Akut miyokard infarktüsü tedavisinde aspirine eklenen tiklopidinin kısa ve orta dönem kardiyak olaylar üzerine etkisi
Küçük Resim Yok
Tarih
1999
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Akut Miyokard İnfarktüsü Tedavisinde Aspirine Eklenen Tiklopidinin Kısa ve Orta Dönem Kardiyak Olaylar Üzerine Etkisi Giriş: Akut Q dalgalı miyokard infarktüsü, akut Q dalgasız miyokard infarktüsü, ka rarsız angina pektoris ve ani iskemik ölümden oluşan akut koroner sendromların patogenezi ortaktır. Akut koroner sendromların fizyopatoloj isindeki temel olay; aterom plağının komplike olması, trombositlerin aktif biçime dönüşmesi ve pıhtı oluşmasıdır. Antitrombositer tedavi, AMÎ geçiren bireylerde sonraki iskemik olayların riskini azaltır. Çalışmalardaki bu fayda aspirin ile ölçülmüştür. Bu klinik prospektif randomize çalışma mızda girşimsel tedavi yapılmayan AMÎ hastalarında aspirine eklenen tiklopidinin kısa ve orta dönem kardiyak olaylar üzerine etkisini belirlemeyi amaçladık Materyal ve Metod: Çalışmaya; tiklopidin grubuna 44, aspirin grubuna 46 olmak ü- zere AMÎ teşhisi konan 90 hasta dahil edildi. Hastalar ortalama 6 ay takip edildi. Primer ve sekonder son noktalar; tekrarlayan angina, kardiyovasküler ölüm, reinfarktüs, konjestif kalp yetmezliği, strok ve revaskülarizasyonu içeriyordu. Bulgular: Son noktalar tiklopidin grubunda üçüncü ve altıncı ayda: tekrarlayan angina 22 (%50) ve 25 (%56,8); reinfarktüs 2 (%4,5) ve 3 (%6,8); kardiyovasküler mortalite 0 (%0) ve 1 (%2,3); konjestif kalp yetmezliği hem 3. hemde 6. ayda 7 (%15,9); toplam reveskülarizasyon ihtiyacı 20 (%45,5) ve 22 (%50) iken, strok hiç görülmedi. As pirin grubunda üçüncü ve altıncı oyda: tekrarlayan angina 20 (%43,5) ve 25 (%54,3); reinfarktüs 5 (%10,9) ve 6 (%13); kardiyovasküler mortalite: 1 (%2,2) ve 3 (%6,5) konjestif kalp yetmezliği: hem 3. hemde 6. ayda 5 (%10,9); toplam reveskülarizasyon ihti yacı 21 (%45,7) ve 22 (%47,8) iken, strok hiç görülmedi Yan etki olarak; tiklopidin gru bunda 2 hastada (%4,5) nötropeni, 2 hastada (%4,5) gastrointestinal sistem intoleransı gö rüldü. Aspirin grubunda ise sadece 2 hastada (%4,3) gastrointestinal sistem intoleransı gö rüldü. Yukarıda sayılan tüm olaylar istatistiksel açıdan anlamlı değildi. Sonuç olarak; Çalışmamızda girişimsel tedavi uygulanmayan AMÎ hastalarında, aspirin ve tiklopidinden oluşan kombine antitrombositer tedavinin prognoz üzerine olumlu etki yaratmadığı, bunun yanında uzun dönemde nötropeni riski gibi reversibl olmakla bir likte yinede kabul edilemez ciddi yan etkiye neden olduğu bulundu. AMÎ hastalarında, aspirine nötropeni riski olmayan klopidogrelin ilave edilmesi düşünülebilirse de, bu teda- 58vinin etkinliğini belirleyen çalışmalar mevcut olmayıp, bu konuda geniş kapsamlı çalış malara ihtiyaç oduğu düşünüldü. Anahtar kelimeler: Tiklopidin, aspirin, antitrombositer tedavi, antitrombositer a- j anlar, akut miyokard infarktüsü, prognoz, kardiyak olaylar.
