Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk.
Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk.
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DOI：
10.1097/hco.0000000000001075
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发表时间：
2023-11-01
影响因子：
2.3
通讯作者：
中科院分区：
文献类型：
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回顾高危出血(HBR)患者经皮冠状动脉介入治疗(PCI)后不同抗血栓策略的临床结果。经皮冠状动脉介入治疗后发生HBR的患者包括高龄患者(例如，75岁)、有大出血、贫血、慢性肾脏疾病病史的患者，以及有长期抗凝指征的患者。在这一人群中，成功降低出血风险的策略包括缩短双重抗血小板治疗(DAPT；1-3个月)，然后用阿司匹林或P2Y12抑制剂进行单一抗血小板治疗，或从更有效的P2Y12抑制剂(普拉格雷或替卡格雷)降级为效力较低的抗血小板方案(阿司匹林加氯吡格雷或半剂量替卡格雷或半剂量普拉格雷)。接受DAPT和其他适应症的全剂量抗凝治疗的患者，当快速从DAPT转向使用阿司匹林或氯吡格雷的单一抗血小板治疗(在介入治疗后一周内)时，发生大出血的风险较低，而不会增加1-2年的不良缺血事件。缺乏有关这些策略的益处和风险的更长期数据。对于经皮冠状动脉介入治疗后出现HBR的患者，较短的DAPT持续时间(1-3个月)可降低大出血的风险，而不会增加不良缺血事件的风险。
Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI). Patients with HBR after PCI include those with advanced age (e.g. >75 years of age), a prior history of major bleeding, anemia, chronic kidney disease, and those with indications for long-term anticoagulation. Strategies that successfully decrease bleeding risk in this population include shorter durations of dual antiplatelet therapy (DAPT; of 1–3 months) followed by single antiplatelet therapy with aspirin or a P2Y12 inhibitor, or de-escalating from a more potent P2Y12 inhibitor (prasugrel or ticagrelor) to less potent antiplatelet regimens (aspirin with clopidogrel or half-dose ticagrelor or half-dose prasugrel). Patients on DAPT, and a full dose anticoagulation for other indications, have a lower risk of major bleeding without an increase in 1–2-year adverse ischemic events, when rapidly switched from DAPT to a single antiplatelet therapy (within a week after PCI) with aspirin or clopidogrel. Longer term data on the benefits and risks of these strategies is lacking. In patients with HBR after PCI, shorter durations of DAPT (1–3 months) decrease the risk of major bleeding without increasing the risk of adverse ischemic events.