When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos Brasileiros de Cardiologia (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016000300236 |
Resumo: | Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS. |
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When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome?Acute Coronary Syndrome / therapyPlatelet Aggregation Inhibitors / administration & dosageAspirin / administration & dosagePercutaneous Coronary InterventionAbstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS.Sociedade Brasileira de Cardiologia - SBC2016-03-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016000300236Arquivos Brasileiros de Cardiologia v.106 n.3 2016reponame:Arquivos Brasileiros de Cardiologia (Online)instname:Sociedade Brasileira de Cardiologia (SBC)instacron:SBC10.5935/abc.20160042info:eu-repo/semantics/openAccessSilva,Pedro Gabriel Melo de Barros eRibeiro,Henrique BarbosaBaruzzi,Antônio Claudio do AmaralSilva,Expedito Eustáquio Ribeiro daeng2016-06-13T00:00:00Zoai:scielo:S0066-782X2016000300236Revistahttp://www.arquivosonline.com.br/https://old.scielo.br/oai/scielo-oai.php||arquivos@cardiol.br1678-41700066-782Xopendoar:2016-06-13T00:00Arquivos Brasileiros de Cardiologia (Online) - Sociedade Brasileira de Cardiologia (SBC)false |
dc.title.none.fl_str_mv |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
title |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
spellingShingle |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? Silva,Pedro Gabriel Melo de Barros e Acute Coronary Syndrome / therapy Platelet Aggregation Inhibitors / administration & dosage Aspirin / administration & dosage Percutaneous Coronary Intervention |
title_short |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
title_full |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
title_fullStr |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
title_full_unstemmed |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
title_sort |
When is the Best Time for the Second Antiplatelet Agent in Non-St Elevation Acute Coronary Syndrome? |
author |
Silva,Pedro Gabriel Melo de Barros e |
author_facet |
Silva,Pedro Gabriel Melo de Barros e Ribeiro,Henrique Barbosa Baruzzi,Antônio Claudio do Amaral Silva,Expedito Eustáquio Ribeiro da |
author_role |
author |
author2 |
Ribeiro,Henrique Barbosa Baruzzi,Antônio Claudio do Amaral Silva,Expedito Eustáquio Ribeiro da |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Silva,Pedro Gabriel Melo de Barros e Ribeiro,Henrique Barbosa Baruzzi,Antônio Claudio do Amaral Silva,Expedito Eustáquio Ribeiro da |
dc.subject.por.fl_str_mv |
Acute Coronary Syndrome / therapy Platelet Aggregation Inhibitors / administration & dosage Aspirin / administration & dosage Percutaneous Coronary Intervention |
topic |
Acute Coronary Syndrome / therapy Platelet Aggregation Inhibitors / administration & dosage Aspirin / administration & dosage Percutaneous Coronary Intervention |
description |
Abstract Dual antiplatelet therapy is a well-established treatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), with class I of recommendation (level of evidence A) in current national and international guidelines. Nonetheless, these guidelines are not precise or consensual regarding the best time to start the second antiplatelet agent. The evidences are conflicting, and after more than a decade using clopidogrel in this scenario, benefits from the routine pretreatment, i.e. without knowing the coronary anatomy, with dual antiplatelet therapy remain uncertain. The recommendation for the upfront treatment with clopidogrel in NSTE-ACS is based on the reduction of non-fatal events in studies that used the conservative strategy with eventual invasive stratification, after many days of the acute event. This approach is different from the current management of these patients, considering the established benefits from the early invasive strategy, especially in moderate to high-risk patients. The only randomized study to date that specifically tested the pretreatment in NSTE-ACS in the context of early invasive strategy, used prasugrel, and it did not show any benefit in reducing ischemic events with pretreatment. On the contrary, its administration increased the risk of bleeding events. This study has brought the pretreatment again into discussion, and led to changes in recent guidelines of the American and European cardiology societies. In this paper, the authors review the main evidence of the pretreatment with dual antiplatelet therapy in NSTE-ACS. |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016-03-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016000300236 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2016000300236 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/abc.20160042 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia - SBC |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia - SBC |
dc.source.none.fl_str_mv |
Arquivos Brasileiros de Cardiologia v.106 n.3 2016 reponame:Arquivos Brasileiros de Cardiologia (Online) instname:Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
instname_str |
Sociedade Brasileira de Cardiologia (SBC) |
instacron_str |
SBC |
institution |
SBC |
reponame_str |
Arquivos Brasileiros de Cardiologia (Online) |
collection |
Arquivos Brasileiros de Cardiologia (Online) |
repository.name.fl_str_mv |
Arquivos Brasileiros de Cardiologia (Online) - Sociedade Brasileira de Cardiologia (SBC) |
repository.mail.fl_str_mv |
||arquivos@cardiol.br |
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1752126566128680960 |