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在急性冠状动脉综合征中降低双重抗血小板治疗的升级到蒂卡格勒单一疗法:随机临床试验的系统审查和个人患者数据元分析
Yong-Joon Lee1, Xiaofei Gao2, Sang-Hyup Lee1
1Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.-J.L., S.-H.L., S.-J.L., S.-J.H., C.-M.A., J.-S.K., B.-K.K., Y.-G.K., D.C., M.-K.H.).
过渡急性冠状动脉综合征患者从双抗血小板治疗到药物释放支架后的蒂卡格勒罗单疗法显著减少出血事件,而不会增加缺血风险. 这种降级策略提供了更安全的治疗选择.
科学领域:
- 心脏病学 心脏病学
- 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:
- 在急性冠状动脉综合征 (ACS) 中,在药物排泄支架 (DES) 植入后,双重抗血小板治疗 (DAPT) 是标准的.
- 对DAPT的最佳持续时间和降级策略仍在调查中.
- 过渡到P2Y12抑制剂单疗是一种潜在的降级方法.
研究的目的:
- 在接受DES植入的ACS患者中,比较降级DAPT与蒂卡格勒单一疗法的疗效和安全性与标准DAPT.
- 在随机临床试验的元分析中评估缺血和出血的结果.
主要方法:
- 在PubMed,EMBASE,Scopus和ClinicalTrials.gov.gov进行了系统的文献搜索.
- 包括随机的临床试验比较了Ticagrelor单一疗法与基于Ticagrelor的标准DAPT在ACS患者中进行12个月的DES.
- 共同初级终点是缺血性事件 (死亡,心肌梗塞,中风) 和严重出血 (BARC类型3或5).
主要成果:
- 分析了来自3项试验 (TICO,T-PASS,ULTIMATE-DAPT) 9130名患者的数据.
- 单独使用蒂卡格雷勒治疗显示出非显著的趋势,导致缺血事件减少 (1.7%对2.1%;HR 0.85).
- 与标准DAPT (0.8%对2.5%;HR 0.30) 相比,单独使用蒂卡格勒治疗显著减少了主要出血事件.
结论:
- 在患有DES的ACS患者中,将DAPT降级为蒂卡格勒单疗法与较低的重大出血风险有关.
- 这种策略不会增加缺血事件的风险.
- 单独使用蒂卡格勒治疗是ACS亚型中安全有效的降级选择.
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