Publicación de los criterios STOPP-START versión 2.

 Las reacciones adversas a medicamentos (RAM) en las personas mayores representan actualmente un problema grave y creciente de salud pública . La polifarmacia y la prescripción inadecuada (IP) son factores de riesgo bien conocidos para las RAM, que comúnmente causan resultados clínicos adversos en las personas mayores . IP abarca medicamentos potencialmente inapropiados (PIM) y omisiones de prescripción potenciales (PPO) . Los criterios STOPP / START  para IP potencial en las personas mayores reconocen la doble naturaleza de IP mediante la inclusión de una lista de PIM (criterios STOPP) y PPO (START criterios). Desde la primera versión de criterios / START STOPP en 2008 , nuestro grupo de investigación ha puesto de manifiesto una serie de propiedades importantes de los criterios / START STOPP, a saber:

     STOPP criterios de medicamentos se asociaron significativamente con eventos adversos por medicamentos (AAM), a diferencia de Beers 2003 Criterios de medicamentos [6].

     STOPP / START criterios como intervención aplicado a un solo punto de tiempo durante la hospitalización por enfermedad aguda en las personas mayores mejorar significativamente idoneidad medicación , un efecto que se mantuvo 6 meses después de la intervención.
Conclusión: La versión 2 de los criterios STOPP / START se han ampliado y actualizado con el fin de minimizar la prescripción inadecuada en las personas mayores. Estos criterios se basan en una revisión actualizada la literatura y la validación de un consenso entre un grupo europeo de expertos.
http://ageing.oxfordjournals.org/content/early/2014/10/16/ageing.afu145.full

STOPP/START criteria for potentially inappropriate prescribing in older people: version 2Table 1.

STOPP/START version 1 criteria removed from the proposed version 2 because of weak or equivocal supporting evidence

STOPP criteria

Aspirin with no history of coronary, cerebral or peripheral arterial occlusive symptoms

Calcium channel blockers with chronic constipation

Non-cardioselective beta-blocker with chronic obstructive pulmonary disease

Use of aspirin and warfarin in combination without histamine H2 receptor antagonist (except cimetidine because of interaction with warfarin) or proton pump inhibitor

Dipyridamole as monotherapy for cardiovascular secondary prevention

Aspirin to treat dizziness not clearly attributable to cerebrovascular disease

Phenothiazines in patients with epilepsy

Diphenoxylate, loperamide or codeine phosphate for treatment of severe gastroenteritis

Selective alpha-blockers in males with frequent urinary incontinence, i.e. one or more episodes of incontinence daily

First-generation antihistamines in patients with falls

Long-term opioids in patients with falls

Long-term opioids in those with dementia unless indicated for palliative care or management of moderate/severe chronic pain syndrome

START criteria

Metformin with type 2 diabetes mellitus +/− metabolic syndrome (in the absence of renal impairment, i.e. serum creatinine > 150 μmol/l, or estimated GFR < 50 ml/min/1.73 m2)

Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Statin therapy for primary prevention of cardiovascular disease in diabetes mellitus

• GFR, glomerular filtration rate.
  
  
  
  
  
  
  Table 2.
  

  Proposed criteria rejected by the expert panel for inclusion in STOPP/START version 2 using Delphi consensus

  Rejected new STOPP criteria

  Diuretic for treatment of hypertension with concurrent urinary incontinence (may exacerbate incontinence)

  SSRIs with concurrent bleeding diathesis, prescription of anticoagulants or antiplatelet agents (increased risk of bleeding in general), active peptic ulcer disease or concurrent NSAID prescription (risk of gastrointestinal bleeding)

  SSRIs in patients with previous history of major non-traumatic bleeding or in combination with drugs that may promote peptic ulceration, e.g. NSAIDs (increased risk of recurrent major bleeding)

  Aspirin, clopidogrel, dipyridamole, vitamin K antagonists, direct thrombin inhibitors or factor Xa inhibitors with concurrent high bleeding risk, i.e. HAS-BLED score ≥3; HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history, labile INRs, elderly (age > 65 years), drugs that promote bleeding/alcohol)

  Antidepressants of any kind in patients with recurrent falls

  Rejected new START criteria

  Memantine for moderate–severe Alzheimer's disease

  Dopamine agonist (e.g. ropinirole or pramipexole) for Restless Legs Syndrome once iron deficiency has been excluded

  Statin therapy in diabetes mellitus, unless the patient is at end of life or more appropriate for palliation

  Phosphodiesterase type-5 inhibitor with persistent erectile dysfunction

  • SSRI, selective serotonin reuptake inhibitor; NSAID, non-steroidal anti-inflammatory drug.
  • While these criteria have a significant supportive evidence, the expert panel did not judge them to be of such high importance as to be considered potentially inappropriate in every case where they are encountered.