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在ST段升高心肌梗塞的初级皮肤冠状动脉干预后进行术后抗凝疗:多中心,随机,双盲试验

Yan Yan ^1,2,3, Jincheng Guo ⁴, Xiao Wang ^1,2,3

¹Center for Coronary Artery Disease (Y.Y., X.W., W.G., S.N.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
²National Clinical Research Center of Cardiovascular Diseases, Beijing, China (Y.Y., X.W., W.G., C.M., S.N.).
³Beijing Institute of Heart, Lung, and Blood Vessel Diseases, China (Y.Y., X.W., W.G., C.M., S.N.).
⁴Beijing Luhe Hospital, Capital Medical University, Beijing, China (J.G., G.W.).
⁵Civil Aviation General Hospital, Beijing, China (Z.F.).
⁶The First People's Hospital of Lianyungang, Jiangsu, China (D.Y.).
⁷Xinxiang Central Hospital, Henan, China (Z.W.).
⁸Beijing Haidian Hospital, Beijing, China (F.Z.).
⁹The People's Hospital of Yongcheng, Henan, China (C.T.).
¹⁰NHC Key Laboratory of Clinical Research for Cardiovascular Medications (J. Liu).
¹¹National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China (J. Lu).
¹²The Second Hospital of Hebei Medical University, Shijiazhuang, China (Y.L.).
¹³Arrhythmia Center (C.M.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
¹⁴ACTION Study Group, Epidemiology and Clinic Research Unit, Lariboisière University Hospital, Paris, France (E.V.).
¹⁵Sorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (G.M.).

⁰Center for Coronary Artery Disease (Y.Y., X.W., W.G., S.N.), Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Circulation +

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2024年二月26日

在PubMed上查看摘要

概括

在ST段升高心肌梗塞的皮肤冠状动脉干预后,术后抗凝药 (PPA) 是安全的,但不会减少缺血事件. 这项研究发现PPA和安慰剂组之间的结果没有显著差异.

科学领域

心脏病学
干预心脏病学
临床试验

背景情况

在ST段升高心肌梗塞 (STEMI) 的初级穿皮冠状动脉干预 (PCI) 后,术后抗凝治疗 (PPA) 是常见的.
在接受初级PCI的STEMI患者中支持常规PPA的证据有限且不确.
RIGHT试验旨在澄清PPA在该患者群体中的作用.

研究的目的

确定手术后抗凝剂 (PPA) 在初级PCI后减少STEMI患者的缺血事件.
通过评估主要出血事件来评估PPA的安全性.
为了比较PPA组内的不同抗凝疗方案 (素,未分离的肝素,双素) 的疗效.

主要方法

一个多中心,随机,双盲,安慰剂控制的优势试验,涉及2989名接受初级PCI的STEMI患者.
患者被分配接受低剂量的PPA或相应的安慰剂至少48小时.
主要终点是所有原因的死亡,非致命性心脏病发作,中风,支架血栓形成或30天内急需的再血管. 安全性终点是出血学术研究联盟 (BARC) 3-5出血.

主要成果

主要疗效终点发生在PPA和安慰剂组的2. 5%的患者中 (HR,1. 00;95% CI,0. 63-1.57).
在PPA和安慰剂组之间,主要出血事件 (BARC 3- 5) 没有显著差异 (0. 5% vs 0. 7%;HR, 0. 74;95% CI, 0. 30-1. 83).
没有特定的PPA疗法在减少缺血事件方面表现出优越性.

结论

在STEMI患者进行初级PCI后进行常规的术后抗凝治疗是安全的.
与安慰剂相比,PPA没有显著降低30天缺血事件的风险.
在这种情况下,常规PPA的实践没有得到来自RIGHT试验的现有证据的支持.

关键词:

ST升高的心肌梗塞抗凝固剂通过皮肤进行冠状动脉干预

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