在急性冠状动脉综合征后的口服抗血小板治疗:一篇评论
Hassan Kamran1, Hani Jneid1,2, Waleed T Kayani1
1Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
JAMA
|April 20, 2021
概括
与阿司匹林和P2Y12抑制剂的双重抗血小板治疗 (DAPT) 在急性冠状动脉综合征 (ACS) 患者中显著减少了心血管事件. 治疗时间和药物选择应根据出血和缺血风险进行个性化.
科学领域:
- 心脏病学
- 药理学
- 临床医学
背景情况:
- 急性冠状动脉综合征 (ACS) 是美国的主要死亡原因,每年约有100万例.
- 结合阿司匹林和P2Y12抑制剂的双重抗血小板治疗 (DAPT) 对于减少心血管事件至关重要.
研究的目的:
- 对ACS患者的DAPT治疗方案和持续时间进行审查.
- 根据个体患者的出血和缺血风险概况调整DAPT的重要性.
主要方法:
- 分析2016年ACC/AHA指导方针以及随后随机临床试验中的抗血小板治疗.
- 影响DAPT持续时间的因素评估,包括出血风险分层和患者特征.
- 较新的P2Y12抑制剂 (普拉苏格勒,蒂卡格勒尔) 与克洛皮多格勒的比较,考虑有效性和安全性.
主要成果:
- DAPT持续时间的建议有所不同:如果出血风险低,则延长DAPT,如果出血风险高,则缩短 (3-6个月).
- 高出血风险是由特定的标准定义的 (例如,年龄≥65,低BMI,先前出血,口服抗凝剂使用).
- 新的P2Y12抑制剂更强效;在ISAR-REACT-5中,普拉苏格勒在减少缺血事件而不会增加出血方面表现出优势,但有 kontraindications.
结论:
- 在ACS中,DAPT有效降低心血管事件.
- 最佳的DAPT策略需要仔细考虑患者特定的出血和缺血风险.
- 新出现的证据表明,在使用P2Y12抑制剂之前停止服用阿司匹林可能会改善结果.
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