接受经皮冠状动脉介入治疗的心肌梗死患者抗血小板治疗的降阶梯治疗：当前文献综述
De-Escalation of Antiplatelet Treatment in Patients with Myocardial Infarction Who Underwent Percutaneous Coronary Intervention: A Review of the Current Literature.
作者信息
Claassens Daniel Mf, Sibbing Dirk
机构信息
Department of cardiology, St. Antonius hospital, 3435CM Nieuwegein, The Netherlands.
Privatklinik Lauterbacher Mühle am Ostersee, 82402 Iffeldorf, Germany.
出版信息
J Clin Med. 2020 Sep 15;9(9):2983. doi: 10.3390/jcm9092983.
Abstract
In acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), treatment with the P2Y inhibitors ticagrelor or prasugrel is recommended over clopidogrel due to a better efficacy, albeit having more bleeding complication. These higher bleeding rates have provoked trials investigating de-escalation from ticagrelor or prasugrel to clopidogrel in the hope of reducing bleeding without increasing thrombotic event rates. In this review, we sought to present an overview of the major trials investigating several different options for de-escalation; unguided, platelet function testing- and genotype-guided. Based on these results, and on other established literature sources, such as guidelines and expert consensus papers, we provide an overview to help decide when and how to de-escalate antiplatelet therapy in ACS patients undergoing PCI.
摘要
在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，推荐使用P2Y抑制剂替格瑞洛或普拉格雷进行治疗，而非氯吡格雷，因为前者疗效更佳，尽管出血并发症更多。这些较高的出血率引发了一些试验，研究从替格瑞洛或普拉格雷降级为氯吡格雷，以期在不增加血栓形成事件发生率的情况下减少出血。在本综述中，我们试图概述主要试验，这些试验研究了几种不同的降级选择：无指导、血小板功能检测指导和基因分型指导。基于这些结果以及其他既定的文献来源，如指南和专家共识文件，我们提供一个概述，以帮助确定何时以及如何对接受PCI的ACS患者进行抗血小板治疗的降级。
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