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The Effectiveness And Safety Of Concomitant Ticagrelor Using With Fibrinolytic In ST-Elevation Myocardial Infarction Patients

Yıl 2024, Cilt: 10 Sayı: 1, 29 - 41, 01.01.2024
https://doi.org/10.53394/akd.1088835

Öz

Objective: The effectiveness and safety of administration ticagrelor simultaneously with fibrinolytic in STEMI remains unclear. Our study aims to compare and evaluate ticagrelor and clopidogrel in STEMI patients treated with fibrinolytics
Material and Methods: The study consisted of 180 STEMI patients over 18 age who were given fibrinolytic therapy and had no absolute contraindications for treatment. Ticagrelor was given to 94 patients and clopidogrel was given to 86 patients. Loading doses were given to patients concurrently with fibrinolysis, followed by maintenance doses. The primary outcome was six-month follow-up for all-cause mortality, major cardiovascular events, stroke, recurrent MI, target vessel revascularization, and major bleeding. The secondary outcome was to evaluate patients over 75 years of age, use of rivaroxaban, and major adverse events that will develop in patients with chronic kidney disease.

Results: There was no significant difference between the groups in terms of in-hospital death, GFR values (<60/≥60 ml/min/1.73 m²), Rivaroxaban Use, Fatal Bleeding, BARC Bleeding Type 1-2, Intracranial Bleeding, Mortality, stroke, target vessel revascularization, and recurrent MI (p>0.05). Mortality was observed in 5 of 86 patients using clopidogrel and in 4 of 94 patients using ticagrelor. (Log-rank test, p:0.63 HR=0.72 (95%CI, 0.19-2.67)). The BARC type 3-5 bleeding in patients using ticagrelor and clopidogrel were statistically similar. (Log-rank test, p:0.77 HR=1.23 (95%CI, 0.31 - 4.79))
Conclusions: In this study, we found the use of ticagrelor with fibrinolytic therapy was similar to clopidogrel in terms of effectiveness and safety.

Destekleyen Kurum

The authors declare no conflict of interest or any financial support.

Proje Numarası

The authors declare no any financial support.

Teşekkür

We would like to thank professor doctor Aslıhan YURUKTUMEN UNAL, Yıldıray CETE and İbrahim BASARICI, who contributed to the writing and design of the article. We also thank our teacher Elif ERTAŞ for her help in statistical analysis.

Kaynakça

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ST Yükselmeli Miyokard Enfarktüslü Hastalarda Fibrinolitik ile Birlikte Kullanılan Tikagrelorun Etkinliği ve Güvenliği

Yıl 2024, Cilt: 10 Sayı: 1, 29 - 41, 01.01.2024
https://doi.org/10.53394/akd.1088835

Öz

Amaç: STEMI'de tikagrelorun fibrinolitik ile aynı anda uygulanmasının etkinliği ve güvenliği belirsizliğini koruyor. Çalışmamız fibrinolitikler ile tedavi edilen STEMI hastalarında tikagrelor ve klopidogrel karşılaştırmayı ve değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntemler: Çalışmaya fibrinolitik tedavi verilen ve tedavi için mutlak kontrendikasyonu olmayan 18 yaş üstü 180 STEMI hastası dahil edildi. 94 hastaya tikagrelor, 86 hastaya klopidogrel verildi. Hastalara fibrinoliz ile eş zamanlı olarak yükleme dozları verildi, ardından idame dozları verildi. Birincil sonuç, tüm nedenlere bağlı mortalite, majör kardiyovasküler olaylar, inme, tekrarlayan MI, hedef damar revaskülarizasyonu ve majör kanama için altı aylık takipti. İkincil sonuç, 75 yaşın üzerindeki hastaları, rivaroksaban kullanımını ve kronik böbrek hastalığı olan hastalarda gelişecek majör advers olayları değerlendirmekti.
Bulgular: Hastane içi ölüm, GFR değerleri (<60/≥60 ml/dk/1.73 m²), Rivaroxaban Kullanımı, Ölümcül Kanama, BARC Kanama Tip 1-2, Kafa İçi Kanama, Mortalite, inme, hedef damar revaskülarizasyonu ve tekrarlayan MI açısından gruplar arasında anlamlı fark bulunmadı (p>0.05). Klopidogrel kullanan 86 hastanın 5'inde ve tikagrelor kullanan 94 hastanın 4'ünde mortalite gözlenmiştir. (Log-rank testi, p:0.63 HR=0.72 (%95GA, 0.19-2.67). Tikagrelor ve klopidogrel kullanan hastalarda BARC tip 3-5 kanaması istatistiksel olarak benzerdi. (Log-rank testi, p:0.77 HR=1.23 (%95GA, 0.31 - 4.79))
Sonuç: Bu çalışmada, tikagrelorun fibrinolitik tedavi ile birlikte kullanımının etkinlik ve güvenlik açısından klopidogrel ile benzer olduğunu bulduk.

