Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients.
复制标题
抗凝患者冠状动脉支架放置后12个月的抗血小板策略的趋势。
DOI：
10.1186/s12872-023-03161-7
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发表时间：
2023-03-08
影响因子：
2.1
通讯作者：
Witt, Daniel M.
中科院分区：
文献类型：
--
作者：
Gamvroulas, Eleni M.;Jones, Aubrey E.;Saunders, John A.;Jones, Tara L.;Witt, Daniel M.
关键词：
接受经皮冠状动脉介入治疗（PCI）并需要抗凝药物治疗的患者的抗血栓指南正在发展。本研究描述了需要持续抗凝治疗的患者PCI术后12个月抗血栓治疗的变化和相关结局。手动审查从电子病历查询中识别的患者记录，以验证从出院到PCI后12个月和12个月时抗血栓治疗的变化，以及额外6个月随访期间的大出血、临床相关非大出血（CRNMB）、主要不良心血管或神经系统事件（MACNE）和全因死亡结局。根据抗血小板治疗状态，将PCI术后12个月接受抗凝治疗的患者（n = 120）分为以下组：无抗血小板治疗（n = 16）、单抗血小板治疗（SAPT）（n = 85）和双重抗血小板治疗（DAPT）（n = 19）。PCI后12- 18个月，发生2例大出血、7例CRNMB、6例MACNE、2例静脉血栓栓塞和5例死亡。除一例出血事件外，所有出血事件均发生在SAPT组。在因急性冠脉综合征接受PCI的患者中（比值比[OR] 2.91，95%置信区间[CI] 0.96，8.77），以及在PCI后12个月内发生MACNE的患者中（OR 1.95，95% CI 0.67，5.66），12个月时继续接受DAPT的几率较高，但这些相关性无统计学显著性。大多数抗凝患者在PCI后12个月继续接受抗血小板治疗。出血在持续SAPT治疗超过12个月的抗凝患者中在数值上更常见。PCI术后12个月的抗血栓处方模式存在显著差异，提示在该患者人群中进行标准化护理的潜在机会。
Antithrombotic guidelines for patients undergoing percutaneous coronary interventions (PCIs) and also requiring anticoagulant medications are evolving. This study describes changes to antithrombotic therapy and associated outcomes 12-months following PCI in patients requiring ongoing anticoagulation therapy. Records of patients identified from queries of electronic medical records were manually reviewed to verify changes to antithrombotic therapy from discharge to 12-months and at 12-months following PCI, and episodes of major bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an additional 6-months follow-up. Patients (n = 120) receiving anticoagulation therapy at 12-months post PCI were classified into the following groups according to antiplatelet therapy status: no antiplatelet therapy (n = 16), single antiplatelet therapy (SAPT) (n = 85), and dual antiplatelet therapy (DAPT) (n = 19). Between 12- and 18-months following PCI there were 2 major bleeds, 7 CRNMB, 6 MACNE, 2 venous thromboembolisms, and 5 deaths. All but one bleeding episode occurred in the SAPT group. The odds of remaining on DAPT at 12-months were higher in patients who had PCI for acute coronary syndrome (odds ratio [OR] 2.91, 95% confidence interval [CI] 0.96, 8.77), and in those experiencing MACNE in the 12-months following PCI (OR 1.95, 95% CI 0.67, 5.66), but these associations were not statistically significant. Most anticoagulated patients were continued on antiplatelet therapy 12-months post PCI. Bleeding was numerically more common in anticoagulated patients continuing SAPT therapy beyond 12 months. There was significant variability in antithrombotic prescribing patterns 12-months post PCI suggesting a potential opportunity for standardizing care in this patient population.
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