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

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.

Anahtar Kelimeler

• İkili antiplatelet tedavi
• fibrinoliz
• Ticagrelor
• farmakoinvaziv reperfüzyon
• Klopidogrel

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

Abstract

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.

Keywords

• Dual antiplatelet therapy
• fibrinolysis
• Ticagrelor
• pharmacoinvasive reperfusion
• Clopidogrel

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