Proje Numarası

The authors declare no any financial support.

Kaynakça

  • 1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-177.
  • 2. Jortveit J, Pripp AH, Halvorsen S.(2021) Outcomes after delayed primary percutaneous coronary intervention versus pharmaco-invasive strategy in ST-segment elevation myocardial infarction in Norway. Eur Heart J Cardiovasc Pharmacother. 2021 May 26:pvab041. doi: 10.1093/ehjcvp/pvab041.
  • 3. Viikilä J, Lilleberg J, Tierala I, Syvänne M, Kupari M, Salomaa V, Nieminen MS; HUS-STEMI Investigators. Outcome up to one year following different reperfusion strategies in acute ST-segment elevation myocardial infarction: the Helsinki-Uusimaa Hospital District registry of ST-Elevation Acute Myocardial Infarction (HUS-STEMI). Eur Heart J Acute Cardiovasc Care. 2013 Dec;2(4):371-8.
  • 4. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-e140.
  • 5. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine GN; The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018 Jan 14;39(3):213-260.
  • 6. Roule V, Ardouin P, Blanchart K, Lemaitre A, Wain-Hobson J, Legallois D, Alexandre J, Sabatier R, Milliez P, Beygui F. Prehospital fibrinolysis versus primary percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016 Nov 5;20(1):359. doi: 10.1186/s13054-016-1530-z.
  • 7. Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, Sulimov V, Rosell Ortiz F, Ostojic M, Welsh RC, Carvalho AC, Nanas J, Arntz HR, Halvorsen S, Huber K, Grajek S, Fresco C, Bluhmki E, Regelin A, Vandenberghe K, Bogaerts K, Van de Werf F; STREAM Investigative Team. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013 Apr 11;368(15):1379-87.
  • 8. Vora AN, Holmes DN, Rokos I, Roe MT, Granger CB, French WJ, Antman E, Henry TD, Thomas L, Bates ER, Wang TY. Fibrinolysis use among patients requiring interhospital transfer for ST-segment elevation myocardial infarction care: a report from the US National Cardiovascular Data Registry. JAMA Intern Med. 2015 Feb;175(2):207-15. doi: 10.1001/jamainternmed.2014.6573.
  • 9. Diego A, de Prado AP, Cuellas C, de Miguel A, Samaniego B, Alonso-Rodríguez D, Bangueses R, Vega B, Martín J, Fernandez-Vazquez F. P2Y12 platelet reactivity after thrombolytic therapy for ST-segment elevation myocardial infarction. Thromb Res. 2012 Sep;130(3):e31-6. doi: 10.1016/j.thromres.2012.05.031.
  • 10. Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, Claeys MJ, Cools F, Hill KA, Skene AM, McCabe CH, Braunwald E; CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005 Mar 24;352(12):1179-89. doi: 10.1056/NEJMoa050522.
  • 11. Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, Collins R, Liu LS; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005 Nov 5;366(9497):1607-21. doi: 10.1016/S0140-6736(05)67660-X.
  • 12. Husted S, van Giezen JJ. Ticagrelor: the first reversibly binding oral P2Y12 receptor antagonist. Cardiovasc Ther. 2009 Winter;27(4):259-74. doi: 10.1111/j.1755-5922.2009.00096.x. PMID: 19604248;
