PERFUSE Study Group, Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
PERFUSE Study Group, Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Prog Cardiovasc Dis. 2018 Jan-Feb;60(4-5):524-530. doi: 10.1016/j.pcad.2018.01.008. Epub 2018 Feb 3.
Dual antiplatelet therapy (DAPT) has been the cornerstone of antithrombotic management for patients undergoing percutaneous coronary intervention (PCI). However, approximately 10% of these patients have concomitant atrial fibrillation (AF) and require chronic oral anticoagulant (OAC) in addition to DAPT. This traditional "triple therapy" has been associated with a three to four-fold increased risk of bleeding. The safety of non-vitamin K OAC (NOAC)-based strategies, using a NOAC plus a P2Y inhibitor, has been compared to vitamin K antagonist (VKA)-based triple therapy in the PIONEER AF-PCI and REDUAL PCI randomized trials, both of which have demonstrated that NOAC-based strategies are safer and provide an attractive alternative to VKA-based triple therapy among AF patients who undergo PCI. This article reviews the rationale, evidence, and recent evaluation of triple antithrombotic therapy among AF patients undergoing PCI.
双重抗血小板治疗（DAPT）一直是经皮冠状动脉介入治疗（PCI）患者抗血栓治疗的基石。然而，这些患者中约有 10%同时患有心房颤动（AF），除了 DAPT 之外，还需要长期口服抗凝剂（OAC）。这种传统的“三联疗法”与出血风险增加三到四倍相关。非维生素 K 口服抗凝剂（NOAC）为基础的策略的安全性，使用 NOAC 加 P2Y 抑制剂，已经在 PIONEER AF-PCI 和 REDUAL PCI 随机试验中与维生素 K 拮抗剂（VKA）为基础的三联疗法进行了比较，这两项试验都表明，NOAC 为基础的策略在安全性方面更具优势，为接受 PCI 的 AF 患者提供了一种有吸引力的替代 VKA 为基础的三联疗法。本文综述了 AF 患者接受 PCI 时三联抗血栓治疗的原理、证据和最新评估。
