根据出血风险 (HOST-BR) 进行皮肤冠状动脉干预后的双重抗血小板治疗:一个开放的,多中心的,随机的临床试验
Jeehoon Kang1, Kyung Woo Park1, Jung-Kyu Han1
1Seoul National University Hospital, Seoul, South Korea; Seoul National University College of Medicine, Seoul, South Korea.
Lancet (London, England)
|February 3, 2026
概括
对于高出血风险的患者,在支架后1个月的双重抗血小板治疗 (DAPT) 并非低于3个月的DAPT. 对于非高出血风险患者,3个月的DAPT与12个月的DAPT不劣,降低了出血.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 冠状动脉支架后双重抗血小板治疗 (DAPT) 的最佳持续时间因出血风险而异.
- 建立基于证据的DAPT持续时间对于患者的治疗结果至关重要.
研究的目的:
- 为了评估冠状动脉支架后DAPT的最佳持续时间,按患者出血风险分层.
- 在高出血风险 (HBR) 和非高出血风险 (非HBR) 人群中比较短期与长期DAPT疗法.
主要方法:
- 一个开放的,多中心的随机临床试验,涉及4897名通过皮肤进行冠状动脉干预的患者,使用药物排泄支架.
- 患者被分为HBR或非HBR群体. HBR患者接受1个月与3个月的DAPT;非HBR患者接受3个月与12个月的DAPT.
- 副原始终点包括净不良临床事件,主要不良心脏或大脑事件以及1年后可采取行动的出血.
主要成果:
- 在HBR组中,1个月的DAPT与3个月的DAPT相比,没有达到净不良临床事件的非劣势.
- 在非HBR组中,3个月的DAPT对净不良临床事件和主要不良心脏或大脑事件来说不低于12个月的DAPT.
- 与12个月疗程相比,非HBR组的3个月DAPT疗程在减少出血事件方面表现出优越性.
结论:
- 一个月的DAPT对于在冠状动脉支架后高出血风险的东亚患者是不够的.
- 对于没有高出血风险的患者来说,为期3个月的DAPT治疗有效且比12个月的治疗更安全.
- 这些发现指导基于个体出血风险概况的个性化DAPT策略.
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