  • 13. S. Husted, H. Emanuelsson, S. Heptinstall, P.M. Sandset, M. Wickens, G. Peters.(2006) Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin Eur Heart J , pp. 1038-47
  • 14. Dehghani P, Lavoie A, Lavi S, Crawford JJ, Harenberg S, Zimmermann RH, Booker J, Kelly S, Cantor WJ, Mehta SR, Bagai A, Goodman SG, Cheema AN. Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI. Am Heart J. 2017 Oct;192:105-112. doi: 10.1016/j.ahj.2017.07.013.
  • 15. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-e140. .
  • 16. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC Jr. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease:. Circulation. 2016 Sep 6;134(10):e123-55. doi: 10.1161/CIR.0000000000000404.
  • 17. Berwanger O, Nicolau JC, Carvalho AC, Jiang L, Goodman SG, Nicholls SJ, Parkhomenko A, Averkov O, Tajer C, Malaga G, Saraiva JFK, Fonseca FA, De Luca FA, Guimaraes HP, de Barros E Silva PGM, Damiani LP, Paisani DM, Lasagno CMR, Candido CT, Valeis N, Moia DDF, Piegas LS, Granger CB, White HD, Lopes RD; TREAT Study Group. Ticagrelor vs Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol. 2018 May 1;3(5):391-399. doi: 10.1001/jamacardio.2018.0612.
  • 18. Berwanger O, Lopes RD, Moia DDF, Fonseca FA, Jiang L, Goodman SG, Nicholls SJ, Parkhomenko A, Averkov O, Tajer C, Malaga G, Saraiva JFK, Guimaraes HP, de Barros E Silva PGM, Damiani LP, Santos RHN, Paisani DM, Miranda TA, Valeis N, Piegas LS, Granger CB, White HD, Nicolau JC. Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis: TREAT Trial. J Am Coll Cardiol. 2019 Jun 11;73(22):2819-2828.
  • 19. Welsh RC, Shavadia JS, Zheng Y, Tyrrell BD, Leung R, Bainey KR. (2021) Ticagrelor or clopidogrel dual antiplatelet therapy following a pharmacoinvasive strategy in ST-segment elevation myocardial infarction. Clin Cardiol ;44:1543-50. doi: 10.1002/clc.23716.
  • 20. Hamilos M, Kanakakis J, Anastasiou I, Karvounis C, Vasilikos V, Goudevenos J, Michalis L, Koutouzis M, Tsiafoutis I, Raisakis K, Stakos D, Hahalis G, Vardas P; Collaborators. Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis: the MIRTOS trial. EuroIntervention. 2021 Feb 19;16(14):1163-1169. doi: 10.4244/EIJ-D-20-00268.
  • 21. Çoner A, Müderrisoğlu IH. (2021) Efficacy and Safety of Switching from Clopidogrel to Ticagrelor at the Time of Discharge in STEMI Patients Treated with a Pharmacoinvasive Approach. Erciyes Med J. 2021; 43(4): 373-378
  • 22. Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van 't Hof A, Widimsky P, Zahger D. . ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012 Oct;33(20):2569-619.
  • 23. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. Eur Heart J. 2012 Oct;33(20):2551-67. doi: 10.1093/eurheartj/ehs184.
  • 24. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. doi: 10.1159/000180580. PMID: 1244564.
  • 25. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289-1367.
  • 26. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011 Jun 14;123(23):2736-47.
  • 27. Norman G. Likert scales, levels of measurement and the "laws" of statistics. Adv Health Sci Educ Theory Pract. 2010 Dec;15(5):625-32. doi: 10.1007/s10459-010-9222-y.
