adenosine
DISEASE INTERVENTION COMPARISON RESULTS
BMJ. 2002 Jan 12;324(7329):71-86 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, peripheral arterial disease The Use of
antiplatelet drugs, aspirin, low-dose (75-150 mg/d), adenosine diphosphate (ADP) receptor inhibitors, clopidogrel
As Treatment, Chronic
Is better Than
placebo
To reduce recurrence of ischemic coronary and cerebral events, with absolute reductions of 3 to 4%, depending on specific conditions
N Engl J Med. 2009 May 14;360(20):2066-78 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin
As Treatment, Chronic
Is better Than
aspirin alone
To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Lancet. 2006 Jun 10;367(9526):1903-12 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin (75-100 mg/day)
As Treatment, Chronic
Is worse Than
oral anticoagulation (target INR 2.0-3.0)
To prevent embolic events (stroke, non-CNS systemic embolus, myocardial infarction, or vascular death): annual risk 3.93% with warfarin VS 5.60% with aspirin plus clopidogrel
N Engl J Med. 2001 Aug 16;345(7):494-502 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce, at 1 year, ischemic events (cardiovascular death, myocardial infarction or stroke): 9.3% in intv VS 11.4% in ctrl. Increase major bleeds (3.7% in intv. VS 2.7% in ctrl.)
Lancet. 2012 Feb 4;379(9814):453-60 Diagnostic
IN coronary disease, chest pain, high risk patients The Use of
magnetic resonance imaging (MRI) of the heart, with adenosine stress
As Diagnostic Tool
Is better Than
single-photon emission computed tomography (SPECT), with adenosine stress, perfusion scintigraphy
To diagnose significant coronary disease (gold standard : coronary angiography) : IRM sensitivity 86%, specificity 83% ; SPECT sensitivity 66%, specificity 82%
N Engl J Med. 2005 Mar 24;352(12):1179-89 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (300-mg loading dose, 75 mg/d after) added to fibrinolysis plus aspirin plus heparin
As Treatment, Acute
Is better Than
standard antithrombotic Tt with fibrinolysis + aspirin + heparin alone (+ placebo)
To reduce at 30 days vascular events (cardiovascular death, recurrent infarction, revascularization because recurrent ischemia): 11,6% with clopidogrel VS 14,6% standard Tt, Major bleeding and intracranial hemorrhage similar in the two groups.
Lancet. 2005 Nov 5;366(9497):1607-21 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to standard Tt (aspirin 100%, fibrinolysis 50%, anticoagulant 75%)
As Treatment, Acute
Is better Than
aspirin alone and standard antithrombotic Tt
To To reduce at 30 days vascular events (death, recurrent infarction, stroke): 9,2% with clopidogrel VS 10,1% aspirin alone.
JAMA. 2009 Apr 15;301(15):1547-55 Randomized Controlled Trial, Diagnostic
IN diabetes mellitus, type 2, asymptomatic for coronary disease The Use of
routine screening for coronary artery disease, adenosine-stress radionuclide myocardial perfusion imaging
As Diagnostic Tool
Is equal Than
non screening
To reduce cardiac death or nonfatal myocardial infarction at 5 years: 2.7% screened patients VS 3% non-screened.
N Engl J Med. 2012 Aug 30;367(9):817-25 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, lacunar, recent The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to aspirin (325 mg/d)
As Treatment, Chronic
Is equal Than
aspirin alone
To modify the the risk of recurrent stroke: 2.5% per year dual therapy VS 2.7% per year aspirin alone
Lancet. 2004 Jul 24;364(9431):331-7 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, thrombotic, recidivant, high-risk patients The Use of
combined anti-platelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin,
As Treatment, Chronic
Is worse Than
only one antipletelet drug, clopidogrel
To reduce new stroke or overall ischemic events (10.5 % per year in intv. VS 11.1 % per year in ctrl.) And increased bleedings, included life-threatening bleedings (1.73 % per year in intv. VS 0.86 % per year in ctrl.)
Stroke. 2012 Apr;43(4):1058-66. Epub 2012 Jan 26 Meta-Analysis
IN stroke, ischemic, thrombotic, transient ischemic attack The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) plus low-dose aspirin
As Prevention, Secondary
Is equal Than
aspirin alone
To reduce stroke recurrence (aspirin+clopidogrel VS aspirin alone : RR 0.67, 95%CI 0.37-1.23). However, a strong trend to reduce combined major cardiovascular events or death (OR 0.68, 95%CI 0.45-1.03, p=0.07).
N Engl J Med. 2013 Jul 4;369(1):11-9 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (75 mg/day) for 90 days
As Treatment, Acute
Is better Than
aspirine alone
To reduce, at 3 months, stroke (8% clopidogrel+aspirin VS 12% aspirine alone), while having similar rate of major haemorrage (0.3% both)
Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005154 Systematic Review, Cochrane Review
IN tachycardia, supraventricular, paroxysmal The Use of
adenosine
As Treatment, Acute
Is equal Than
verapamil, calcium channel antagonists
To reverse the tachycardia, avoid relapse after reversion, and avoid major adverse events. Minor but unpleasant side effects more frequent with adenosine: 11% VS 0.6%. Hypotension only with verapamil: 1.8%