Carlos Augusto Bueno Silva,Dr Serviço de Hemodinâmica e Cardiologia Intervencionista do Hospital São João de Deus – Divinópolis Sem conflito de interesses.

 Aspirina  Ticlopidina  Clopidogrel  Prasugrel  Cilostazol  Inibidores 2b3a

ISIS 2 Lancet 1988;2:349-60

The ISAR-REACT trial evaluated the efficacy of abciximab in 2159 patients undergoing elective percutaneous coronary intervention (PCI). All patients were pretreated with 600 mg of clopidogrel at least two hours before PCI. When the study subjects were grouped into four subsets based upon duration of clopidogrel pretreatment (2 to 3 hours, 3 to 6 hours, 6 to 12 hours, and >12 hours), there was no significant difference among the four groups in the incidence of death, MI, or urgent revascularization at 30 days or in the rate of major bleeding.abciximab clopidogrel The ISAR-REACT trial evaluated the efficacy of abciximab in 2159 patients undergoing elective percutaneous coronary intervention (PCI). All patients were pretreated with 600 mg of clopidogrel at least two hours before PCI. When the study subjects were grouped into four subsets based upon duration of clopidogrel pretreatment (2 to 3 hours, 3 to 6 hours, 6 to 12 hours, and >12 hours), there was no significant difference among the four groups in the incidence of death, MI, or urgent revascularization at 30 days or in the rate of major bleeding.abciximab clopidogrel

).CONCLUSIONS: Single doses of clopidogrel higher than 600 mg are not associated with an additional significant suppression of platelet function because of limited clopidogrel absorption. Absorption, metabolization, and antiplatelet effects of 300-, 600-, and 900-mg loading doses of clopidogrel: results of the ISAR-CHOICE (Intracoronary Stenting and Antithrombotic Regimen: Choose Between 3 High Oral Doses for Immediate Clopidogrel Effect) Trial. von Beckerath N, Taubert D, Pogatsa-Murray G, Schömig E, Kastrati A, Schömig A Circulation. 2005;112(19):2946.

The ARMYDA-4 RELOAD study involved 503 patients already taking chronic clopidogrel who required PCI. They were randomized to a 600-mg clopidogrel loading dose four to eight hours before PCI or placebo. The primary end point was death, MI, or target vessel revascularization at 30 days. In the overall population, this was slightly reduced in the loading-dose group but not significantly so. But those patients with ACS (about 40% of the trial population) did show a better outcome when given the additional loading dose. There was no excess bleeding in the reload arm (6% in both groups).

 Heparina não fracionada  Heparina de baixo peso molecular  Inibidores diretos da trombina  Fondaparinux

CSA de alto risco ( VS enoxaparina) Similar eficácia, menor sangramento Necessidade de HNF suplementear para ICP