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TAILORED- CHIPランダム化臨床試験

Do-Yoon Kang1, Seong-Bong Wee1, Jung-Min Ahn1

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まとめ

パーキュタヌス冠動脈干渉 (PCI) を受けている高リスクの患者では,調整された抗血小板策が有害事象を減少させなかった. 標準の二重抗血小板療法と比較して,試験では同様の不血症発生率がみられたが,血流が増加した.

キーワード:
抗血小板療法クロピドグレル冠動脈疾患経皮冠動脈介入ステントチカグレロール

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科学分野:

  • 心臓病科
  • 介入心臓科
  • 薬理学について

背景:

  • 複雑な皮経冠動脈干渉 (PCI) を受けている高リスク患者の最適の抗血小板策は不明である.
  • この研究では,この集団に合わせた抗血小板療法に関する証拠の必要性に対処しています.

研究 の 目的:

  • 血小板抑制の強度を時間的に調節する,個別化された抗血小板戦略の有効性と安全性を調査する.
  • 複合PCIを受けた患者の標準的な二重抗血小板治療と,この量身治療を比較する.

主な方法:

  • 2018年にPCIを施した高リスク患者のランダム化試験です.
  • 患者には,特別の治療法 (ティカグレル/アスピリンによる早期エスカレーション,クロピドグレルによる後期的なデエスカレーション) または標準の二重抗血小板療法 (クロピドグレル/アスピリンによる12ヶ月間) が割り当てられました.
  • 主なアウトカムには,主要な有害事象 (死亡,心筋梗塞,脳卒中,ステント結血症,緊急再血管化) と12ヶ月後の臨床的に重要な出血が含まれる.

主要な成果:

  • 主要コンポジットアウトカムは,調整された治療群の10. 5%で,二重治療群の8. 8%であった (HR,1. 19;95%CI,0. 90-1. 58;P=0. 21).
  • 主要な不血症イベントは,グループ間で類似していました.
  • 臨床的に重要な出血は,二重治療群 (4. 8%) と比較して,量身治療群 (7. 2%) で高かった.

結論:

  • 早期エスカレートと遅いエスカレートによる調整された抗血小板戦略は,複雑なPCIを受けた高リスクの患者で12ヶ月後の有害事象の発生率を減少させなかった.
  • 標準的な二重抗血小板療法と比較して,特別のアプローチは,数値的に主要なイベントの発生率と,著しく多くの出血イベントに関連していました.