服用口服抗凝药的慢性冠状动脉综合征患者的阿司匹林
Gilles Lemesle1,2,3,4, Romain Didier5,6,7, Philippe Gabriel Steg4,8,9,10
1Heart and Lung Institute, University Hospital of Lille, Centre Hospitalier Universitaire (CHU) Lille, Lille, France.
The New England journal of medicine
|September 1, 2025
概括
在高危慢性冠状动脉综合征患者的口服抗凝药中添加阿司匹林会增加死亡和严重出血的风险. 由于安全问题,不建议使用这种联合疗法.
科学领域:
- 心脏病学
- 药理学
- 临床试验
背景情况:
- 长期服用口服抗凝药 (OAC) 的慢性冠状动脉综合征 (CCS) 患者的最佳抗凝药策略尚未确定.
- 在这种患者群体中,先前植入支架是常见的.
研究的目的:
- 评估高风险CCS患者添加阿司匹林的疗效和安全性.
- 确定这种特定患者群体的最佳抗血栓治疗方案.
主要方法:
- 进行了一项多中心,双盲,随机,安慰剂对照试验.
- 872名患有CCS,先前植入支架,高动脉血栓风险和长期OAC的患者被随机 (1:1) 分给阿司匹林 (100 mg/ 天) 或安慰剂,继续OAC.
- 主要疗效结论:结合心血管死亡,心脏病发作,中风,血栓塞,再血管或急性肢体缺血. 关键安全结果:严重出血.
主要成果:
- 由于阿司匹林组所有原因的死亡率过高,该试验被提前停止.
- 在阿司匹林组 (16. 9%) 和安慰剂组 (12. 1%) 中,主要疗效结局事件发生的频率更高.
- 随着阿司匹林的添加,所有原因的死亡率 (13. 4% vs. 8. 4%) 和严重出血率 (10. 2% vs.
结论:
- 在高风险的CCS患者中,添加阿司匹林可显著增加主要心血管不良事件,全因死亡和严重出血的风险.
- 这些发现表明,由于风险/ 益处概况不利,阿司匹林不应在该患者群中添加到OAC中.
- 可能需要进一步的研究来探索替代的抗血栓策略.
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