高出血风险患者的双重抗血小板治疗持续时间和支架类型:系统性审查和网络分析
Tetsuya Saito1, Toshiki Kuno2, Tomohiro Fujisaki3
1Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
American heart journal
|October 7, 2024
概括
对于高出血风险 (HBR) 的患者,使用耐用聚合物药物排泄支架 (DP-DES) 进行短期双重抗血小板治疗 (DAPT) 提供了预防心血管事件和减少出血的最佳平衡. 这种方法对于接受穿皮冠状动脉干预的HBR患者来说更安全,更有效.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 双重抗血小板治疗 (DAPT) 持续时间和支架类型对高出血风险 (HBR) 患者的影响.
- 对于接受皮肤冠状动脉干预 (PCI) 的HBR患者的最佳DAPT策略存在不确定性.
研究的目的:
- 为了确定适合HBR患者的支架类型和DAPT持续时间.
- 在HBR患者中比较不同DAPT持续时间和支架类型的疗效和安全性.
主要方法:
- 13项随机对照试验 (RCT) 的网络元分析,涉及19418名HBR患者.
- 在PubMed和EMBASE搜索到2023年10月的RCT,将标准DAPT (6-12个月) 与使用各种支架类型 (DP-DES,BP-DES,PF-DCS,BMS) 的短DAPT (≤3个月) 进行比较.
- 主要结局:主要不良心血管事件 (MACE) 和主要出血. 二次结局:心肌梗塞 (MI) 和支架血栓 (ST).
主要成果:
- 使用裸金属支架 (BMS) 的简短DAPT与使用耐用聚合物药物排泄支架 (DP-DES) 的标准DAPT相比,增加了MACE和MI风险.
- 与标准DAPT相比,简短DAPT策略显著降低了大出血风险 (例如,使用DP-DES的简短DAPT与使用DP-DES的标准DAPT相比;HR:0.48 [95%CI:0.28-0.82]).
- 生物降解聚合物DES (BP-DES) 的使用与比DP-DES更高的支架血栓形成风险有关.
结论:
- 建议HBR患者使用DP-DES进行简短的DAPT策略.
- 这一策略在接受PCI的HBR患者中提供了心血管疗效和安全之间的最佳平衡.
- 使用DP-DES的简短DAPT可最大限度地降低出血风险,同时保持对MACE和MI的充分保护.
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