在冠状动脉干预后,蒂卡格勒单一治疗的出血和缺血风险
Guiomar Mendieta1, Shamir Mehta2, Usman Baber3
1National Center of Cardiovascular Investigations Carlos III (CNIC), Madrid, Spain.
Journal of the American College of Cardiology
|August 17, 2023
概括
经皮肤冠状动脉干预 (PCI) 后的蒂卡格勒单疗法与双抗血小板治疗 (DAPT) 相比,减少了出血事件. 在高风险患者中,这种方法没有增加缺血事件,提供了更安全的替代方案.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在TWILIGHT试验中,研究了Ticagrelor单疗法与双抗血小板治疗 (DAPT) 在高风险患者中进行皮肤穿刺冠状动脉干预 (PCI) 后的治疗.
- 以前的策略包括在初始疗程后继续使用阿司匹林和提卡格勒勒的DAPT.
研究的目的:
- 与DAPT相比,评估蒂卡格勒罗单一治疗的临床净益.
- 单独模拟与每个治疗策略相关的出血益处和缺血风险.
主要方法:
- 多变量考克斯回归模型被用于评估Bleeding Academic Research Consortium (BARC) 类型2,3,或5事件以及主要不良心脏和脑血管事件 (MACCE).
- 根据模型系数,为每个患者计算出出血和缺血的风险得分.
- 在模型开发中使用了逐步前进的变量选择.
主要成果:
- 在7,119名患者中,与DAPT相比,提卡格雷勒单一疗法在所有风险层一致降低了出血事件.
- 这种降低出血并没有伴随MACCE的增加,即使是在高风险患者中.
- 对出血和缺血风险层的相互作用P值分别为0.54和0.11.
结论:
- 在PCI后三个月停止服用阿司匹林以维持蒂卡格雷勒单一治疗,可减少高危患者的出血.
- 这种策略提供了显著的降低出血的好处,而没有明显增加缺血风险.
- 这些研究结果支持提卡格雷勒单一治疗作为PCI后在特定高风险人群中潜在的更安全的选择.
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