Approach to antiplatelet therapy in the context of digestive endoscopy
Keywords:
antiagregantes plaquetarios, ácido acetilsalicílico, clopidogrel, endoscopia digestiva.Abstract
Introduction: The use of platelet antiaggregant agents is increasingly widespread in the world population. The decision regarding the endoscopic management of this treatment should be based on the type of medical indication that justifies the use of these medications. A review of the articles published in the Pubmed, Scielo, Medline and Cochrane databases related to the subject was made.Objective: To deepen the knowledge related to periendoscopic digestive antiplatelet therapy.
Development: Platelet antiaggregant are key in the treatment and prevention of vascular, cardiac or cerebral thrombotic events. Just as the indications of antithrombotic agents have been established, the thromboembolic risk has also been evaluated when treatment is suspended. The thromboembolic risk may be low or high, so the risk-benefit of discontinuing therapy in this context should be evaluated. All endoscopic procedures present a risk of bleeding considering the low risk of bleeding below 1 % and high risk above 1 %. The decision about anti-aggregation in the perioperative / periprocedural period depends not only on the balance between thrombotic and hemorrhagic risks, but also on the type and indication of antiplatelet therapy.
Conclusions: Platelet anti-aggregation in patients who will undergo interventional gastrointestinal procedures is observed more and more frequently. This makes knowledge about the risk assessment of thrombotic phenomena necessary when interrupting these drugs, together with the determination of the potential risk of bleeding according to the endoscopic procedure performed.
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2. González-Bárcenas ML, Pérez-Aisa A. Manejo de la antiagregación y anticoagulación periendoscópica: introducción a antiagregantes y anticoagulantes orales más novedosos. Rev Esp Enferm Dig. 2016 [acceso: 21/03/2020];108(2):89-96. Disponible en: https://www.reed.es/ArticuloFicha.aspx?id=598&hst=0&idR=33&tp=1
3. Kono Y, Matsubara M, Toyokawa T, Takenaka R, Suzuki S, Nasu J, et al. Multicenter prospective study on the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users. Dig Dis Sci. 2017 [acceso: 20/03/2020]; 62:730-8. Disponible en: https://link.springer.com/article/10.1007%2Fs10620-016-4437-2
4. Di Minno A, Spadarella G, Prisco D, Scalera A, Ricciardi E, Di Minno G. Antithromboticdrugs, patient characteristics, and gastrointestinal bleeding:Clinical translation and areas of research. Blood Rev. 2015 [acceso: 20/03/2020]; 29:335-43. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0268960X15000272
5. Aguilar-Olivos NE, Ramírez-Polo AI, Téllez-Ávila FI. Manejo de antitrombóticos en pacientes que requieren procedimientos endoscópicos. Endoscopia. 2015 [acceso: 20/03/2020];27(4):180-187. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0188989315000780?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fre-trieve%2F-pii%2FS0188989315000780%3Fshowall%3Dtrue&referrer=
6. Cedeño MJA, Rivas RN, Tuliano CRA. Manejo odontológico en pacientes con terapia antiagregante plaquetaria. Rev Odont Mex. 2013 [acceso: 20/03/2020]; 17(4):256-60. Disponible en: https://www.sciencedirect.com/science/article/pii/S1870199X13720457
7. Samama CM, Godier A. Recomendaciones sencillas sobre el uso de agentes antiplaquetarios: por fin un documento ameno. Rev Esp Anestesiol Reanim. 2019 [acceso: 20/03/2020];66(1):1-2. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0034935618302275?returnurl=https:%2F%2Flinkinghub.elsevier.com%2-Fretrieve%2Fpi-i%2FS0034935618302275%3Fshowall%3Dtrue&referrer=
8. Nazar C, Contreras CJI, Molina PI, Fuentes HR. Manejo perioperatorio de pacientes usuarios de antiagregantes plaquetarios. Rev Chil Cir. 2018 [acceso: 20/03/2020]; 70(3):291-9. Disponible en: https://scielo.conicyt.cl/scielo.php?pid=S0718-40262018000300291&script=sci_arttext&tlng=e
9. Gómez-Gómez B, Rodríguez-Weber FL, Díaz-Greene E.J. Fisiología plaquetaria, agregometría plaquetaria y su utilidad clínica. Med Int Méx. 2018 mar [acceso: 20/03/2020]; 34(2):244-63. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=78719
10. Cattaneo M. P2Y12 receptor: structure and function. J. Thromb. Haemost. 2015[acceso: 20/03/2020];13(1):10-6. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.12952
11. Campuzano-Maya G. Inhibidores del receptor plaquetario P2Y12 . Parte 1 y 2: escenario de acción, farmacología, aplicación clínica y limitaciones de su uso. Medicina & Laboratorio. 2017 enero [acceso: 20/03/2020]; 23(1-2):13-4. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/57/43
12. Bye AP, Unsworth AJ, Gibbins JM. Platelet signaling: a complex interplay between inhibitory and activatory networks. J. Thromb. Haemost. 2016 [acceso: 20/03/2020]; 14:918-30. Disponible en: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jth.13302
13. Rana A, Westein E, Niego B, Hagemeyer CE. Shear-dependent platelet aggregation: mechanisms and therapeutic opportunities. Frontiers in Cardiovascular Med. 2019 sep [acceso: 20/03/2020]; 6:141. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763557/
14. Derszniak K., Przyborowski K., Matyjaszczyk K, Moorlag M, de Laat B, Nowakowska M, Chlopicki S. Comparison of Effects of Anti-thrombin AptamersHD1 and HD22 on Aggregation of Human Platelets, Thrombin Generation, Fibrin Formation, and Thrombus Formation Under Flow Conditions. Front. Pharmacol. 2019 feb [acceso: 20/03/2020]; 10:68. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391317/
15. Bonow RO, Mann DL, Zipes DZ, Libby P. Hemostasia, trombosis, fibrinólisis y enfermedad cardiovascular. En: Mann DL, Zipes DP, Bonow RO. Braunwald: Tratado de cardiología. Barcelona: Elsevier España, S.L; 2013. p. 1868-92.
