Internal Medicine "T", Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Internal Medicine "T", Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Cardiol. 2020 Sep 1;130:56-63. doi: 10.1016/j.amjcard.2020.06.016. Epub 2020 Jun 17.
In light of recent studies describing the antibacterial properties of ticagrelor, the association between treatment with ticagrelor and subsequent risk for infection following acute coronary syndrome (ACS) is taking on increased importance. A single center, retrospective, matched cohort analysis was performed. All patients older than 30 years of age admitted between January 1, 2013 and November 1, 2019 for an ACS and discharged with dual antiplatelet therapy (DAPT) were included. The primary outcome was defined as hospital admissions due to infections likely caused by gram-positive bacteria up to 1 year following the ACS hospitalization. The base cohort included 3,909 patients. About 2,035 (52.1%) were treated with ticagrelor and 1,874 (47.9%) with clopidogrel. Patients treated with ticagrelor had a 64% lower risk of gram-positive infection during the first year following hospitalization after adjusting for demographic and co-morbidity factors compared with those treated with clopidogrel (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.21 to 0.61; p <0.001). In a cohort starting from 1 year (conclusion of DAPT period) and up to 3 years following ACS hospitalization, the risk of gram-positive infection was comparable in both groups (HR, 0.70; 95% CI, 0.41 to 1.19; p = 0.182). Treatment with ticagrelor was not associated with a reduced risk of gram-negative infections (HR, 0.48; 95% CI, 0.21 to 1.06; p = 0.07). In conclusion, DAPT regimen that includes aspirin and ticagrelor is associated with reduced risk of gram-positive infection compared with the combination of aspirin and clopidogrel.
鉴于最近的研究描述了替格瑞洛的抗菌特性，替格瑞洛治疗与急性冠脉综合征（ACS）后感染风险之间的关联变得越来越重要。进行了一项单中心、回顾性、匹配队列分析。纳入 2013 年 1 月 1 日至 2019 年 11 月 1 日期间因 ACS 入院并接受双联抗血小板治疗（DAPT）出院的年龄大于 30 岁的所有患者。主要结局定义为 ACS 住院后 1 年内因可能由革兰阳性菌引起的感染而住院。基础队列包括 3909 例患者。约 2035 例（52.1%）接受替格瑞洛治疗，1874 例（47.9%）接受氯吡格雷治疗。在校正人口统计学和合并症因素后，与接受氯吡格雷治疗的患者相比，接受替格瑞洛治疗的患者在 ACS 住院后第一年发生革兰阳性感染的风险降低 64%（风险比 [HR]，0.36；95%置信区间 [CI]，0.21 至 0.61；p<0.001）。在从 ACS 住院后 1 年（DAPT 结束）开始至 3 年的队列中，两组的革兰阳性感染风险相当（HR，0.70；95%CI，0.41 至 1.19；p=0.182）。替格瑞洛治疗与革兰阴性感染风险降低无关（HR，0.48；95%CI，0.21 至 1.06；p=0.07）。总之，与阿司匹林和氯吡格雷联合治疗相比，包含阿司匹林和替格瑞洛的 DAPT 方案与革兰阳性感染风险降低相关。
