Is There Safety in the Use of Clopidogrel Loading Dose in Patients Over 75 Years of Age with Acute Coronary Syndrome?

Imagem de Miniatura
Arquivos
art_SOEIRO_Is_There_Safety_in_the_Use_of_Clopidogrel_2019.PDF (248.36 KB)
Citações na Scopus
3
Tipo de produção
article
Data de publicação
2019
DOI
SciELO
Scopus
Título da Revista
ISSN da Revista
Título do Volume
Editora
Sociedade Brasileira de Cardiologia
Autores
Citação
INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES, v.32, n.5, p.449-456, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Abstract Background: There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population. Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age. Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results: Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 - 0.614, p = 0.007). Conclusion: A loading dose of 300 mg or more of clopidogrel.
Palavras-chave
Platelet Aggregation Inhibitors/therapeutic use, Acute Coronary Syndrome/complications, Aged, Hemorrhage, Treatment Outcome
URI
https://observatorio.fm.usp.br/handle/OPI/35298
Referências
  1. Abuzahra M, 2008, AM J CARDIOL, V102, P401, DOI 10.1016/j.amjcard.2008.03.073
  2. [Anonymous], 2009, Arq. Bras. Cardiol., V93, pe179, DOI 10.1590/S0066-782X2009001400001
  3. Chen ZM, 2005, LANCET, V366, P1607
  4. Choi CU, 2011, AM HEART J, V161, P373, DOI 10.1016/j.ahj.2010.10.031
  5. Cuisset T, 2006, J AM COLL CARDIOL, V48, P1339, DOI 10.1016/j.jacc.2006.06.049
  6. Cuisset T, 2011, AM J CARDIOL, V108, P1411, DOI 10.1016/j.amjcard.2011.06.060
  7. Dangas G, 2009, J AM COLL CARDIOL, V54, P1438, DOI 10.1016/j.jacc.2009.06.021
  8. Eikelboom JW, 2006, CIRCULATION, V114, P774, DOI 10.1161/CIRCULATIONAHA.106.612812
  9. Fach A, 2015, AM J CARDIOL, V116, P1802, DOI 10.1016/j.amjcard.2015.09.022
  10. Feldman DN, 2010, AM J CARDIOL, V105, P323, DOI 10.1016/j.amjcard.2009.09.034
  11. Fernandez A, 2011, AM J CARDIOL, V107, P6, DOI 10.1016/j.amjcard.2010.08.035
  12. Fukushima K, 2008, CIRC J, V72, P1282, DOI 10.1253/circj.72.1282
  13. Gibson CM, 2008, AM HEART J, V155, P133, DOI 10.1016/j.ahj.2007.08.034
  14. Ibanez B, 2018, EUR HEART J, V39, P119, DOI 10.1093/eurheartj/ehx393
  15. Jneid H, 2012, CIRCULATION, V126, P875, DOI 10.1161/CIR.0b013e318256f1e0
  16. Lemesle G, 2009, AM HEART J, V157, P375, DOI 10.1016/j.ahj.2008.09.013
  17. Levine GN, 2016, CIRCULATION, V134, pE123, DOI 10.1161/CIR.0000000000000404
  18. Lin YL, 2009, ACTA PHARMACOL SIN, V30, P553, DOI 10.1038/aps.2009.38
  19. Lopes RD, 2012, EUR HEART J, V33, P2044, DOI 10.1093/eurheartj/ehs012
  20. Mangiacapra F, 2010, AM J CARDIOL, V106, P1208, DOI 10.1016/j.amjcard.2010.06.044
  21. Mazhari R, 2014, HEART, V100, P1483, DOI 10.1136/heartjnl-2014-306134
  22. Mehran R, 2011, CIRCULATION, V123, P2736, DOI 10.1161/CIRCULATIONAHA.110.009449
  23. Mehta SR, 2010, LANCET, V376, P1233, DOI 10.1016/S0140-6736(10)61088-4
  24. Montalescot G, 2006, J AM COLL CARDIOL, V48, P931, DOI 10.1016/j.jacc.2006.04.090
  25. Nicolau José Carlos, 2014, Arq. Bras. Cardiol., V103, P183, DOI 10.5935/abc.20140106
  26. Patti G, 2005, CIRCULATION, V111, P2099, DOI 10.1161/01.CIR.0000161383.06692.D4
  27. Piegas LS, 2015, ARQ BRAS CARDIOL, V105, P1, DOI 10.5935/abc.20150107
  28. Sabatine MS, 2005, JAMA-J AM MED ASSOC, V294, P1224, DOI 10.1001/jama.294.10.1224
  29. Soeiro Alexandre de Matos, 2016, Arq. Bras. Cardiol., V107, P239, DOI 10.5935/abc.20160127
  30. Soeiro AM, 2016, Open J Emerg Med, V4, P53
  31. Song YB, 2012, AM HEART J, V163, P500, DOI 10.1016/j.ahj.2011.12.007
  32. Valgimigli M, 2018, EUR HEART J, V39, P213, DOI 10.1093/eurheartj/ehx419
  33. Yong G, 2009, AM HEART J, V157, P60, DOI 10.1016/j.ahj.2008.09.024
  34. Zaman MJ, 2014, EUR HEART J, V35, P1551, DOI 10.1093/eurheartj/ehu039

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - ODS/03