现代化双抗血小板疗法在流量转移:在过渡到普拉苏格雷尔通用后的比较结果
Pratham B Bhatt1,2, Evan McNeil1,2, Aryan Wadhwa1,2
1Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Journal of neurointerventional surgery
|February 11, 2026
概括
与克洛皮多格勒和提卡格勒相比,普拉苏格勒的安全性和有效性与脑动脉瘤的流量转移 (FD) 治疗相似. 需要进一步的研究,以建立最佳的双抗血小板治疗 (DAPT) 协议,用于FD程序.
科学领域:
- 神经外科 神经外科
- 干预性神经辐射学
- 心脏病学 心脏病学
背景情况:
- 双抗血小板治疗 (DAPT) 对流量转移 (FD) 至关重要,但缺乏用于内使用的具体证据.
- 对克洛皮多格雷尔的可变反应需要替代的DAPT策略.
- 这项研究评估了基于普拉苏格勒的通用DAPT方法的结果.
研究的目的:
- 为了比较 klopidogrel,ticagrelor 和基于 prasugrel 的 DAPT 的安全性和有效性,在接受内FD 的患者中.
- 评估并发症率,动脉瘤闭塞和功能结果.
- 调查PED表面修改对再处理率的影响.
主要方法:
- 从2021年7月到2024年7月使用管道栓塞装置 (PED) 的243个FD程序的回顾性审查.
- 主要结局的分析:血栓栓塞/出血并发症,闭塞率和修改的兰金度量表 (mRS).
- 基于PED表面修饰和DAPT疗法 (克洛皮多格雷尔,蒂卡格雷尔,普拉苏格雷尔) 的二次分析.
主要成果:
- 97.8%的患者获得了有利的功能结果 (mRS ≤2) 无论DAPT治疗方案.
- 动脉瘤封闭率很高 (86.4%),在DAPT组中类似.
- 血栓塞栓 (4.1%) 或出血 (4.9%) 的并发症没有显著差异;然而,所有出血都发生在提卡格雷勒. 表面修饰PED的再处理率较低 (0.9%与8.3%相比).
结论:
- 基于prasugrel的DAPT是一种安全有效的内FD选择,与克洛皮多格雷尔和蒂卡格雷罗尔相当.
- 在FD中DAPT选择的证据中存在显著的差距.
- 迫切需要多中心注册表和前性试验,以标准化用于内FD的DAPT协议.
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