16. Sierra P, Gómez-Luqueb A, Llauc JV, Ferrandisd R, Cassinelloe C, Hidalgo F. Recomendaciones de manejo perioperatorio de antiagregantes plaquetarios en cirugía no cardíaca. Grupo de trabajo de la Sección de Hemostasia, Medicina Transfusional y Fluidoterapia de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR). Actualización de la Guía de práctica clínica 2018. Rev. Esp. Anestesiol. Reanim. 2019[acceso: 20/03/2020]; 66(1):18-36. Disponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0034935618301385?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fre-trieve%2-Fpii%2FS0034935618301385%3Fshowall%3Dtrue&referrer =
17. Bittl J A, Baber U, Bradley SM, Wijeysundera DN. Duration of Dual Antiplatelet Therapy: A Systematic Review for the 2016ACC/AHA Guideline Focused Updateon Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. J. Ame. Coll. Cardiology.2016 Sept [acceso: 20/03/2020]; 68(10):1116-39. Disponible en: https://doi.org/10.1016/j.jacc.2016.03.512
18. Gelbenegger G, Postula M, Pecen L, Halvorsen S, Lesiak M, Schoergenhofer C, et al. Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups. Medicine 2019 [acceso: 23/03/2020]; 17:198. Disponible en: https://link.springer.com/article/10.1186/s12916-019-1428-0
19. Yamaguchi T, Shirai T, Yoshiba S, Abe K, Ikeda Y. Pharmacodynamic assessment of prasugrel and clopidogrelin patients with non cardioembolic stroke: a multicenter, randomized, active‑control clinical trial. J. T. Thromb. 2020 [acceso: 20/03/2020];49:10-17. Disponible en: https://link.springer.com/article/10.1007/s11239-019-01926-6
20. Krishnamurthy A, Keeble C, Anderson M, Somers K, Burton-Wood N, Harland C, et al. Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention. Open Heart. 2019 [acceso: 20/03/2020]; 6:e000951. Disponible en: https://openheart.bmj.com/content/6/1/e000951.full
21. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 [acceso: 20/03/2020]; 34:2949-3003.13. Disponible en: https://academic.oup.com/eurheartj/article/34/38/2949/442952
22. Estradas Trujillo JA, Molina DA, Farca Belsaguy A, Salceda Otero J, Lozoya González D, Palomo Hoil RA. Uso de agentes anticoagulantes y antiagregantes plaquetarios durante procedimientos endoscópicos. An Med Mex. 2016[acceso: 20/03/2020]; 61(3):202-8. Disponible en: https://www.medigraphic.com/pdfs/abc/bc-2016/bc163h.pdf
23. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. 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 [acceso: 20/03/2020]; 39:213-60. https://www.researchgate.net/publication/319606682_2017_ESC_focused_-update_on_dual_-perioperatorio y periprocedimiento del tratamiento antitrombótico: documento de consenso. Rev Esp Cardiol. 2018 [acceso: 21/03/2020];71(7):553-64.Disponible en: https://www.revespcardiol.org/es-manejo-perioperatorio-periprocedimiento-del-tratamiento-articulo-S0300893218300034
25. Korte W, Cattaneo M, Chassot PG, Eichinger S, von HeymannC, Hofmann N, et al. Peri-operative management of antiplatelettherapy in patients with coronary artery disease: joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC). Thromb Haemost. 2011[acceso: 20/03/2020]; 105(5):743-9. Disponible en: https://www.researchgate.net/publication/50851686_Peri-operative_management_of_antiplatelet_therapy_in_patients_with_coronary_-artery_disease_Joint_position_paper_by_members_of_the_working_group_-on_Perioperative-_Haemostasis_of_the_Society_on_Thrombosi
26. Zeymer U, Hochadel M, Lauer B, Kaul N, Wöhrle J, Andresen D, et al. Use, efficacy and safety of prasugrel in patients with ST segment elevation myocardial infarction scheduled for primary percutaneous coronary intervention in clinical practice. Results of the prospective ATACS-registry. Int J Cardiol. 2015 [acceso: 19/02/2020]; 84:122-7. Disponible en: https://www.internationaljournalofcardiology.com/article/S0167-5273%2815%2900074-1/fulltext
27. Angiolillo DJ, Firstenberg MS, Price MJ, E Tummala P, Hutyra M, Welsby, I, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: a randomized controlled trial. JAMA. 2012[acceso: 20/03/2020]; 56(5):207-8. Disponible en: https://www.researchgate.net/publication/221755306_Bridging_-Antiplatelet_Therapy_With_Cangrelor_in_Patients_Undergoing_Cardiac_Surgery_A_-Randomized_Controlled_Trial
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