无阿司匹林与双抗血小板策略用于冠状动脉支架:STOPDAPT-3随机试验
Masahiro Natsuaki1, Hirotoshi Watanabe2, Takeshi Morimoto3
1Department of Cardiovascular Medicine, Saga University, Japan (M.N.).
在经皮冠状动脉干预 (PCI) 后,与双重抗血小板治疗 (DAPT) 相比,使用普拉苏格勒单独治疗的无阿司匹林策略没有降低出血率. 虽然这种方法对心血管事件没有劣势,但显示了冠状动脉事件的潜在增加.
科学领域:
- 心脏病学
- 干预心脏病学
- 药理学
背景情况:
- 经皮肤冠状动脉干预 (PCI) 后的双重抗血小板治疗 (DAPT) 仍然存在高出血率,特别是在急性冠状动脉综合征 (ACS) 或高出血风险的患者中.
- 没有阿司匹林的策略可以降低PCI后的早期出血,而不会影响心血管结果,但需要在随机试验中进行验证.
研究的目的:
- 在接受PCI的患者中,与DAPT相比,评估无阿司匹林普拉苏格勒单一疗法的疗效和安全性.
- 在PCI后一个月内,评估主要出血的优势和心血管事件的非劣势.
主要方法:
- 一个随机试验,涉及6002名患有ACS或高出血风险的患者接受PCI.
- 患者被分配到普拉苏格勒单一治疗 (无阿司匹林组) 或DAPT (阿司匹林加普拉苏格勒组).
- 主要终点包括严重出血和心血管事件的组合.
主要成果:
- 没有阿司匹林的组在减少严重出血方面没有优势 (4. 47% vs 4. 71%) 但在心血管事件方面没有劣势 (4. 12% vs 3. 69%).
- 在净不良临床结果或个体心血管事件组件中没有发现显著差异.
- 没有阿司匹林的组显示出非计划的冠状动脉再血管和亚急性支架血栓的发生率较高.
结论:
- 与DAPT相比,没有阿司匹林的低剂量普拉苏格勒策略在PCI后严重出血方面没有取得优势.
- 没有阿司匹林的策略对心血管事件没有劣势,但带来了冠状动脉事件增加的信号,包括支架血栓形成.
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