The Effect of Ticlopidine Combined with Aspirin on Cardiac Events in the Therapy of Acute Myocardial Infarction in Short and Intermediate Term Setting Introduction: The pathogenesis of acute coronary syndromes (ACS) involving Q- wave acute myocardial infarction (AMI), non-Q-wave AMI, unstable angina pectoris, sudden cardiac death is same. Basic events in pathophysiology of ACS are complication of atheromatous plaque, activation of platelets, and trombus formation respectively. Antiplatelet therapy reduces the risk of subsequent ischemic events in patients suffering from AMI. This benefit has been shown by studies using aspirin as an antiplatelet agent. In this prospective, randimzed study, we aimed to determine the effect of ticlopidine combined with aspirin on cardiac events appearing in a short or intermediate term in patients suffering from AMI and not undergoing interventional therapy. Material and Methods: A total of 90 patients diagnosed as AMI were included in the study. 44 of them were taken as ticlopidine group and 46 of them formed aspirin group. Patients are followed for 6 months in average. Primary or secondary end points were recurrent angina, cardiovascular death, reinfarction, congestive heart failure (CHF), stroke and revascularization. Results: End points of ticlopidine group at third and sixth months were recurrent angina in 22 (50 %) and 25 (56.8 %) patients, reinfarction in 2 (4.5 %) and 3 (6.8 %) patients, cardiovascular death in 0 (0 %) and 1 (2.3 %) patients, CHF in 7 (15.9 %) patients for both months, revascularization in 20 (45.5 %) and 22 (50 %) patients respectively. No stroke was observed. End point of aspirin group at third and sixt months were recurrent angina in 20 (43.5 %) and 25 (54.3 %) patients, reinfarction in 5 (10.9 %) and 6 (13 %) patients, cardiovascular death in 1 (2.2 %) and 3 (6.5 %) patients, CHF in 5 (10.9 %) patients for both months, total revascularization in 21 (45.7 %) and 22 (47.8 %) patients. Again stroke was not observed. About the side effects of ticlopidine, neutropenia in 2 (4.5 %) patients and gastointestinal intolerance was observed in 2 (4.5 %) patients. In aspirin group, only gastrointestinal intolerance occurred in 2 (4.3 %) patients. These results were not statistically significant. 60Conclusion: In this study, it was found that combined antiplatelet therapy composed of aspirin and ticlopidine had no positive effect on prognosis in AMI not undergoing interventional therapy. Besides, this therapy caused netropenia which was a reversible but serious and unacceptable side effect and was observed in long term therapy. Although, it is possible to add clopidogrel which has no risk of neutropenia to aspirin, there are no reports sufficient to document its efficacy. More detailed studies about this combination are needed. Key words: Ticlopidine, aspirin, antiplatelet therapy, antiplatelet agents, acute myocardial infarction (AMI), prognosis, cardiac events.
The Effect of Ticlopidine Combined with Aspirin on Cardiac Events in the Therapy of Acute Myocardial Infarction in Short and Intermediate Term Setting Introduction: The pathogenesis of acute coronary syndromes (ACS) involving Q- wave acute myocardial infarction (AMI), non-Q-wave AMI, unstable angina pectoris, sudden cardiac death is same. Basic events in pathophysiology of ACS are complication of atheromatous plaque, activation of platelets, and trombus formation respectively. Antiplatelet therapy reduces the risk of subsequent ischemic events in patients suffering from AMI. This benefit has been shown by studies using aspirin as an antiplatelet agent. In this prospective, randimzed study, we aimed to determine the effect of ticlopidine combined with aspirin on cardiac events appearing in a short or intermediate term in patients suffering from AMI and not undergoing interventional therapy. Material and Methods: A total of 90 patients diagnosed as AMI were included in the study. 44 of them were taken as ticlopidine group and 46 of them formed aspirin group. Patients are followed for 6 months in average. Primary or secondary end points were recurrent angina, cardiovascular death, reinfarction, congestive heart failure (CHF), stroke and revascularization. Results: End points of ticlopidine group at third and sixth months were recurrent angina in 22 (50 %) and 25 (56.8 %) patients, reinfarction in 2 (4.5 %) and 3 (6.8 %) patients, cardiovascular death in 0 (0 %) and 1 (2.3 %) patients, CHF in 7 (15.9 %) patients for both months, revascularization in 20 (45.5 %) and 22 (50 %) patients respectively. No stroke was observed. End point of aspirin group at third and sixt months were recurrent angina in 20 (43.5 %) and 25 (54.3 %) patients, reinfarction in 5 (10.9 %) and 6 (13 %) patients, cardiovascular death in 1 (2.2 %) and 3 (6.5 %) patients, CHF in 5 (10.9 %) patients for both months, total revascularization in 21 (45.7 %) and 22 (47.8 %) patients. Again stroke was not observed. About the side effects of ticlopidine, neutropenia in 2 (4.5 %) patients and gastointestinal intolerance was observed in 2 (4.5 %) patients. In aspirin group, only gastrointestinal intolerance occurred in 2 (4.3 %) patients. These results were not statistically significant. 60Conclusion: In this study, it was found that combined antiplatelet therapy composed of aspirin and ticlopidine had no positive effect on prognosis in AMI not undergoing interventional therapy. Besides, this therapy caused netropenia which was a reversible but serious and unacceptable side effect and was observed in long term therapy. Although, it is possible to add clopidogrel which has no risk of neutropenia to aspirin, there are no reports sufficient to document its efficacy. More detailed studies about this combination are needed. Key words: Ticlopidine, aspirin, antiplatelet therapy, antiplatelet agents, acute myocardial infarction (AMI), prognosis, cardiac events.
Açıklama
Anahtar Kelimeler
Antitrombinler, Antithrombins, Aspirin, Aspirin, Heparin, Heparin, Kalp hastalıkları, Heart diseases
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Salman, A. (1999). Akut miyokard infarktüsü tedavisinde aspirine eklenen tiklopidinin kısa ve orta dönem kardiyak olaylar üzerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
