Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Abu Dhabi Campus, Abu Dhabi, United Arab Emirates.
Professor of Cardiology, Heart Centre, Medical School, University of Pecs, Pecs, Hungary.
Curr Rev Clin Exp Pharmacol. 2021;16(1):52-63. doi: 10.2174/1574884715666200518091359.
Despite the developments of single or dual antiplatelet therapy consisting of aspirin and/or clopidogrel, prasugrel or ticagrelor, post-acute coronary syndrome a room for potential improvement towards optimal prevention persist. The addition of a direct oral anticoagulant to the antiplatelet treatment of patients with the acute coronary syndrome is clinically practiced in cases where anticoagulation is indicated by high thromboembolic risk.
The main objective of this review was to explore the role of supplementation with a direct oral anticoagulant to antiplatelet (aspirin or P2Y12 inhibitor) in patients with the acute coronary syndrome.
We have searched the Medline for studies involving direct oral anticoagulant use in acute coronary syndrome. We have reviewed specific relevant 9 meta-analyses between the years 2012 to 2019.
Our review of nine meta-analyses has revealed that the addition of direct oral anticoagulant to antiplatelet therapy compared with antiplatelet alone was beneficial about the composite endpoints of major ischemic events in patients with the acute coronary syndrome. Furthermore, the combined regimen of single antiplatelet plus direct oral anticoagulant is as effective as the triple regimen of dual antiplatelet plus direct oral anticoagulant and results in less bleeding.
Cardiologists should balance the efficacy with a higher risk of bleeding with more intensified DOAC therapy. Better risk characterization and timely adaptation of the regime to the patient's need should be tested. Recurrent ischemic events and bleeding event risk scoring should guide individualized treatment.
尽管采用了由阿司匹林和/或氯吡格雷、普拉格雷或替格瑞洛组成的单药或双联抗血小板治疗，急性冠脉综合征（ACS）患者仍有进一步优化预防的空间。在高血栓栓塞风险需要抗凝的情况下，将直接口服抗凝剂（DOAC）添加到 ACS 患者的抗血小板治疗中已在临床上得到应用。
本综述的主要目的是探讨在急性冠脉综合征患者中补充直接口服抗凝剂（DOAC）以联合抗血小板（阿司匹林或 P2Y12 抑制剂）治疗的作用。
我们在 Medline 上检索了 DOAC 在急性冠脉综合征中的应用研究。我们复习了 2012 年至 2019 年之间的 9 项特定相关的荟萃分析。
我们对 9 项荟萃分析的回顾表明，与单独抗血小板治疗相比，抗血小板治疗联合 DOAC 治疗可使急性冠脉综合征患者的主要缺血事件复合终点获益。此外，与双联抗血小板加直接口服抗凝剂的三联治疗方案相比，单药抗血小板加直接口服抗凝剂的联合方案同样有效，且出血风险较低。
心脏病专家应权衡疗效与更高的出血风险，更强化的 DOAC 治疗。应进一步验证更好的风险特征评估以及及时根据患者的需求调整治疗方案。复发性缺血事件和出血事件风险评分应指导个体化治疗。
