TRITON-TIMI 38 Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infraction.

Slides:

Advertisements

Présentations similaires

unstable angina undergoing PCI.

Advertisements

Nouveautés et perspectives dans le traitement anti-agrégant

PRAGUE-8 PRAGUE-8 ESC 2007.

PLATO Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery. Held C et al. ACC 2010.

JPAD The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes Trial. Efficacy of Low-Dose Aspirin Therapy for the Primary Prevention.

TAPAS Thrombus aspiration during percutaneous coronary intervention in acute myocardial infarction study (TAPAS) mortality and reinfarction at 1 year.

FUTURA/OASIS-8 Low versus standard dose unfractionned heparin for percutaneous coronary intervention in acute coronary syndrome patients treated with fondaparinux.

ISAR-TEST 4 Intracoronary stenting and antirestenotic results : test efficacy of 3 limus-eluting stents Mehilli J et al.

FINESSE Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events ESC 2007 FINESSE.

CLEAR PLATELETS Variabilité génétiquement déterminée de l’effet du clopidogrel Influence du polymorphism du CYP2C19 sur les effets antiplaquettaires du.

GRACE The Global Registry of Acute Coronary Events Montalescot G et al.

COURAGE Nuclear Differential Improvement in Stress Myocardial Perfusion Ischemia following Percutaneous Coronary Intervention as compared with Optimal.

ATOLL Acute STEMI treated with primary PCI and intravenous enoxaparin or UFH to lower ischemic and bleeding events at short and long-term follow-up. Montalescot.

ABOARD* Essai multicentrique randomisé comparant une stratégie invasive immédiate versus différée chez des patients présentant un syndrome coronarien aigu.

PEACE* Prévention par un IEC** (trandolapril) des accidents évolutifs graves chez des coronariens stables à fonction systolique ventriculaire gauche conservée.

ATLAS ACS 2 -TIMI 51 Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome.  Présentée.

TITRATION DU CLOPIDOGREL Tailored Clopidogrel Loading Dose according to Platelet Reactivity Monitoring Decrease Early Stent Thrombosis. Paganelli F et.

Apixaban versus warfarin in patients with atrial fibrillation

Revascularisation coronaire prophylactique avant chirurgie vasculaire

CARESS-AMI Combined Abciximab Reteplase Stent Study in Acute Myocardial Infarction ESC CARESS-AMI.

RE-LY Randomization Evaluation of Long-Term Anticoagulation Therapy Connolly S.J et al. N Engl J Med 2009 ; 361.

Registre MATRIX Long term safety of DES (drug eluting stents) in off-label use : results of the MATRIX registry. Dangas G.D et al. American College of.

TRITON-TIMI 38 Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes.

ISAR-REACT Anti-GPIIbIIIa (abciximab) en complément d’une dose de charge en clopidogrel avant angioplastie avec mise en place d’une endoprothèse coronaire.

Actualités sur les antiagrégants plaquettaires

TRA-CER Vorapaxar, a platelet thrombin receptor antagonist, in acute coronary syndromes. Mahaffey KW et al . AHA 2011.

ISAR REACT 3A A trial of reduced dose of unfractioned heparin in biomarker negative patients undergoing percutaneous coronary intervention. Schulz S et.

un infarctus du myocarde récent.

TRIANA Tratamiento del infarto agudo de miocardio en ancianos Bueno H et al.

Platelet inhibition with cangrelor in patients undergoing PCI.

PRODIGY Prolonging dual antiplatelet treatment after grading stent-induced intimal hyperplasia study Valgimigli M et al. ESC 2011.

ROCKET AF Rivaroxaban Once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in Atrial.

Critère principal : décès CV, IDM ou AVC n = Médiane de suivi 33 mois

Mass-DAC Drug-Eluting and Bare Metal Stenting in Diabetes Mellitus : Results from the Mass-DAC Registry. Mauri L et al. AHA 2008.

