RESUMO

JUSTIFICATIVA E OBJETIVOS: As síndromes coronarianas agudas (SCA) estão entre as principais causas de admissão em unidades de terapia intensiva (UTI). Novos fármacos vêem sendo desenvolvidos para o manuseio das SCA. O uso combinado destes medicamentos tem reduzido de forma considerável a morbimortalidade desta síndrome, no entanto seus efeitos adversos ou mesmo seu manuseio incorreto podem levar à maior incidência de sangramento. O objetivo deste estudo foi apresentar os principais aspectos terapêuticos, indicações e manuseio dos fármacos em síndromes coronárias agudas. MÉTODO: Foi realizada uma busca por artigos originais cruzando os unitermos acute coronary syndromes e antitrombotic therapy na base de dados -MedLine; busca de artigos e diretrizes nacionais e internacionais no endereço eletrônico: http://sumsearch.uthscsa.edu. RESULTADOS: No tratamento de angina instável e infarto sem supradesnivelamento de ST, a enoxaparina mostrou-se tão eficaz quanto à heparina não fracionada (HNF) e de manuseio mais simples (estudos SYNERGY e A a Z). Neste cenário, o fondaparinux também não foi inferior à enoxaparina e; no entanto, promoveu menor taxa de sangramento (OASIS-5), a bivalirudina também foi não inferior combinada ou não à GPIIB/IIIa comparada a outras heparinas (ACUITY). No infarto com supradesnivelamento do segmento ST, a enoxaparina foi superior à HNF em pacientes submetidos à trombólise (EXTRACT TIMI 25), e no estudo OASIS 6, o fondaparinux foi superior à HNF em pacientes submetidos à trombólise e os não submetidos à reperfusão. CONCLUSÕES: A correta administração das doses dos antitrombóticos e a escolha individualizada da combinação de fármacos são imprescindíveis para a redução de óbito e eventos cardiovasculares maiores, reduzindo o desconfortável risco de sangramento adicional.

BACKGROUND AND OBJECTIVES: Acute coronary syndromes (ACS) are one of the most common causes of ICU admissions. New drugs have been developed for management of ACS. These drugs reduced morbidity and mortality; however their adverse effects or their incorrect use may cause excessive bleeding. The objective of this review is to present the principal peculiarities, doses, and indications of these drugs in ACS settings. METHODS: Original articles were retrieved crossing the terms acute coronary syndromes and antithrombotic therapy in the MedLine database as well as search for Brazilian and international guidelines in http://sumsearch.uthscsa.edu. RESULTS: In the treatment of acute coronary syndromes with non-ST-segment elevation enoxaparin was as efficient as UFH, but with a simpler management (SYNERGY and A to Z studies). In this same setting, fondaparinux was non inferior to enoxaparin and had lesser bleedings (OASIS 5), bivalirudin, combined or not with GPIIbIIIa blockers, was not inferior when compared with other heparins (ACUITY). In ST-segment elevation ACS, enoxaparin was superior to HNF in patients treated with fibrinolysis (EXTRACT TIMI 25); in OASIS 6 fondaparinux was superior to UFH in patients treated with thrombolytic therapy and not submitted to reperfusion. CONCLUSIONS: The correct management and individual combination of antithrombotic drugs are mandatory for decreased mortality and of major cardiovascular events, reducing the undesirable risk of additional bleeding.

Assuntos

RESUMO

BACKGROUND AND OBJECTIVES: Acute coronary syndromes (ACS) are one of the most common causes of ICU admissions. New drugs have been developed for management of ACS. These drugs reduced morbidity and mortality; however their adverse effects or their incorrect use may cause excessive bleeding. The objective of this review is to present the principal peculiarities, doses, and indications of these drugs in ACS settings. METHODS: Original articles were retrieved crossing the terms acute coronary syndromes and antithrombotic therapy in the MedLine database as well as search for Brazilian and international guidelines in http://sumsearch.uthscsa.edu. RESULTS: In the treatment of acute coronary syndromes with non-ST-segment elevation enoxaparin was as efficient as UFH, but with a simpler management (SYNERGY and A to Z studies). In this same setting, fondaparinux was non inferior to enoxaparin and had lesser bleedings (OASIS 5), bivalirudin, combined or not with GPIIbIIIa blockers, was not inferior when compared with other heparins (ACUITY). In ST-segment elevation ACS, enoxaparin was superior to HNF in patients treated with fibrinolysis (EXTRACT TIMI 25); in OASIS 6 fondaparinux was superior to UFH in patients treated with thrombolytic therapy and not submitted to reperfusion. CONCLUSIONS: The correct management and individual combination of antithrombotic drugs are mandatory for decreased mortality and of major cardiovascular events, reducing the undesirable risk of additional bleeding.