novedades anticoagulaciÓncursocardio.com/descargas/curso2017/4_01_davidvivas.pdfidarucizumab...
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![Page 1: NOVEDADES ANTICOAGULACIÓNcursocardio.com/descargas/Curso2017/4_01_DavidVivas.pdfIDARUCIZUMAB Idarucizumab (s) 2×2.5 g 130 110 70 60 50 40 30 20 120 100 90 80 Baseline Between 1 h](https://reader035.vdocuments.co/reader035/viewer/2022062603/5f02556b7e708231d403c154/html5/thumbnails/1.jpg)
NOVEDADES
ANTICOAGULACIÓN
DAVID VIVAS, MD, PhD
CARDIOLOGÍA CLÍNICA
HOSPITAL CLINICO SAN CARLOS, MADRID
![Page 2: NOVEDADES ANTICOAGULACIÓNcursocardio.com/descargas/Curso2017/4_01_DavidVivas.pdfIDARUCIZUMAB Idarucizumab (s) 2×2.5 g 130 110 70 60 50 40 30 20 120 100 90 80 Baseline Between 1 h](https://reader035.vdocuments.co/reader035/viewer/2022062603/5f02556b7e708231d403c154/html5/thumbnails/2.jpg)
• ANTICOAGULACIÓN Y FA: NUEVAS EVIDENCIAS
• ANTÍDOTOS
• ENFERMEDAD ATEROSCLERÓTICA
• ANTICOAGULACIÓN + ANTIAGREGACIÓN
• NUEVAS GUÍAS 2017 ESC
ESQUEMA
![Page 3: NOVEDADES ANTICOAGULACIÓNcursocardio.com/descargas/Curso2017/4_01_DavidVivas.pdfIDARUCIZUMAB Idarucizumab (s) 2×2.5 g 130 110 70 60 50 40 30 20 120 100 90 80 Baseline Between 1 h](https://reader035.vdocuments.co/reader035/viewer/2022062603/5f02556b7e708231d403c154/html5/thumbnails/3.jpg)
• ANTICOAGULACIÓN Y FA: NUEVAS EVIDENCIAS
• ANTÍDOTOS
• ENFERMEDAD ATEROSCLERÓTICA
• ANTICOAGULACIÓN + ANTIAGREGACIÓN
• NUEVAS GUÍAS 2017 ESC
ESQUEMA
![Page 4: NOVEDADES ANTICOAGULACIÓNcursocardio.com/descargas/Curso2017/4_01_DavidVivas.pdfIDARUCIZUMAB Idarucizumab (s) 2×2.5 g 130 110 70 60 50 40 30 20 120 100 90 80 Baseline Between 1 h](https://reader035.vdocuments.co/reader035/viewer/2022062603/5f02556b7e708231d403c154/html5/thumbnails/4.jpg)
ANTICOAGULACIÓN Y VIDA REAL
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VISADO PRESCRIPCIÓN
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ESC CONGRESS BARCELONA, 2017
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ARISTOTLE- subanálisis en pacientes con o sin cáncer
Mellonich et al The American Journal of Medicine (2017) – In press
▪ En el momento basal, el 6.8% de los pacientes del estudio ARISTOTLE presentaban historia previa de cáncer
(12.7% cancer activo, 87.3% cáncer previo)
▪ El cáncer no se asoció con alto riesgo de ictus/ES.
▪ La eficacia superior de apixaban vs warfarina para la prevención de ictus/ES fue consistente en los pacientes
con historia previa de cáncer (evento/100 pacientes –año = 1.4 vs 1.2; HR 1.09; 95% CI 0.53-2.26) y sin
cáncer (1.3 vs 1.6; HR, 0.77; 95% CI, 0.64-0.93) (P interacción = 0.37).
▪ Apixaban se asoció a mayor beneficio en la reducción de ictus/ES, IAM y muerte en los pacientes con cáncer
activo (HR, 0.30; 95% CI, 0.11-0.83) vs sin cáncer (HR, 0.86; 95% CI, 0.78-0.95), pero no en los pacientes
con cáncer previo (HR, 1.46; 95% CI,1.01-2.10) (interaction P = .0028).
▪ La seguridad y la eficacia de apixaban vs warfarina se mantuvo independientemente de si los pacientes tenían
cáncer activo o no.
