Saito Yuichi, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan.
Yale School of Medicine, USA.
Intern Med. 2020 Feb 1;59(3):311-321. doi: 10.2169/internalmedicine.3685-19. Epub 2019 Oct 7.
Percutaneous coronary intervention (PCI) has become a standard-of-care procedure in the setting of angina or acute coronary syndrome. Antithrombotic therapy is the cornerstone of pharmacological treatment aimed at preventing ischemic events following PCI. Dual antiplatelet therapy as the combination of aspirin and P2Y inhibitor has been proven to decrease stent-related thrombotic risks. However, the optimal duration of dual antiplatelet therapy, an appropriate P2Y inhibitor, and the choice of aspirin versus P2Y inhibitor as single antiplatelet therapy remain controversial. Furthermore, the combined use of oral anticoagulation in addition to antiplatelet therapy is a complex issue in clinical practice, such as in patients with atrial fibrillation. The key challenge concerning the optimal antithrombotic regimen is ensuring a balance between protection against thrombotic events and against excessive increases in bleeding risk. In this review article, we summarize the current evidence concerning antithrombotic therapy in patients with coronary artery disease undergoing PCI.
经皮冠状动脉介入治疗（PCI）已成为心绞痛或急性冠状动脉综合征情况下的标准治疗程序。抗栓治疗是旨在预防PCI后缺血事件的药物治疗的基石。阿司匹林与P2Y抑制剂联合使用的双重抗血小板治疗已被证明可降低支架相关血栓形成风险。然而，双重抗血小板治疗的最佳持续时间、合适的P2Y抑制剂以及作为单一抗血小板治疗时阿司匹林与P2Y抑制剂的选择仍存在争议。此外，除抗血小板治疗外联合使用口服抗凝药在临床实践中是一个复杂的问题，例如在房颤患者中。关于最佳抗栓方案的关键挑战是确保在预防血栓形成事件和防止出血风险过度增加之间取得平衡。在这篇综述文章中，我们总结了目前关于接受PCI的冠心病患者抗栓治疗的证据。
