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药物洗脱支架经皮冠状动脉介入治疗后双联抗血小板治疗的持续时间:我们能缩短到多短?

Dual antiplatelet therapy duration after percutaneous coronary intervention with drug-eluting stents: how short can we go?

机构信息

Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

出版信息

Minerva Cardioangiol. 2020 Oct;68(5):436-450. doi: 10.23736/S0026-4725.20.05196-8. Epub 2020 Sep 29.

DOI:10.23736/S0026-4725.20.05196-8
PMID:32989963
Abstract

Current guidelines recommend a duration of dual antiplatelet therapy (DAPT) with aspirin and oral P2Y12 receptor inhibitors following percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) of 6 months for most patients with stable coronary disease and of 12 months for most patients with acute coronary syndromes. Large evidence from randomised clinical trials of shorter DAPT regimens after PCI with newer-generation DES is now emerging in heterogenous patient population not selected on the basis of high bleeding risk as well as in patients at high bleeding risk. The scope of this review is to provide an update on the benefits and harms of these short DAPT regimens and to discuss future directions in DAPT strategies after PCI with newer generation DES.

摘要

目前的指南建议,对于大多数稳定性冠心病患者,在接受第二代药物洗脱支架(DES)经皮冠状动脉介入治疗(PCI)后,使用阿司匹林和口服 P2Y12受体抑制剂进行双联抗血小板治疗(DAPT)的时间为 6 个月;对于大多数急性冠脉综合征患者,DAPT 的时间为 12 个月。现在,越来越多的来自随机临床试验的新证据表明,在非高出血风险患者以及高出血风险患者中,新一代 DES 支架 PCI 后采用更短的 DAPT 方案具有优势。本综述的目的是提供新一代 DES 支架 PCI 后这些短程 DAPT 方案的获益和危害的最新信息,并讨论 DAPT 策略的未来方向。

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