Brigham and Women's Hospital, Boston, MA, USA.
Brigham and Women's Hospital, Boston, MA, USA.
Clin Ther. 2018 Nov;40(11):1907-1917.e3. doi: 10.1016/j.clinthera.2018.09.014. Epub 2018 Oct 24.
Combining antiplatelet and anticoagulant therapy is often necessary in clinical practice. However, there is limited literature on tolerability and efficacy for triple therapy with the newer direct oral anticoagulants (DOACs). The objective of this study is to characterize the discharge prescribing practice of double versus triple antithrombotic therapy with a DOAC at a large, tertiary academic medical center.
In this retrospective, cross-sectional, observational study, patients were identified if they had received any combination of a DOAC, aspirin, and a P2Y inhibitor during an admission at our institution from June 1, 2015, to May 31, 2016. Patients were included in the analysis if they had any indication for anticoagulation and antiplatelet therapies and were discharged from the hospital with prescriptions for a DOAC and single or dual antiplatelet agents (aspirin and/or P2Y inhibitor). Patients were excluded if they had an unclear indication for antiplatelet therapy. Patient characteristics and 6-month efficacy and tolerability outcomes were collected via review of the electronic medical record.
A total of 367 patients were included in this analysis. Most patients at our institution who required both antiplatelet and anticoagulant agents were discharged on a regimen of aspirin and a DOAC. Patients across all groups most commonly received antiplatelet therapy for coronary artery disease and acute coronary syndrome-related events, whereas they received anticoagulation for stroke prophylaxis in atrial fibrillation. Within 6 months of discharge, there were 16 bleeding-related readmissions in the DOAC-aspirin group, 1 in the DOAC-P2Y group, and 0 in the triple therapy group.
This analysis found that varying combinations of antiplatelet agents and anticoagulants are used, depending on clinical indications. Further studies are needed that focus on patients with indications for dual antiplatelet therapy and anticoagulation to compare double and triple therapy strategies for efficacy and bleeding risk.
在临床实践中，联合抗血小板和抗凝治疗通常是必要的。然而，关于新型直接口服抗凝剂（DOAC）三联治疗的耐受性和疗效的文献有限。本研究的目的是描述在一家大型三级学术医疗中心，使用 DOAC 时双联与三联抗血栓治疗的出院处方实践。
在这项回顾性、横断面、观察性研究中，如果患者在我院住院期间接受了任何一种 DOAC、阿司匹林和 P2Y 抑制剂的联合治疗，即符合入选条件。入选患者必须有抗凝和抗血小板治疗的指征，并在出院时处方 DOAC 以及单药或双联抗血小板药物（阿司匹林和/或 P2Y 抑制剂）。如果抗血小板治疗的指征不明确，则将患者排除在外。通过查阅电子病历收集患者特征以及 6 个月的疗效和耐受性结局。
共有 367 例患者纳入本分析。我们机构中需要同时使用抗血小板和抗凝药物的大多数患者出院时的治疗方案为阿司匹林和 DOAC。所有组别的患者最常因冠状动脉疾病和急性冠脉综合征相关事件接受抗血小板治疗，而因房颤接受抗凝治疗以预防卒中。出院后 6 个月内，DOAC-阿司匹林组有 16 例出血相关再入院，DOAC-P2Y 组有 1 例，三联治疗组无再入院。
本分析发现，根据临床指征，使用了不同的抗血小板药物和抗凝剂组合。需要进一步研究有双重抗血小板治疗和抗凝指征的患者，以比较双联和三联治疗策略的疗效和出血风险。
