Dott. Marco Piccininno S.C. Cardiologia Ospedale Galliera, Genova

Presentazione sul tema: "Dott. Marco Piccininno S.C. Cardiologia Ospedale Galliera, Genova"— Transcript della presentazione:

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2 Dott. Marco Piccininno S.C. Cardiologia Ospedale Galliera, Genova

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5 METABOLISMO Rapido assorbimento pro-farmaco
Non importanti interferenze con il cibo Concentrazioni plasmatiche stabili entro 3 giorni dall’inizio della terapia Farmacocinetica prevedibile (minima variabilità interindividuale)

6 18113 pz età media: 71.5 anni CHADS2: 2.1
follow-up: 2 anni

7 Criteri di esclusione RELY

8 RELY: results -Dab 110 non inferior to Warfarin SSE prevention
-Dab 150 superior to Warfarin SSE prevention (-34%) -Dab 150 reduced ischemic stroke (-25%) and CV death (-15%) - Both doses reduced hemorragic stroke (-74% e – 69%) -Dab 110 caused less major bleeding (-20%) -No significant difference in CV and all-cause mortality between the 2 doses of Dab SSE= stroke & sistemic embolism

9 SAFETY & EFFICACY RELY

10 ESC Guidelines. European Heart Journal 2012; doi:10
ESC Guidelines. European Heart Journal 2012; doi: /eurheartj/ehs253

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12 Bleeding post-marketing & Case Report

13 RELY ?

14 JACC 2013; 61:2264

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16 CONTROINDICAZIONI ALL’UTILIZZO DEL DABIGATRAN

17 PAZIENTE RELY 60% 40% Follow-up visit 2 SETTIMANE 1 MESE 3 MESI 6 MESI 9 MESI 12 MESI 16 MESI 20 MESI 24 MESI 83 kg Cl creat 69 ml/min CC 71aa > 85 aa = 4 % Iperteso (80%) controllato (130/77, 60% βblock, 65% ACE/ARB, 45% stat.) 1/7 pregr. stroke (1/5 stroke+TIA), 1/6 pregr. IM, 1/4 DM, 1/3 HF

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19 Source of bleeding Time of the last dose Measure aPTT/TT Measure creat/ cl.cr Wait at least 30’ to assess the effect aPTT and/or TT every 3 h MODERATE-SEVERE BLEEDING: reduction in hemoglobin > 2 g/dl, trasfusion of > 2 U red cells, symptomatic bleeding in critical area (intraocular, intraspiinal, intramuscolar with compartimen syndrome, retroperitoneal, intraarticular, pericardial). LIFE THREATENING BLEEDING: symptomatic intracranial bleeding, reduction in hemoglobin > 5 g/dl, trasfusion of > 4 U red cells, hypotension requiring inotropic agents, or bleeding requiring surgical interventions.

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