention in a population of patients with thrombocytopenia at baseline: a meta-analysis. BMC Pharmacol. Toxicol., 21, 1-16.

Montalto, C., Costa, F., Leonardi, S., Micari, A., Oreglia, J. A., Vranckx, P., & Valgimigli, M. (2023). Dual antiplatelet therapy duration after percutaneous coronary intervention in patients with indication to oral anticoagulant therapy. A systematic review and meta-analysis of randomized controlled trials. Eur. Heart J. Cardiovasc. Pharmacother., 9(3), 220-230.

Nicolau, J. C., Feitosa Filho, G. S., Petriz, J. L., Furtado, R. H. D. M., Précoma, D. B., Lemke, W., & Mathias Júnior, W. (2021). Diretrizes da Sociedade Brasileira de Cardiologia sobre angina instável e infarto agudo do miocárdio sem supradesnível do segmento ST–2021. Arq. Bras. Cardiol, 117, 181-264.

Parfrey, S., Abdelrahman, A., Blackman, D., Blaxill, J. M., Cunnington, M. S., Greenwood, J. P., & Bulluck, H. (2022). Safety and efficacy of interrupting dual antiplatelet therapy one month following percutaneous coronary intervention: a meta-analysis of randomized controlled trials. BMC Cardiovasc. Disord., 22(1), 1-11.

Park, D. Y., An, S., Kumar, A., Malhotra, S., Jolly, N., Kaur, A., & Vij, A. (2022). Abbreviated versus Standard Duration of DAPT after PCI: A Systematic Review and Network Meta-analysis. Am J. Cardiovasc Drugs., 22(6), 633-645.

Park, D. Y., Wang, P., An, S., Grimshaw, A. A., Frampton, J., Ohman, E. M., & Nanna, M. G. (2022). Shortening the duration of dual antiplatelet therapy after percutaneous coronary intervention for acute coronary syndrome: a systematic review and meta-analysis. Am. Heart J., 251, 101-114.

Pufulete, M., Harris, J., Pouwels, K., Reeves, B. C., Lasserson, D., Loke, Y. K., & Johnson, T. W. (2022). Real-world bleeding in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and prescribed different combinations of dual antiplatelet therapy (DAPT) in England: a population-based cohort study emulating a ‘target trial’. Open Heart., 9(2), e001999.

Rout, A., Sharma, A., Ikram, S., & Garg, A. (2023). Short‐term dual antiplatelet therapy for 1–3 months after percutaneous coronary intervention using drug eluting stents: A systematic review and meta‐analysis of randomized clinical trials. Catheter. Cardiovasc. Interv., 101(2), 299-307.

Samuelsen, P. J., Eggen, A. E., Steigen, T., Wilsgaard, T., Kristensen, A., Skogsholm, A., & Bønaa, K. H. (2021). Incidence and risk factors for major bleeding among patients undergoing percutaneous coronary intervention: Findings from the Norwegian Coronary Stent Trial (NORSTENT). PLoS One, 16(3), e0247358.

Selvaraj, V., Chatterjee, S., Hirai, T., Abbott, J. D., & Bavishi, C. (2022). Three versus 12‐month dual antiplatelet therapy duration in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials. Catheter. Cardiovasc. Interv., 100(7), 1151-1158.

Sheng, X. Y., An, H. J., He, Y. Y., Ye, Y. F., Zhao, J. L., & Li, S. (2022). High‐Dose Clopidogrel versus Ticagrelor in CYP2C19 intermediate or poor metabolizers after percutaneous coronary intervention: A Meta‐Analysis of Randomized Trials. J. Clin. Pharm. Ther., 47(8), 1112-1121.

Sidhu, M. S., Lyubarova, R., Bangalore, S., & Bonaca, M. P. (2022). Challenges of long-term dual antiplatelet therapy use following acute coronary syndromes. Am. Heart J., 246, 44-64.

Silva, M. P. B., Lima, E. R., Borges, P. R. P., Máximo, L. W. M., de Sousa, M. V. A., Leite, A. C., & Dutra, Í. W. (2020). Intervenções de emergência ao paciente com suspeita de infarto agudo do miocárdio. RSD, 9(9), e781997949-e781997949.

Subhaharan, D., Mridha, N., & Singh, K. (2020). Clinical benefits of prolonged dual antiplatelet therapy following complex percutaneous coronary intervention. Coron. Artery Dis., 31(3), 273-278.

Tritschler, T., Patel, A., Kraaijpoel, N., Bhatt, D. L., De Luca, G., Di Santo, P., & Castellucci, L. A. (2022). Case‐fatality rate of major bleeding events in patients on dual antiplatelet therapy after percutaneous coronary intervention: A systematic review and meta‐analysis. Res. Practice Tromb. Haemost., 6(7), e12834.

Tsigkas, G., Apostolos, A., Chlorogiannis, D. D., Bousoula, E., Vasilagkos, G., Tsalamandris, S., & Davlouros, P. (2023). Thirty-Days versus Longer Duration of Dual Antiplatelet Treatment after Percutaneous Coronary Interventions with Newer Drug-Eluting Stents: A Systematic Review and Meta-Analysis. Life, 13(3), 666.

