2014


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2014/№6

Relevant issues of risks and benefits of antiplatelet therapy

Leshchinsky S.P.
State Budgetary Educational Institution “I. M. Sechenov First Moscow State Medical University” of the RF Ministry of Health Care, Trubetskaya 8, Bld. 2, Moscow 119991

Keywords: disaggregation therapy, medicinal treatment, cardiovascular diseases


DOI: 10.18087/rhj.2014.6.1980

At present time, antiplatelet therapy is an integral part of comprehensive drug therapy for many cardiovascular diseases (CVDs), such as IHD, atrial fibrillation and flutter, etc. However, these therapies are associated with increased risk of hemorrhagic complications due to the effect of antiplatelet drugs on blood coagulation. Another problem of antiplatelet therapy is drug resistance. In this case, despite administration of adequate doses, insufficient effect of these drugs and resulting thrombotic complications become the major danger for the patient. The review provides data explaining the risk-benefit ratio for antiplatelet drugs.
  1. Рыкунов И. Е., Сандриков В. А., Буравихина Т. А. и др. Чрес­пище­водная эхокардиография в диагностике объемных образований сердца и паракардиального пространства. Кардиология. 1996;36 (12):95–101.
  2. Baigent C, Blackwell L, Collins R et al; Antithrombotic Trialists’ Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analisis of individual participant data from randomized trials. Lancet. 2009 May 30;373 (9678):1849–60.
  3. Kles P. Results of the CREDO study. AHA Chicago, 2002. Neth Heart J. Feb 2003; 11 (2): 104–5.
  4. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996 Nov 16;348 (9038):1329–39.
  5. Cannon CP, Harrington RA, James S et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive stategy for acute coronary syndromes (PLATO): a randomized double-blind study. Lancet. 2010 Jan 23;375 (9711):283–93.
  6. Antman EM, Wiviott SD, Murphy SA et al. Early and Late Benefits of Prasugrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: A TRITON -TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimazing Platelet Inhibition with Prasugre l – Thrombolysis in Myocardial Infarction) Analysis. J Am Coll Cardiol. 2008 May 27;51 (21):2028–33.
  7. Мазур Н. А. Недогода С. А. Дезагреганты и их роль в профилактике атеротромботических заболеваний. Сердце. 2012;11 (2):94–8.
  8. Cox D, Maree AO, Dooley M et al. Effect of enteric coating on antiplatelet activity of low-dose aspirin in healthy voluntieers. Stroke. 2006 Aug;37 (8):2153–8.
  9. Antithrombotic Trialists' Collaboration. Collaborative meta-ana­lysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002 January 19; 324 (7330):141.
  10. Селюк М. Н., Козачок Н. Н., Ливинская О. Г. Рудаков Н. И. Срав­нительная оценка безопасности разных схем дезагрегантной терапии. Артериальная гипертензия. 2013;3 (29):11–6.
  11. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012 Jul;33 (13):1635–701.
  12. Malfertheiner P, Megraud F, O'Morain C et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007 Jun;56 (6):772–81.
  13. Cattaneo M. New P2Y (12) inhibitors. Circulation. 2010 Jan;121 (1):171–9.
  14. Harker LA, Boissel JP, Pilgrim AJ, Gent M. Comparative safety and tolerability of clopidogrel and aspirin: results from CAPRIE. CAPRIE Steering Committee and Investigators. Clopidogrel versus aspirin in patients at risk of ischaemic events. Drug Saf. 1999 Oct;21 (4):325–35.
  15. Dippel DW. The results of CAPRIE, IST and CAST. Clopidogrel vs. Aspirin in Patients at Risk of Ischaemic Events. International Stroke Trial. Chinese Acute Stroke Trial. Thromb Res. 1998;92 (1 Suppl 1):S13–16.
  16. Yusuf S, Zhao F, Mehta SR et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001 Aug 16;345 (7):494–502.
  17. Cannon CP, Husted S, Harrington RA et al. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adeno­sine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. J Am Coll Cardiol. 2007 Nov 6;50 (19):1844–51.
  18. Wallentin L, Becker RC, Budaj A et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009 Sep 10;361 (11):1045–57.
  19. Metha SR, Yusuf S, Peters RJ et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI–CURE study. Lancet. 2001 Aug 18;358 (9281):527–33.
  20. Steinhubl SR, Berger PB, Tift Mann III J et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002 Nov 20;288 (19):2411–20.
  21. Lamberts M, Olesen JB, Ruwald MH et al. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention. A nationwide cohort study. Circulation. 2012 Sep 4;126 (10):1185–93.
  22. Lamberts M, Gislason GH, Olesen JB et al. Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention. J Am Coll Cardiol. 2013 Sep 10;62 (11):981–9.
  23. Serebruany VL, Midei MG, Meilman H et al. Rebound platelet activation after termination of prasugrel and aspirin therapy due to confirmed non-compliance in patient enrolled in the JUMBO Trial. Int J Clin Pract. 2006 Jul;60 (7):863–6.
  24. Бурякина Т. А., Затейщиков Д. А. Место обратимых ингибиторов P2Y12 при остром коронарном синдроме. Кардиология. 2012;52 (4):74–9.
  25. Becker RC, Bassand JP, Budaj A et al. Bleeding complications with the P2Y12 receptor antagonists clopidogrel and ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2011 Dec;32 (23):2933–44.
  26. Subherwal S, Bach RG, Cage BF et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC / AHA Guidelines) Bleeding Score. Circulation. 2009 Apr 14;119 (14):1873–82.
  27. Mahaffey KW, Wojdyla DM, Carroll K et al. Ticagrelor compared with clopidogrel by geographic region in the platelet inhibition and patient outcomes (PLATO) Trial. Circulation. 2011 Aug 2;124 (5):544–54.
  28. Crouch MA, Colucci VJ, Howard PA, Spinier SA. P2Y12 receptor inhibitors: integrating ticagrelor into the management of acute coronary syndrome. Ann Pharmacother. 2011 Sep;45 (9):1151–6.
  29. Кукес В. Г., Сычев Д. А., Ших Е. В., Изучение биотрансформации лекарственных средств – путь к повышению эффективности и безопасности фармакотерапии Врач. 2007;1:6–8
  30. Сивков А. С., Пауков С. В., Рувинов Ю. В., Кукес И. В. Инди­видуальная безопасность фармакотерапии при оценке активности изофермента цитохрома P-450 3A4 (CYP3A4). Клиническая медицина. 2010;88 (2):61–7.
  31. Сулимов В. А. Мороз Е. В. Резистентность к антитромбоцитарным препаратам у больных ишемической болезнью сердца. Кардиоваскулярная терапия и профилактика 2012;11 (6):71–7.
Leshchinsky S. P. Relevant issues of risks and benefits of antiplatelet therapy. Russian Heart Journal. 2014;13 (6):367–374

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