治疗心房和急性冠状动脉综合征的患者的抗血栓治疗或经过皮肤冠状动脉干预或接受选择性皮肤冠状动脉干预:来自AUGUSTUS试验的见解
Stephan Windecker1, Renato D Lopes2, Tyler Massaro2
1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (S.W.).
Circulation
|September 27, 2019
概括
与维生素K对抗剂或阿司匹林相比,在患有急性冠状动脉综合征 (ACS) 或接受PCI的心房动患者中,阿皮克萨班加P2Y12抑制剂更安全且同样有效.
科学领域:
- 心脏病学
- 药理学
- 临床试验
背景情况:
- 在患有急性冠状动脉综合征 (ACS) 或经过皮肤冠状动脉干预 (PCI) 的心房动患者中,抗血栓治疗的安全性和有效性可能有所不同.
- 在接受医疗治疗的ACS,接受PCI治疗的ACS和选择性PCI子组之间存在结果差异.
研究的目的:
- 在接受PCI或ACS的AF患者中,比较阿皮克萨班与维生素K抗剂 (VKAs) 和阿司匹林与安慰剂.
- 在不同抗血栓策略和患者小组中评估出血,死亡,住院和缺血事件.
主要方法:
- 一项2x2因子设计研究招募了4614名AF患者.
- 患者接受了阿皮克萨班或VKA,阿司匹林或安慰剂,以及P2Y12抑制剂.
- 分析结果分为三个小组:医疗治疗的ACS,PCI治疗的ACS和选择性PCI.
主要成果:
- 与VKAs相比,阿皮克萨班在所有三组患者中显著降低了重大或临床相关的非重大出血 (P_ 相互作用=0. 052).
- 与VKAs相比,Apixaban还减少了医疗治疗的ACS和PCI治疗的ACS患者的死亡或住院 (P_ 相互作用=0. 345).
- 与安慰剂相比,阿司匹林增加了所有亚组的出血率 (P_ 相互作用=0. 479),死亡/ 入院或死亡/ 缺血事件没有显著差异.
结论:
- 在患有ACS或接受PCI的AF患者中,阿皮克萨班加P2Y12抑制剂的抗血栓治疗方案提供了更高的安全性和类似的疗效.
- 与包括VKA或阿司匹林在内的疗法相比,这种策略具有优势.
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