提卡格勒与克洛皮多格勒相比,患者先前在外周动脉疾病中进行了下肢再血管化
W Schuyler Jones1, Iris Baumgartner1, William R Hiatt1
1From Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (W.S.J., G.H., C.R., M.P.P.); Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Switzerland (I.B.); University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.); Department of Surgery, University of California San Francisco (M.S.C.); Department of Cardiology, Ochsner Clinical School, University of Queensland, Australia (C.J.W.); Ochsner Medical Center, New Orleans, LA (C.J.W.); Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.); AstraZeneca Gothenburg, Mölndal, Sweden (P.H., J.B., M.M.); AstraZeneca Gaithersburg, MD (B.G.K.); Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.); Faculty of Medicine and Health, Örebro University, Sweden (L.N.); and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK (F.G.R.F.).
对于先前接受了再血管化的外周动脉疾病患者,蒂卡格勒和克洛皮多格勒的疗效和安全性结果相似. 然而,与根据脚和手臂指数标准的参与者相比,该组心肌梗塞和急性肢体缺血的发生率更高.
科学领域:
- 心脏病学
- 血管医学
- 药理学
背景情况:
- 对于症状表现的外周动脉疾病 (PAD) 患者,前期肢体再血管化的最佳抗血栓治疗仍未确定.
- 在EUCLID试验中,研究了Ticagrelor与Clopidogrel在PAD患者中的对比.
- 这项分析专门研究了由于先前下肢再血管化的患者的结局.
研究的目的:
- 在PAD患者中比较蒂卡格勒罗与克洛皮多格勒的疗效和安全性.
- 评估这一特定小组患者心血管事件和出血的风险.
主要方法:
- 在EUCLID试验中,有13,885名PAD患者被随机分配给提卡格勒或克洛皮多格勒.
- 这项子研究集中在7,875名患者中,根据之前的下肢再血管化 (不包括脚和手臂指数≤0. 80).
- 排除标准包括最近的复血管化 (<30天) 和需要双重抗血小板治疗.
主要成果:
- 与按照ABI标准进行注册的患者相比,先前进行了再血管化的患者心肌梗塞 (HR 1.29) 和急性肢体缺血 (HR 4.23) 发生率更高.
- 对于主要疗效终点 (心血管死亡,心脏病发作,中风的组合),所有原因的死亡率,急性肢体缺血或严重出血,没有观察到任何显著差异.
- 随访时间中位数约为30个月.
结论:
- 患有外周动脉疾病且先前进行了再血管化,患心肌梗塞和急性肢体缺血的风险增加.
- 在该患者群体中,蒂卡格勒和克洛皮多格勒的疗效和安全性表现相似.
- 可能需要进一步的研究来优化PAD患者的抗血栓治疗策略.
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