Terapia antitrombótica


Via: Galo Sanchez

Las guías clínicas de la Sociedad europea de cardiología, en 2011, y de la American Heart Association, en 2009, aconsejan que todas las personas que han padecido un IAM reciban terapia antitrombótica con aspirina y clopidogrel durante 12 meses, y un agente de los dos para continuar. Además, una proporción de pacientes requerirá luego terapia con anticoagulantes orales. Ciertos agentes (por ejemplo Ibuprofeno) pueden impedir los efectos antitrombóticos de la aspirina. Los AINEs pueden no sólo aumentar el riesgo de hemorragia, sino también el riesgo de sufrir eventos cardiovasculares. A pesar del amplio uso de AINEs en la población, no se ha evaluado la seguridad de la adición un AINE a las diferentes combinaciones de medicaciones antitrombóticas después de IAM. Y para investigarlo, Carter y col diseñaron y llevaron a cabo un Estudio de Cohortes Retrospectivo (que constituye la mejor evidencia disponible en la seguridad en este asunto).

 

Por el interés que tiene para la seguridad de un gran número de pacientes actualmente, Martha Hack[1] ha hecho una evaluación GRADE de este estudio, cuyo resultado hemos puesto a disposición de los lectores en evalmed.es, pestaña FORMACIÓN, aunque puede verse directamente en: http://evalmedicamento.weebly.com/formacioacuten/evaluacion-grade-del-estudio-retrospectivo-hemorragia-mayor-y-eventos-cardiovasculares-asociados-al-uso-de-aine-en-pacientes-con-terapia-antitrombotica-tras-haber-recibido-el-alta-hospitalaria-por-infarto-de-miocardio-martha-hack

[1] Martha Hack. R-4 Medicina de Familia. Centro de Salud Zona Norte, Cáceres.

Prevencion cardiovascular en diabeticos: Documento de la American Heart Association & American Diabetes Association


Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus: A Scientific Statement From the American Heart Association and the American Diabetes Association.

AHA/ADA Scientific Statement

Circulation. 115(1):114-126, January 2/9, 2007.
Buse, John B. MD, PhD, Co-chair; Ginsberg, Henry N. MD, FAHA, Co-chair; Bakris, George L. MD, FAHA; Clark, Nathaniel G. MD, MS, RD; Costa, Fernando MD, FAHA; Eckel, Robert MD, FAHA; Fonseca, Vivian MD; Gerstein, Hertzel C. MD, MSc, FRCPC; Grundy, Scott MD, FAHA; Nesto, Richard W. MD, FAHA; Pignone, Michael P. MD, MPH; Plutzky, Jorge MD; Porte, Daniel MD; Redberg, Rita MD, FAHA; Stitzel, Kimberly F. MS, RD; Stone, Neil J. MD, FAHA

Abstract:
mdash;: The American Heart Association (AHA) and the American Diabetes Association (ADA) have each published guidelines for cardiovascular disease prevention: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. This statement will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which AHA and ADA recommendations differ.

(C) 2007 American Heart Association, Inc.

Statement from the American Heart Association on ENHANCE Study Results


DALLAS, TX — January 16, 2008 — Merck/Schering-Plough Pharmaceuticals released results from the ENHANCE trial, which found that the ezetimibe/simvastatin (Zetia/Zocor) combination drug known as Vytorin was no more effective in reducing artery plaque build-up than simvastatin (Zocor) alone. There were no statistically significant differences in the safety of the drugs, which are used to lower cholesterol. The combination drug did lower low-density lipoprotein (LDL — “bad” cholesterol) significantly more than the single agent, but it did not reduce the amount of arterial plaque build-up in the carotid (neck) arteries. However, the LDL levels in both groups remained well above target level.

Plaque build-up (atherosclerosis) in the arteries can lead to coronary heart disease or stroke. However, the study was not large enough or long enough to determine whether the combination drug is more or less effective than the single drug in reducing heart attacks or deaths.

“It will be very important for those larger studies, directed at assessing cardiac outcomes, to be completed, so we can fairly assess the potential of ezetimibe,” said American Heart President Daniel W. Jones, M.D.

Because high cholesterol levels are a very important risk factor for coronary heart disease, the American Heart Association urges patients to consult with their physician before changing or stopping any medication treatment.

“Because Vytorin does not appear to be unsafe, lipid-lowering therapy with simvastatin is of proven benefit, and some patients have been prescribed Vytorin because a statin alone may not have been sufficiently effective in lowering their LDL or was not appropriate for them because of other medical conditions, we do not believe patients should stop taking the drug on their own,” said Dr. Jones. “However, patients on this combination drug should check with their doctor to see if they should stay on the drug, be switched to a statin alone, or take another combination of drugs for their cholesterol.”

Statins are the only drug class for lowering cholesterol that currently has evidence that heart attacks are prevented and life extended with their use. Until other drug classes have mortality data available, to lower cholesterol in patients with continued above-goal LDL cholesterol, who are already taking the maximum tolerated doses of a statin, physicians will need to choose among drugs known to lower LDL cholesterol, but with uncertain benefit in regard to preventing events.

American Heart Association guidelines have long recommended statin treatment for lowering cholesterol. It is important that patients who need to lower their cholesterol take the medications prescribed to them because stopping those medications can increase their health risks.

SOURCE: American Heart Association