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ESC CONGRESS BARCELONA, 2017
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ESC CONGRESS BARCELONA, 2017
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ESC CONGRESS BARCELONA, 2017
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Edoxabán versus enoxaparina/warfarina en
pacientes con fibrilación auricular sometidos
a cardioversión
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Score de biomarcadores
cardiovasculares y resultados clínicos
en pacientes con Fibrílación Auricular
Un subanalisis del ensayo clínico
ENGAGE AF-TIMI 48
Christian T. Ruff; Robert P. Giugliano; Eugene Braunwald;
Sabina A. Murphy; Karen Brown; Petr Jarolim, MD; Michele
Mercuri; Elliott M. Antman; David A. Morrow
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0 .5 1 .0 2 .0 5 .0 1 0 .0
Event Rate/100 Patient-Years,
n (%)
Biomarker Level vs
Referent Biomarker Levela HR (95% CI)b
D-Dimer, µg/mL
Quartile 2: 0.27–0.39 118 (3.68) 1.22 (0.95–1.59)
Quartile 3: 0.40–0.67 172 (5.66) 1.85 (1.46–2.35)
Quartile 4: 0.62–16.00 266 (8.89) 2.83 (2.27–3.54)
Cardiac Troponin I,
ng/mL
Tertile 1: 0.006–0.008 85 (4.45) 1.40 (1.08–1.80)
Tertile 2: 0.009–0.014 136 (6.50) 2.03 (1.63–2.52)
Tertile 3: 0.015–0.039 168 (8.85) 2.80 (2.28–3.43)
≥99th percentile: ≥0.04 76 (12.92) 4.07 (3.12–5.30)
NT-proBNP, pg/mL
Quartile 2: 371-776 113 (3.34) 1.39 (1.05–1.86)
Quartile 3: 777-1360 157 (4.75) 1.96 (1.50–2.57)
Quartile 4: 1361-
18993319 (10.45) 4.16 (3.25–5.33)
Decreased Risk of Event Increased Risk of Event
a Referent values are 113 (2.85%) for D-dimer (quartile 1); 2421 (3.04%) for cardiac troponin I (<LOD); and 80 (2.31%) for NT-proBNP (quartile 1). b Hazard ratios are adjusted for CHA2DS2-VASc scores
CHA2DS2-VASc = Congestive heart failure, Hypertension, Age ≥75, Diabetes mellitus, and prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65–74 years, Sex Category; CI = confidence interval; HR = hazard ratio; LOD =
limit of detection; NT-proBNP = N-terminal pro-B-type natriuretic peptide; SEE = systemic embolic event
Riesgo relativo de ictus/embolia sistémica/muerte
según niveles de biomarcadores
Ruff CT, et al. JAMA Cardiol. 2016; Dec 1;1(9):999-1006
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• ANTICOAGULACIÓN Y FA: NUEVAS EVIDENCIAS
• ANTÍDOTOS
• ENFERMEDAD ATEROSCLERÓTICA
• ANTICOAGULACIÓN + ANTIAGREGACIÓN
• NUEVAS GUÍAS 2017 ESC
ESQUEMA
![Page 15: NOVEDADES ANTICOAGULACIÓNcursocardio.com/descargas/Curso2017/4_01_DavidVivas.pdfIDARUCIZUMAB Idarucizumab (s) 2×2.5 g 130 110 70 60 50 40 30 20 120 100 90 80 Baseline Between 1 h](https://reader035.vdocuments.co/reader035/viewer/2022062603/5f02556b7e708231d403c154/html5/thumbnails/15.jpg)
IDARUCIZUMAB
Idarucizumab
2×2.5 g
dT
T (
s)
130
110
70
60
50
40
30
20
120
100
90
80
1 h 2 h 4 h 12 h 24 hBaseline Between
vials
10–30
min
Time post-idarucizumab
Idarucizumab
2×2.5 g
dT
T (
s)
130
110
70
60
50
40
30
20
120
100
90
80
1 h 2 h 4 h 12 h 24 hBaseline Between
vials
10–30
min
Time post-idarucizumab
Assay upper
limit of
normal
Assay upper
limit of
normal
0 0
Pollack CV, et al. NEJM. 2017;377:431-41
N=503
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• ANTICOAGULACIÓN Y FA: NUEVAS EVIDENCIAS
• ANTÍDOTOS
• ENFERMEDAD ATEROSCLERÓTICA
• ANTICOAGULACIÓN + ANTIAGREGACIÓN
• NUEVAS GUÍAS 2017 ESC
ESQUEMA
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N = 27.395
Eikelboom JW, et al. NEJM. 2017
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Eikelboom JW, et al. NEJM. 2017
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Eikelboom JW, et al. NEJM. 2017
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• ANTICOAGULACIÓN Y FA: NUEVAS EVIDENCIAS
• ANTÍDOTOS
• ENFERMEDAD ATEROSCLERÓTICA
• ANTICOAGULACIÓN + ANTIAGREGACIÓN
• NUEVAS GUÍAS 2017 ESC
ESQUEMA
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Gibson CM, et al. NEJM. 2016;375:2423-34
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Gibson CM, et al. NEJM. 2016;375:2423-34
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Gibson CM, et al. NEJM. 2016;375:2423-34
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Cannon CP, et al. NEJM. 2017
N = 2725 Mediana seguimiento = 14m
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Cannon CP, et al. NEJM. 2017
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• ANTICOAGULACIÓN Y FA: NUEVAS EVIDENCIAS
• ANTÍDOTOS
• ENFERMEDAD ATEROSCLERÓTICA
• ANTICOAGULACIÓN + ANTIAGREGACIÓN
• NUEVAS GUÍAS 2017 ESC
ESQUEMA
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ESC 2017 GUIDELINES DAPT
AF GUIDELINES. ESCARDIO BARCELONA 2017
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ESC 2017 GUIDELINES VHD
AF GUIDELINES. ESCARDIO BARCELONA 2017
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ESC 2017 GUIDELINES VHD
AF GUIDELINES. ESCARDIO BARCELONA 2017
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MUCHAS
GRACIAS
DAVID VIVAS, MD, PhD
CARDIOLOGÍA CLÍNICA
HOSPITAL CLINICO SAN CARLOS, MADRID