在轻度缺血性中风或TIA后服用DAPT的患者的LDL-C水平和出血风险
Aichun Cheng1,2, Jing Xue1,2, Anxin Wang1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
较低的LDL-C水平增加了DAPT患者的出血风险,特别是在Ticagrelor-阿司匹林. 仔细考虑LDL-C目标和DAPT对于管理这些风险至关重要.
科学领域:
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 双重抗血小板治疗 (DAPT) 是轻度缺血性中风 (MIS) 和高风险过渡性缺血性发作 (HRTIA) 的标准.
- 证据表明低密度脂蛋白胆固醇 (LDL-C) 水平与DAPT期间出血风险的联系是有限的.
- 了解这种关联对于优化患者管理至关重要.
研究的目的:
- 研究在接受DAPT的MIS或HRTIA患者的LDL-C基线水平和出血风险之间的关联.
- 为了比较不同DAPT疗法 (蒂卡格勒罗-阿司匹林与克洛皮多格雷尔-阿司匹林) 的出血风险,与LDL-C水平相关.
主要方法:
- 在中国进行的两项随机,双盲,安慰剂对照试验 (CHANCE和CHANCE-2) 的数据的综合分析.
- 包括7440名接受蒂卡格雷罗-阿司匹林或克洛皮多格雷尔-阿司匹林DAPT的患者.
- 评估90天内任何出血和严重/中度出血的结果,使用Cox比例危险模型.
主要成果:
- 较低的LDL-C水平 (<70 mg/dL) 与任何出血 (aHR: 1.48) 和严重/中度出血 (aHR: 2.78) 的风险增加有关.
- 提卡格雷勒-阿司匹林组显示出任何出血的风险增加,LDL-C较低 (aHR: 1.71).
- 在重度/中度出血的克洛皮多格瑞尔-阿司匹林组中,LDL-C水平和出血风险之间没有显著的关联.
结论:
- 较低的LDL-C水平与DAPT治疗中MIS/HRTIA患者出血风险更高有关.
- 这种关联在接受提卡格雷勒或阿司匹林治疗的患者中更为明显.
- 关于LDL-C目标和DAPT选择的临床决定需要仔细评估风险和益处.
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