双重抗血小板治疗的最佳持续时间用于支架辅助卷轴或流量转移器放置
Yukiko Enomoto1, Hirofumi Matsubara2, Takuma Ishihara3
1Neurosurgery, Gifu Univeristy Graduate School of Medicine, Gifu, Japan enomoto.yukiko.k1@f.gifu-u.ac.jp.
Journal of neurointerventional surgery
|June 21, 2023
概括
在用支架辅助卷轴 (SAC) 或流量转移 (FD) 治疗脑动脉瘤后,双重抗血小板治疗 (DAPT) 很少导致超过30天的事件. 较短的DAPT持续时间对于没有周围手术并发症的患者可能是安全的.
科学领域:
- 神经外科 神经外科
- 干预性神经辐射学
- 心脏病学 心脏病学
背景情况:
- 双重抗血小板疗法 (DAPT) 对于预防干支辅助卷轴 (SAC) 或脑动脉瘤流动转移 (FD) 后的血栓栓塞并发症至关重要.
- 在这些患者中,DAPT的最佳持续时间仍然是临床不确定性的领域.
研究的目的:
- 为了研究双抗血小板治疗 (DAPT) 的最佳持续时间,在接受支架辅助卷轴 (SAC) 或脑动脉瘤流动转移 (FD) 的患者中.
主要方法:
- 一项多中心队列研究,涉及632名在2010年至2020年期间在七家日本机构接受治疗的患者.
- 主要结局:目标血管相关的血栓栓塞事件,严重出血或死亡的组合.
- 分析包括卡普兰-梅尔曲线和日志等级测试,以根据DAPT持续时间来比较结果.
主要成果:
- 主要综合结局发生在10.0%的患者中,大多数事件发生在手术后30天内.
- 在30天后,无事件生存率为93.3%,在1年后为91.5%,在2年后为89.5%.
- 在DAPT持续时间>91天和<90天的组中观察到类似的无事件生存,当转换到单一治疗时没有重大临床事件时.
结论:
- 在SAC/FD之后的血栓塞栓事件在最初的30天期间之外并不频繁.
- 对于在周围手术期间保持无事件的患者,可以考虑较短的DAPT持续时间.
- 需要进一步的前性研究来确定最终的最佳抗血小板治疗持续时间.
相关概念视频
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
567
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
567
Venous Thrombosis III: Interprofessional Care
11
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
11
Peripheral Artery Disease III: Interprofessional Care
13
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
13
Acute Coronary Syndrome IV: Interprofessional Care
13
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
13
Coronary Artery Disease V: Interprofessional Care
11
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
11
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
14
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
14


