Asociación entre las escalas de riesgo isquémico y hemorrágico y el uso de los nuevos inhibidores del P2Y 12 en pacientes con síndrome coronario agudo

No Differences in Gastrointestinal Bleeding Risk among Clopidogrel-, Ticagrelor-, or Prasugrel-Based Dual Antiplatelet Therapy

“…In this study, as previously described [23,[26][27][28], we have confirmed that in clinical practice, the baseline characteristics of patients taking clopidogrel-DAPT are significantly different from those in treatment with new antiplatelet-DAPT. In European registries [23], patients treated with prasugrel are usually younger than those treated with ticagrelor [31], and patients treated with clopidogrel are older, with almost 10 years of difference in some studies.…”

“…Danchin et al [23] showed that older age is usually associated with more comorbidities and higher cardiovascular risk, as we confirm in our study. Paradoxically, patients with a worse cardiovascular profile are being treated with clopidogrel [23,26,27], which can be less effective than the new antiplatelets [9,10]. In an Israeli study, age over 75 years (odds ratio [OR] 0,17; 95% CI 0.10-0.27), non-ST segment elevation myocardial infarction (OR 0.37; 95% CI 0.26-0.54), and prior cardiovascular event or stroke (OR 0.41; 95% CI 0.2-0.68) were factors associated with under treatment with new antiplatelets [26].…”

“…Despite this mixed evidence, the potential higher risk of bleeding associated with new antiplatelet agents has been translated into clinical practice, so that their use has been limited to younger patients with fewer comorbidities [23,[26][27][28]. The paradoxical outcome is that these new antiplatelets are not used in patients with higher cardiovascular risk and who might benefit the most.…”