TRITON-TIMI 38 Evaluation of Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes and Planned Percutaneous Coronary Intervention:

PRAGUE 7 Primary angioplasty in patients from general hospital transported to cathlab units with/without emergency thrombolysis Widimski P et al.

EARLY-ACS Inhibition de la glycoprotéine IIb/IIIa dans le syndrome coronarien aigu sans sus-décalage de ST Newby K et al. ACC Anti-GPIIb/IIIa précoce.

EXTRACT-TIMI 25 Enoxaparin and Thrombolysis reperfusion for acute myocardial infarction treatment ESC 2007 EXTRACT-TIMI 25.

Intravenous platelet blockade with cangrelor during PCI.

NORDISTEMI Norwegian study on district treatment of ST-elevation myocardial infarction Halvorsen S. et al.

Tests d’évaluation de la réactivité plaquettaire

AVERROES Apixaban versus acetylsalicylic acid (ASA) to reduce the risk of stroke Connolly S et al. ESC 2010.

Revascularisation coronaire : ATL-endoprothèses ou chirurgie ?

AIDA STEMI The abciximab intracoronary versus intravenously drug application in ST-elevation myocardial infarction (AIDA STEMI). Thiele H et al. AHA 2011.

ISAR-REACT 4 The abciximab intracoronary versus intravenously drug application in ST-elevation myocardial infarction (AIDA STEMI). Kastrati A et al. AHA.

ICTUS Comparaison entre revascularisation coronaire précoce

Prasugrel vs Clopidogrel for Patients managed with unstable angina or non-ST-segment elevation myocardial infarction with or without angiography : a secondary,

CRASH-2 Effets de l’acide tranexamique sur la mortalité, les événements cardiovasculaires et la transfusion sanguine chez les patients traumatisés ayant.

Clopidogrel with aspirin in acute minor stroke or transient ischemic attack CHANCE Wang Y et al. N Engl J Med 2013 ;369:11-19.

CHARISMA Analyse post-hoc Complications hémorragiques de l’association clopidogrel + aspirine chez les patients avec maladie vasculaire stable ou avec.

ISAR-SAFE, ITALIC, DAPT Durée de la bithérapie AAP post ATL-stent actif Schulz-Schüpke S, et al. ISAR-SAFE, Gilard M, et al. ITALIC, Mauri L, et al. DAPT.

LODOCO Low Dose Colchicine for Secondary Prevention of Cardiovascular Disease Nidorf M et al. AHA 2012.

ECASS III Thrombolyse avec l’altéplase 3 à 4,5 heures après un AVC ischémique. Hacke et al. N Engl J Med 2008;359: Thrombolysis with alteplase.

FREEDOM Strategies for Multivessel Revascularization in Patients with Diabetes N Engl J Med 2012 DOI : /NEJMoa Farkouh ME et al. AHA 2012.

Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS TIMI 51 ATLAS ACS 2 –TIMI 51 * Gibson CM.

Host-ASSURE Adjunctive Cilostazol vs double dose clopidogrel after PCI with drug eluting stent Hyo-Soo K et al. ACC 2012.

RE-LY Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial.

TRA 2° P Vorapaxar in the secondary prevention in atherothrombotic events Morrow DA et al. N Engl J Med 2012 ; 366 : Morrow DA et al. ACC 2012.

CHARISMA Clopidogrel + aspirine contre aspirine seule pour la prévention des accidents athérothrombotiques. Bhatt DL et al. N Engl J Med 2006;354:

Aspirin in Patients Undergoing Non Cardiac Surgery POISE 2 Devereaux PJ et al. NEJM 2014;370:

ARISTOTLE Apixaban versus warfarine dans la fibrillation atriale

POISE-2 Aspirin in patients undergoing noncardiac surgery ACC Devereaux P.J, et al. N Engl J Med 2014 ; 370 :

Recombinant Administration of Ticagrelor in the cath lab or in the ambulance for new ST elevation myocardial infarction to open the coronary artery ATLANTIC.

JPPP Low-dose aspirin for primary prevention of cardiovascular events in elderly patients with multiple atherosclerotic risk factors. A randomized control.

