Shlofmitz Evan, Shlofmitz Richard, Lee Michael S
MedStar Washington Hospital Center, Washington, D.C., USA.
St. Francis Hospital, The Heart Center, Roslyn, NY, USA.
Korean Circ J. 2019 Aug;49(8):645-656. doi: 10.4070/kcj.2019.0185. Epub 2019 Jul 2.
The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the tradeoff is an increased risk for bleeding while on DAPT. The addition of a novel oral anticoagulant (NOAC) further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on NOAC must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Patients on NOAC undergoing PCI should undergo routine assessment with intravascular imaging as the role of high-risk lesion-related features have increased importance prior to determining optimal duration of treatment with DAPT. We review the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.
需要额外口服抗凝治疗的接受经皮冠状动脉介入治疗（PCI）的患者数量一直在增加。双联抗血小板治疗（DAPT）与PCI后包括支架血栓形成、心肌梗死和中风在内的缺血事件减少相关。然而，权衡之处在于接受DAPT时出血风险增加。添加新型口服抗凝剂（NOAC）会进一步增加抗血小板治疗时出血的可能性。因此，必须评估每位接受NOAC的PCI患者的总体风险和益处，并使治疗个体化，以确保针对每种独特情况进行最佳治疗。接受NOAC的PCI患者应接受血管内成像的常规评估，因为在确定DAPT的最佳治疗持续时间之前，高危病变相关特征的作用变得更加重要。我们回顾了接受PCI治疗且需要抗血小板治疗的使用NOAC进行抗凝治疗患者的药物管理最佳实践。
