Vardi Moshe, Debidda Marcella, Bhatt Deepak L, Mauri Laura, Cannon Christopher P
Clin Cardiol. 2014 Feb;37(2):103-7. doi: 10.1002/clc.22226.
Many patients treated with oral anticoagulants for atrial fibrillation undergo percutaneous stent implantation, where dual antiplatelet therapy (DAPT) is also recommended. The current evidence to support triple oral antithrombotic therapy (TOAT) in these patients is limited, and new strategies are being discussed to optimize outcomes.
There will be variation in antithrombotic strategies in patients with atrial fibrillation needing stenting.
We surveyed US-based cardiologists serving as clinical investigators in academic sites and posted an online "question of the month" on cardiosource.org.
Seventy-five (10.7%) responses were received to the email survey and 119 to the online question. Bare-metal stenting (BMS) was a priori preferred over drug-eluting stenting (DES) for 50.6% of patients. Only 8.8% of the responders chose newer anticoagulants in addition to DAPT as the preferred oral anticoagulant. For duration of TOAT, 79.4% of physicians recommended stopping DAPT at 1 month when BMS was used in patients presenting without acute coronary syndrome (ACS) vs 57.4% in patients with ACS. In patients implanted with a DES, 73.5% and 76.5% preferred stopping DAPT at 6 to 12 months (no ACS vs ACS, respectively). When asked which of the 2 antiplatelet agents they would recommend stopping after the above durations, 50% chose to quit aspirin.
The survey highlights an interest in the new strategy of dropping aspirin, but the lack of concrete evidence triggers undesired diversity in clinical approaches. High-quality data on the efficacy and safety of such interventions are needed to further consolidate these approaches.
许多接受口服抗凝剂治疗心房颤动的患者会接受经皮支架植入术，在此情况下也推荐双联抗血小板治疗（DAPT）。目前支持这些患者采用三联口服抗栓治疗（TOAT）的证据有限，并且正在讨论新的策略以优化治疗效果。
需要进行支架植入的心房颤动患者的抗栓策略会存在差异。
我们对在美国学术机构担任临床研究人员的心脏病专家进行了调查，并在cardiosource.org网站上发布了“月度问题”。
电子邮件调查收到了75份（10.7%）回复，在线问题收到了119份回复。对于50.6%的患者，裸金属支架置入术（BMS）在一开始就比药物洗脱支架置入术（DES）更受青睐。只有8.8%的受访者选择在DAPT基础上联合使用新型抗凝剂作为首选口服抗凝剂。对于TOAT的持续时间，79.4%的医生建议在无急性冠状动脉综合征（ACS）的患者使用BMS时，在1个月时停用DAPT，而在有ACS的患者中这一比例为57.4%。在植入DES的患者中，73.5%和76.5%的医生分别倾向于在6至12个月时停用DAPT（无ACS与有ACS的情况）。当被问及在上述时间段后会建议停用哪一种抗血小板药物时，50%的人选择停用阿司匹林。
该调查凸显了对停用阿司匹林这一新策略的关注，但缺乏确凿证据导致临床方法出现不必要的多样性。需要关于此类干预措施有效性和安全性的高质量数据，以进一步整合这些方法。
