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在当代实践中使用P2Y₁₂抑制剂进行预治疗:我们站在哪里?

Mandeep Singh¹, Marco Valgimigli²

¹Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, USA.

Mayo Clinic proceedings

|May 3, 2025

概括

用P2Y12抑制剂预治疗急性冠状动脉综合征 (ACS) 患者可能会带来缺血性益处,但证据仍在争论中,特别是在高危人群中. 本综述审查了在ACS管理中使用P2Y12抑制剂预治疗的理由和风险.

科学领域:

心脏病学心脏病学
药理学药理学是指药理学的学科.
干预心脏病学干预心脏病学

背景情况:

在急性冠状动脉综合征 (ACS) 中抗血小板策略的管理正在发展.
在ACS中使用P2Y12抑制剂的预治疗显示了先前的缺血性益处,但当代试验有限.
患者人口统计学正在向具有较高血栓和缺血风险的老年人转移.

研究的目的:

审查有关在ACS患者中使用P2Y12抑制剂预治疗的益处和风险的现有文献.
在不断发展的ACS管理和指导方针的背景下,综合P2Y12抑制剂预治疗的理由.

主要方法:

1980年至2023年间发表的文章的文献综述.
搜索的数据库:PubMed,MEDLINE,EMBASE,以及科克兰图书馆.
关键词:P2Y12抑制剂 (克罗皮多格雷尔,蒂卡格雷尔,普拉苏格雷尔),预治疗,皮肤冠状动脉干预,冠状动脉旁路移植手术.

主要成果:

缺乏大型当代随机试验,支持在ACS中进行常规P2Y12抑制剂预治疗.
关于P2Y12抑制剂预治疗时间的美国和欧洲指南的矛盾.
对患有高出血风险或需要紧急手术的患者来说,考虑预治疗是很重要的.

结论:

由于ACS呈现的异质性和不断变化的治疗策略,需要对P2Y12抑制剂预治疗进行审查.
需要进一步的研究来澄清ACS.中P2Y12抑制剂预治疗的最佳时间和患者选择.

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