皮肤冠状动脉干预后老年人较短的双重抗血小板治疗:系统性审查和网络元分析
Dae Yong Park1, Jiun-Ruey Hu2, Yasser Jamil3
1Department of Medicine, Cook County Health, Chicago, Illinois.
JAMA network open
|March 28, 2024
概括
在老年人皮肤冠状动脉干预 (PCI) 后,双重抗血小板治疗 (DAPT) 的较短持续时间可以降低出血风险,而不会增加缺血事件. 对于这个人群,可以考虑使用缩写的DAPT.
科学领域:
- 心脏病学 心脏病学
- 老年医学 老年医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 接受皮革冠状动脉干预 (PCI) 的老年人面临缺血和出血事件的风险增加,这使双重抗血小板治疗 (DAPT) 的最佳持续时间复杂化.
- 在这个人口群体中,关于理想的DAPT持续时间存在不确定性,平衡了预防血栓事件的需要和不良出血结果的风险.
研究的目的:
- 为了研究与PCI后老年人中缩短的DAPT持续时间相关的临床结果.
- 为了确定较短的DAPT疗程是否会增加老年患者不良临床事件的风险.
- 为老年人提供基于证据的关于PCI后DAPT持续时间的指导.
主要方法:
- 随机临床试验的系统审查和元分析,比较1,3,6和12个月的DAPT.
- 纳入标准集中在65岁或以上或75岁或以上的成年人报告结果的试验上.
- 数据提取和质量评估遵循PRISMA指南;风险比率计算为不同的DAPT持续时间.
主要成果:
- 在1,3,6和12个月的DAPT中,没有观察到净不良临床事件 (NACE) 或主要不良心血管事件 (MACE) 的显著差异.
- 与6个月 (RR,0.50) 和12个月 (RR,0.57) 持续时间相比,3个月的DAPT持续时间与出血风险明显降低.
- 与六个月的DAPT相比,一个月的DAPT也显示出降低了出血风险 (RR,0.68).
结论:
- 在PCI后,老年人中缩短的DAPT持续时间与降低出血风险有关,而不会同时增加MACE或NACE.
- 这一网络元分析表明,临床医生可以考虑缩短老年患者的DAPT持续时间,即使是那些有复杂冠状动脉解剖或并发症的患者.
- 这些发现支持老年人个性化DAPT策略,以减轻出血并发症,同时保持心血管保护.
相关概念视频
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
522
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...
522
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
173
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
173
Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
162
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
162
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
Anticoagulant Drugs: Low-Molecular-Weight Heparins
690
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
690
Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
153
Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
153