Prasugrel vs Clopidogrel for Acute Coronary Syndromes without Revascularization TRILOGY ACS Roe MT et al. N Engl J Med 2012 ; 367:

ATLAS ACS 2 – TIMI 51 Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome Gibson CM.

1–Thrombolysis in myocardial infarction

ATLANTIC Administration of Ticagrelor in the cath lab or in the ambulance for new ST elevation myocardial infarction to open the coronary artery Montalescot.

ACCOAST Pretreatment with prasugrel in non-ST elevation acute coronary syndromes ESC 2013 Montalescot G, et al. N Engl J Med 2013.

Platelet inhibition and patient outcomes

Transcription de la présentation:

TRITON-TIMI 38 Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infraction 38 trial Wiviott S.D et al. N Engl J Med 2007 ; 357 : 2001-15.

TRITON-TIMI 38 Méthodologie Objectif Etude Critères d’inclusion Comparaison de 2 AAP prasugrel-clopidogrel (thiénopyridines, inhibiteurs ADP) associés à l’aspirine pour ATL programmée dans les suites du SCA Etude Étude randomisée, en double insu, multicentrique Critères d’inclusion ATL coronaire programmée pour SCA ST+/- Aspirine systématique TRITON-TIMI 38 AAP = antiagrégant plaquettaire ATL : angioplastie transluminale SCA = syndrome coronaire aigu Wiviott S.D et al. N Engl J Med 2007 ; 357 : 2001-15.

TRITON-TIMI 38 Schéma de l’étude R Clopidogrel : DC 300 mg puis 75 mg/j n = 6795 ATL coronaire programmée pour SCA ST+/- Aspirine systématique (n=13608) Critère de jugement principal Mortalité CV, IDM, AVC TRITON-TIMI 38 R Prasugrel : DC 60 mg puis 10 mg/j n = 6813 ATL=angioplastie transluminale SCA : syndrome coronaire aigu Wiviott S.D et al. N Engl J Med 2007 ; 357 : 2001-15.

TRITON-TIMI 38 Résultats Efficacité et tolérance Clopidogrel Prasugrel 12,1 % Prasugrel 9,9 % TRITON-TIMI 38 2,4 % 2,4 % 1,8 % 1,1 % p < 0,001 p = 0,03 p < 0,001 Critère I : mortalité CV, IDM, AVC Hémorragies graves Thrombose endoprothèse IDM = infarctus du myocarde AVC= accident vasculaire cérébral Wiviott S.D et al. N Engl J Med 2007 ; 357 : 2001-15.

TRITON-TIMI 38 Résultats Analyse de l’effet d’une coprescription d’IPP* (à la discrétion du médecin) au prasugrel ou clopidogrel sur le risque cardiovasculaire (n = 4529, 33% population étude) 14 Sans IPP 12 Clopidogrel IPP TRITON-TIMI 38 IPP 10 Prasugrel Sans IPP 8 Décès CV, IDM, AVC (%) 6 4 Clopidogrel IPP vs sans IPP : RR ajusté 0,96 (IC95 : 0,82-1,12) 2 Prasugrel IPP vs sans IPP : RR ajusté 0,99 (IC95 : 0,83-1,17) 100 200 300 400 Jours * Pentoprazole 40%, oméprazole 37%, ésoméprazole 14%, lansoprazole 9,7%, rabéprazole 1,5% Wiviott S.D et al. N Engl J Med 2007 ; 357 : 2001-15.

TRITON-TIMI 38 Conclusion Prasugrel : efficacité significativement supérieure au clopidogrel pour diminuer mortalité CV, IDM, AVC après ATL programmée pour SCA au prix d’un surcroît significatif d’hémorragies graves Aucun effet indésirable CV de l’association IPP-AAP type Prasugrel ou Clopidogrel MAIS prescription IPP non randomisée TRITON-TIMI 38 Wiviott S.D et al. N Engl J Med 2007 ; 357 : 2001-15.