在急性冠状动脉综合征 (ULTIMATE- DAPT) 患者的皮肤冠状动脉干预后的第1至第12个月,单独使用蒂卡格勒勒或加上阿司匹林:随机对照的双盲临床试验
在PubMed上查看摘要
概括
此摘要是机器生成的。在经皮冠状动脉干预治疗急性冠状动脉综合征后,双重抗血小板治疗可以安全地减少到单一治疗. 这种方法可以减少出血事件而不会增加重大心血管或脑血管事件 (MACCE).
科学领域
- 心脏病学
- 临床试验
- 药理学
背景情况
- 在经皮冠状动脉干预 (PCI) 后,国际指南建议在急性冠状动脉综合征 (ACS) 后进行12个月的双重抗血小板治疗 (DAPT).
- 对于ACS治疗后使用P2Y12抑制剂的单抗血小板治疗 (SAPT) 的早期降级,存在有限的数据.
- 这项研究评估了Ticagrelor单一治疗与初始DAPT后Ticagrelor加阿司匹林.
研究的目的
- 与提卡格勒尔加阿司匹林相比,评估单独使用提卡格勒尔是否可以减少临床相关的出血.
- 为了确定单独治疗的Ticagrelor是否与Ticagrelor和阿司匹林相比,在重大心血管或脑血管不良事件 (MACCE) 方面没有劣势.
- 评估ACS早期的SAPT降级后的安全性和有效性.
主要方法
- 随机化,安慰剂对照的双盲临床试验,涉及ACSPCI后的患者.
- 患者接受1个月的DAPT治疗,然后随机分配给提卡格勒尔加阿司匹林或提卡格勒尔加安慰剂11个月.
- 主要终点是临床相关出血的优势 (BARC类型2,3或5) 和MACCE的非劣势.
主要成果
- 单独治疗时发生的临床相关出血率为2. 1%,加上阿司匹林治疗时为4. 6% (HR为0. 45;p< 0. 0001).
- 单独治疗时发生的重大心血管或脑血管不良事件 (MACCE) 是3. 6%;单独治疗时发生的3. 7% (HR 0. 98;p<sub>non- inferiority</ sub>< 0. 0001).
- 在单一治疗中,蒂卡格勒在减少出血方面表现优越,在预防缺血事件方面表现不劣.
结论
- 在PCI治疗ACS后1个月,单一治疗Ticagrelor与双重治疗相比显著减少出血事件.
- 单一治疗是一种安全有效的策略,保持与双重治疗相似的心血管保护.
- 在PCI后选择的ACS患者可以考虑停用阿司匹林和维持单一治疗.
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