2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease
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DOI：
10.1016/j.jacc.2016.03.513
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发表时间：
2016-09-06
影响因子：
24
通讯作者：
Hundley, Jody
中科院分区：
文献类型：
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作者：
Levine, Glenn N.;Bates, Eric R.;Hundley, Jody
本次重点更新的范围仅限于针对冠心病（CAD）患者双联抗血小板治疗（DAPT）（阿司匹林加P2 Y12抑制剂）持续时间的建议。考虑的建议包括6项指南：《2011年ACCF/AHA/SCAI经皮冠状动脉介入治疗指南》、9《2011年ACCF/AHA冠状动脉旁路移植术指南》、10《2012年ACCF/AHA/ACP/AATS/PCNA/SCAI/STS稳定性缺血性心脏病患者诊断和管理指南》、11、12《2013年ACC/AHA ST段抬高型心肌梗死管理指南》、13《2014年ACC/AHA非ST段抬高型急性冠状动脉综合征指南》、14和《2014年ACC/AHA非心脏手术患者围手术期心血管评价和管理指南》。15本次重点更新综述的推动力是11项研究16 -27，这些研究对接受冠状动脉支架植入术（主要是药物洗脱支架[DES]）治疗的患者进行了短期或长期DAPT评估，以及一项大型随机对照试验（RCT），该试验对心肌梗死（MI）后1至3年的患者进行了DAPT与阿司匹林单药治疗相比的疗效评估。28这些研究是在先前指南中制定DAPT持续时间建议后发表的。本编写小组的具体任务是评估、更新、协调并在可能时简化关于DAPT持续时间的建议。虽然有几种潜在的抗血小板治疗组合，但术语和首字母缩略词DAPT已用于专门指阿司匹林和P2 Y12受体抑制剂（氯吡格雷、普拉格雷或替格瑞洛）的抗血小板联合治疗，并将在本次重点更新中以类似方式使用。本次重点更新中关于DAPT持续时间、接受DAPT治疗的患者的阿司匹林剂量以及接受经皮冠状动脉介入治疗（PCI）和DAPT治疗的患者的择期非心脏手术时间的建议取代了6项相关指南中先前的相应建议。这些DAPT持续时间的建议适用于新一代支架，一般仅适用于未接受口服抗凝治疗的支架。出于本次重点更新的目的，急性冠状动脉综合征（ACS）病史> 1年且此后未复发ACS的患者被视为已转变为稳定型缺血性心脏病（SIHD），并在SIHD章节中进行了讨论。关于P2 Y12抑制剂“预处理"、“预加载”和加载的问题和建议超出了本文件的范围，但在其他指南中得到了解决。九、十四、二十九
The scope of this focused update is limited to addressing recommendations on duration of dual antiplatelet therapy (DAPT)(aspirin plus a P2Y12 inhibitor) in patients with coronary artery disease (CAD). Recommendations considered are those in 6 guidelines:“2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention”, 9 “2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery”, 10 “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease”, 11, 12 “2013 ACC/AHA Guideline for the Management of ST-Elevation Myocardial Infarction”, 13 “2014 ACC/AHA Guideline for Non–ST-Elevation Acute Coronary Syndromes”, 14 and “2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery”. 15 The impetus for this focused update review is 11 studies16–27 of patients treated with coronary stent implantation (predominantly with drug-eluting stents [DES]) assessing shorter-duration or longer-duration DAPT, as well as a large, randomized controlled trial (RCT) of patients 1 to 3 years after myocardial infarction (MI) assessing the efficacy of DAPT compared with aspirin monotherapy. 28 These studies were published after the formulation of recommendations for duration of DAPT in prior guidelines. The specific mandate of the present writing group is to evaluate, update, harmonize, and, when possible, simplify recommendations on duration of DAPT. Although there are several potential combinations of antiplatelet therapy, the term and acronym DAPT has been used to specifically refer to combination antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, or ticagrelor) and will be used similarly in this focused update. Recommendations in this focused update on duration of DAPT, aspirin dosing in patients treated with DAPT, and timing of elective noncardiac surgery in patients treated with percutaneous coronary intervention (PCI) and DAPT supersede prior corresponding recommendations in the 6 relevant guidelines. These recommendations for duration of DAPT apply to newer-generation stents and, in general, only to those not treated with oral anticoagulant therapy. For the purposes of this focused update, patients with a history of acute coronary syndrome (ACS)> 1 year prior who have since remained free of recurrent ACS are considered to have transitioned to stable ischemic heart disease (SIHD) and are addressed in the section on SIHD. Issues and recommendations with regard to P2Y12 inhibitor “pretreatment,”“preloading,” and loading are beyond the scope of this document but are addressed in other guidelines. 9, 14, 29