Oleh Admin Kalbe Medical pada March 20, 2017 07:30

Kelebihan Dual Anti-platelet Therapy (DAPT) Dibandingkan Monoterapi Aspirin pada Pasien PAD

Pasien-pasien dengan peripheral arterial disease (PAD) memiliki risiko major adverse cardiovascular events (MACEs) dan mortalitas kardiovaskular yang lebih besar dibandingkan dengan pasien penderita penyakit jantung koroner atau penyakit serebrovaskular saja. PAD mengindikasikan penyakit ateroklerotik yang lebih sistemik dan biasanya underdiagnosed serta undertreated. Diduga hal inilah penyebab utama pasien-pasien PAD memiliki risiko MACEs dan mortalitas lebih tinggi.

Beberapa terapi medis terbukti menurunkan mortalitas kardiovaskular pada pasien PAD, meliputi statin, angiotensin-converting enzymes (ACE) inhibitors, dan berhenti merokok. Obat-obatan antiplatelet juga menurunkan risiko MACEs pada pasien PAD simptomatik, dengan manfaat tambahan relatif clopidogrel terhadap monoterapi aspirin (acetylsalicylic acid/ ASA). Sebuah analisis subgroup dari uji Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) menyatakan bahwa penggunaan dual-antiplatelet therapy (DAPT) terkait dengan penurunan kejadian infark miokardium dan rawat inap akibat kejadian iskemik pada pasien PAD. Beberapa studi juga membandingkan DAPT dan monoterapi ASA pada pasien dengan PAD tahap lebih lanjut, termasuk klaudikasio berat yang lifestyle-limiting atau critical limb ischemia (CLI).


Armstrong EJ, et al, melakukan sebuah studi kohort observasional pada 629 pasien dengan kaludikasio atau CLI. Pasien-pasien tersebut dibagi ke dalam 2 kelompok perlakuan, yaitu kelompok monoterapi ASA dan kelompok DAPT. Dilakukan penilaian setiap bulan selama 3 tahun perlakuan. Pada akhir studi didapatkan bahwa pemberian DAPT pada pasien PAD simptomatik berhubungan dengan penurunan mortalitas dan MACEs yang signifikan dibandingkan dengan monoterapi ASA. Namun, tidak didapati adanya asosiasi yang signifikan untuk luaran ¬limb-related, termasuk kejadian amputasi.


Hasil studi lainnya dikemukakan Thott O, et al, pada studi kohort restrospektif berbasis populasi nationwide di Swedia yang melibatkan 1941 pasien dengan CLI yang telah menjalani intervensi endovaskular femoropopliteal primer antara tahun 2006 dan 2012. Studi ini menyatakan bahwa DAPT dibandingkan monoterapi ASA berkaitan dengan tingkat amputasi yang lebih rendah pada pasien dengan diabetes melitus dan CLI setelah stenting endovaskular femoropopliteal.


Simpulan:
Pemberian dual anti-platelet therapy (DAPT) pada pasien dengan peripheral arterial disease (PAD) secara signifikan menurunkan risiko major adverse cardiovascular events (MACEs) dan mortalitas kardiovaskular secara keseluruhan dibandingkan dengan monoterapi aspirin. (JCH)

Image : Ilustrasi
Referensi:
1.Armstrong EJ, Naderson DR, Yeo KK, Singh GD, Bang H, Amsterdam EA, et al. Association of dual-antiplatelet therapy with reduced major adverse cardiovascular events in patients with symptomatic peripheral arterial disease. J Vasc Surg. 2015;62:157-65.
2.Soden PA, Zettervall SL, Ultee KHJ, Landon BE, O'Malley AJ, Goodney PP, et al. Dual antiplatelet therapy is associated with prolonged survival after lower extremity revascularization. J Vasc Surg. 2016;64(6):1633-44. doi: 10.1016/j.jvs.2016.05.098.
3.Thott O, Granath F, Malmstedt J et al. Dual Antiplatelet Therapy Improves Outcome in Diabetic Patients Undergoing Endovascular Femoropopliteal Stenting for Critical Limb Ischaemia. Eur J Vasc Endovasc Surg 2017;16 : 1-8.

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