El panel de consenso de Delphi consideró que 3 de los 114 criterios de STOPP/START versión 2 eran obsoletos o redundantes y, en consecuencia, se eliminaron estos 3 criterios, es decir, STOPP C2 y H7 y START B1. Los detalles específicos de estos criterios fueron:
(i) STOPP C2: Aspirina con antecedentes de enfermedad ulcerosa péptica sin IBP concomitante (riesgo de úlcera péptica recurrente).
(ii)STOPP H7: AINE selectivos de COX-2 con enfermedad cardiovascular concurrente (aumento del riesgo de infarto de miocardio y accidente cerebrovascular).
(iii)INICIO B1: Agonista β-2 inhalado regular o broncodilatador antimuscarínico (p. ej., ipratropio, tiotropio) para el asma o la EPOC de leve a moderada.
Table 2 Proposed criteria rejected by the expert panel for inclusion in STOPP/START version 3 using Delphi consensus methodology
From: STOPP/START criteria for potentially inappropriate prescribing in older people: version 3
Rejected STOPP Criteria |
|---|
Aspirin with a previous history of peptic ulcer disease without concomitant proton pump inhibitor (risk of recurrent peptic ulcer) |
Mirabegron with known QTc interval prolongation (risk of exacerbation with associated ventricular arrhythmias) |
Angiotensin converting enzyme inhibitors if eGFR < 30 ml/min/1.73m2 (risk of deterioration in renal function) |
Angiotensin receptor blockers if eGFR < 30/min/1.73m2 (risk of deterioration in renal function) |
Serotonin/noradrenaline reuptake inhibitors (SNRI’s e.g. venlafaxine, duloxetine) and chronic insomnia (likely to make insomnia worse) |
Antiplatelet agents and Vitamin K antagonist, direct thrombin inhibitor or factor Xa inhibitors with a known history of cerebral amyloid angiopathy (increased risk of major intracerebral bleeding) |
Thiazolidenediones (e.g. rosiglitazone, pioglitazone) with symptomatic hypotension (risk of exacerbation of hypotension) |
Glucagon-like peptide-1 receptor (GLP-1) agonists (e.g. dulaglutide, exenatide, liraglutide, lixisenatide) with chronic constipation (risk of exacerbation of constipation) |
Glucagon-like peptide-1 receptor (GLP-1) agonists (e.g. dulaglutide, exenatide, liraglutide, lixisenatide) with gastro-oesophageal reflux disease (risk of exacerbation of gastro-oesophageal reflux) |
Mirabegron with current or previous tachyarrhythmia (risk of exacerbation or relapse of tachyarrhythmia) |
Loop diuretics in patients with recurrent falls (may cause intravascular volume depletion and orthostatic hypotension) |
Rejected START Criteria |
Quinine sulphate in patients with recurrent painful lower limb muscle cramps |
Memantine for moderate-severe Alzheimer’s disease |
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