  • 28. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA; PLATO Investigators, Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009 Sep 10;361(11):1045-57. doi: 10.1056/NEJMoa0904327.
  • 29. Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC, Magnani G, Bansilal S, Fish MP, Im K, Bengtsson O, Oude Ophuis T, Budaj A, Theroux P, Ruda M, Hamm C, Goto S, Spinar J, Nicolau JC, Kiss RG, Murphy SA, Wiviott SD, Held P, Braunwald E, Sabatine MS; PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015 May 7;372(19):1791-800.
  • 30. Falcão FJ, Alves CM, Barbosa AH, Caixeta A, Sousa JM, Souza JA, Amaral A, Wilke LC, Perez FC, Gonçalves Júnior I, Stefanini E, Carvalho AC. Predictors of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing pharmacoinvasive treatment. Clinics (Sao Paulo). 2013 Dec;68(12):1516-20. doi: 10.6061/clinics/2013(12)07.
  • 31. Ayanian JZ, Braunwald E.(2000) Thrombolytic therapy for patients with myocardial infarction who are older than 75 years. Do the risks outweigh the benefits? Circulation 16;101:2224-6. doi: 10.1161/01.cir.101.19.2224.
  • 32. Schmucker J, Fach A, Mata Marin LA, Retzlaff T, Osteresch R, Kollhorst B, Hambrecht R, Pohlabeln H, Wienbergen H. Efficacy and Safety of Ticagrelor in Comparison to Clopidogrel in Elderly Patients With ST-Segment-Elevation Myocardial Infarctions. J Am Heart Assoc. 2019 Sep 17;8(18):e012530. doi: 10.1161/JAHA.119.012530.
  • 33. V. Agrawal, B. Rai, J. Fellows, P.A. McCullough. (2010) In-hospital outcomes with thrombolytic therapy in patients with renal dysfunction presenting with acute ischaemic stroke Nephrol Dial Transplant 25 (2010), pp. 1150-57
  • 34. Power A, Epstein D, Cohen D, Bathula R, Devine J, Kar A, Taube D, Duncan N, Ames D. Renal impairment reduces the efficacy of thrombolytic therapy in acute ischemic stroke. Cerebrovasc Dis. 2013;35(1):45-52. doi: 10.1159/000345071.
  • 35. Hsieh CY, Lin HJ, Sung SF, Hsieh HC, Lai EC, Chen CH. (2014) Is renal dysfunction associated with adverse stroke outcome after thrombolytic therapy? Cerebrovasc Dis ;37:51-6. doi: 10.1159/000356348.
  • 36. Mega JL, Braunwald E, Murphy SA, Plotnikov AN, Burton P, Kiss RG, Parkhomenko A, Tendera M, Widimsky P, Gibson CM. Rivaroxaban in patients stabilized after a ST-segment elevation myocardial infarction: results from the ATLAS ACS-2-TIMI-51 trial (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction-51). J Am Coll Cardiol. 2013 May 7;61(18):1853-9.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Murat Duyan 0000-0002-6420-3259

Serhat Günlü 0000-0001-6985-6112

Proje Numarası The authors declare no any financial support.
Erken Görünüm Tarihi 15 Ocak 2024
Yayımlanma Tarihi 1 Ocak 2024
Gönderilme Tarihi 16 Mart 2022
Yayımlandığı Sayı Yıl 2024 Cilt: 10 Sayı: 1

Kaynak Göster

APA Duyan, M., & Günlü, S. (2024). The Effectiveness And Safety Of Concomitant Ticagrelor Using With Fibrinolytic In ST-Elevation Myocardial Infarction Patients. Akdeniz Tıp Dergisi, 10(1), 29-41. https://doi.org/10.53394/akd.1088835