Tsigkas, G., Apostolos, A., Trigka, A., Chlorogiannis, D., Katsanos, K., Toutouzas, K., & Davlouros, P. (2023). Very short versus longer dual antiplatelet treatment after coronary interventions: A systematic review and meta-analysis. Am. J. Cardiovasc. Drugs, 23(1), 35-46.

Valgimigli, M., Cao, D., Angiolillo, D. J., Bangalore, S., Bhatt, D. L., Ge, J., & XIENCE 90 and XIENCE 28 Investigators. (2021). Duration of dual antiplatelet therapy for patients at high bleeding risk undergoing PCI. J. Am. Coll. Cardiol., 78(21), 2060-2072.

Valgimigli, M., Cao, D., Makkar, R. R., Bangalore, S., Bhatt, D. L., Angiolillo, D. J., & Mehran, R. (2021). Design and rationale of the XIENCE short DAPT clinical program: An assessment of the safety of 3-month and 1-month DAPT in patients at high bleeding risk undergoing PCI with an everolimus-eluting stent. Am. Heart J., 231, 147-156.

Valgimigli, M., Frigoli, E., Heg, D., Tijssen, J., Jüni, P., Vranckx, P., & Smits, P. C. (2021). Dual antiplatelet therapy after PCI in patients at high bleeding risk. N. Engl. J. Med., 385(18), 1643-1655.

Valgimigli, M., Smits, P. C., Frigoli, E., Bongiovanni, D., Tijssen, J., Hovasse, T., & MASTER DAPT Investigators. (2022). Duration of antiplatelet therapy after complex percutaneous coronary intervention in patients at high bleeding risk: a MASTER DAPT trial sub-analysis. Eur. Heart J., 43(33), 3100-3114.

Verdoia, M., Suryapranata, H., Damen, S., Camaro, C., Benit, E., Barbieri, L., & De Luca, G. (2021). Gender differences with short-term vs 12 months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: 2-years follow-up results of the REDUCE trial. J. Thromb. Thrombolysis, 1-11.

Watanabe, H., Domei, T., Morimoto, T., Natsuaki, M., Shiomi, H., Toyota, T., & STOPDAPT-2 investigators. (2021). Details on the effect of very short dual antiplatelet therapy after drug-eluting stent implantation in patients with high bleeding risk: insight from the STOPDAPT-2 trial. Cardiovasc. Interv. Ther., 36, 91-103.

Witberg, G., Zusman, O., Bental, T., Plakht, I., Gabbay, H., Gerber, Y., & Kornowski, R. (2020). Validation of the DAPT score in real-world patients undergoing coronary stent implantation. Int. J. Cardiol., 300, 99-105.

Xu, Y., Shen, Y., Chen, D., Zhao, P., & Jiang, J. (2021). Efficacy and safety of dual antiplatelet therapy in patients undergoing coronary stent implantation: A systematic review and network meta-analysis. J. Interv. Cardiol., 2021, 1-12.

Zahid, M. B. A., Memon, M. S., Tappiti, M., Kumar, V. S., Nazir, A. M., Koganti, B., & Zahid, M. B. A. (2021). Duration of dual antiplatelet therapy after stent implantation, still an enigma: a systematic review of randomized clinical trials. Cureus, 13(11).

Zhang, J., Chen, Z., Li, C., Wang, D., He, S., Luo, C., & He, Y. (2022). Short dual antiplatelet therapy in patients with high bleeding risk undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Coron. Artery Dis., 33(7), 580-589.

Zhang, W. J., Qiao, X., Liang, X. Y., Li, Y., Yang, R. R., & Wang, Z. L. (2021). Efficacy and safety of short-term 1–3 months versus standard 12 months dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a meta-analysis of randomized clinical trials. Platelets, 32(5), 582-590.

Zhong, P. Y., Shang, Y. S., Bai, N., Ma, Y., Niu, Y., & Wang, Z. L. (2021). Efficacy and safety of very short-term dual antiplatelet therapy after drug-eluting stents implantation for acute coronary syndrome: a systematic review and meta-analysis of randomized clinical trials. Front. Cardiovasc. Med., 8, 660360.

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17/08/2023

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SANTOS, T. L. .; PARREIRA, W. da S. P. .; FRACARO, A. C.; CAMPOS, D. R. .; PAVONI, B. de C. .; BEZERRA NETO, P. D. .; SADY, L. M. da R. .; PINHO, L. A. de .; PEREIRA, L. F. B. . Avaliação da duração e do risco de sangramento entre diferentes estratégias de dupla antiagregação plaquetária administradas após a intervenção coronária percutânea: uma revisão de escopo. Research, Society and Development, [S. l.], v. 12, n. 8, p. e7112842867, 2023. DOI: 10.33448/rsd-v12i8.42867. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/42867. Acesso em: 23 nov. 2024.

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