抗血栓药物处方的变化和评估延长皮多格雷尔治疗后的下肢再血管化为外周动脉疾病的评估
Nicholas Wells1, Dana Alameddine2, Uday Dhanda3
1Yale School of Medicine, New Haven, CT.
Journal of vascular surgery
|March 23, 2025
概括
在周围动脉疾病 (PAD) 患者的下肢再血管化 (LER) 后,延长克洛皮多格雷尔治疗与更好的生存率有关. 这种更长的克洛皮多格雷尔持续时间并没有增加出血风险,这表明在PAD管理中可能有好处.
科学领域:
- 血管外科 血管外科
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 对于周围动脉疾病 (PAD) 的下肢再血管化 (LER) 后的最佳抗血栓治疗持续时间仍未确定.
- 在处方抗血栓组合和持续时间方面存在显著的变异性,使研究和临床实践复杂化.
- 这项研究专门研究了皮多格雷尔治疗持续时间对LER后患者结果的影响.
研究的目的:
- 检查在PAD患者中LER后抗血栓药物处方的变异性.
- 评估延长 klopidogrel 治疗 (> 12 个月) 与患者结局之间的关联.
- 为了比较包括主要不良肢体事件 (MALEs),主要不良心脏事件 (MACEs) 和有限 (≤12个月) 和延长皮多格雷尔治疗组之间的死亡率在内的结果.
主要方法:
- 1954年接受LER的PAD患者电子病历的回顾性审查.
- 抽象所有药剂师在LER后的抗血栓药物处方.
- 对接受长期 (>12个月) 与有限 (≤12个月) 克洛皮多格雷尔治疗的患者之间的结局进行比较,重点关注MALE,MACE和死亡率.
主要成果:
- 克洛皮多格勒在69.8%的患者中使用,其中69.5%接受延长治疗.
- 延长 klopidogrel 治疗与显著更高的整体存活率,MALE 无存活率和 MACE 无存活率有关.
- 限定的克洛皮多格雷尔治疗独立地与增加的死亡率 (HR 1.93),死亡率或MALE (HR 1.32) 和死亡率或MACE (HR 1.39) 相关;没有观察到增加的出血风险.
结论:
- 在PAD的LER后的现实世界抗血栓治疗显示出相当大的处方变异性.
- 延长克洛皮多格雷尔治疗表明与改善存活率的关联,而不会增加出血风险.
- 未来的随机试验是必要的,以证实这些发现,由于观察性研究的局限性.
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