Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Department of Nutritional Sciences, Pennsylvania State University, State College, PA, United States of America.
Thromb Res. 2021 Feb;198:115-121. doi: 10.1016/j.thromres.2020.11.038. Epub 2020 Dec 7.
Long-term dual antiplatelet therapy (DAPT) has substantially reduced the risk of post-percutaneous coronary intervention (PCI) myocardial infarction and stent thrombosis at the expense of major bleeding. We hypothesized that a short-term DAPT followed by extended P2Y inhibitor monotherapy might be appropriate for patients with both high ischemic and bleeding risks.
We searched the databases: Pubmed, EMBASE, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov to identify randomized trials assessing the antiplatelet strategies after PCI. The primary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The efficacy outcome was a composite of all-cause mortality/cardiovascular disease (CVD) death, myocardial infarction, or stroke. A random-effect model was used to calculate the pooled hazard ratios (HRs) with 95% confidence intervals (CIs).
We identified 5 randomized trials comparing P2Y inhibitor monotherapy with standard DAPT (12 months) (16,057 versus 16,088). P2Y inhibitor monotherapy following short-term DAPT (1 to 3 months) significantly reduced the risk of BARC type 3 or 5 bleeding compared to standard DAPT (pooled HR: 0.63, 95%CI: 0.46-0.86). The difference between P2Y inhibitor monotherapy and standard DAPT in reducing the composite CVD outcomes was not statistically significant (HR: 0.88, 95%CI: 0.77-1.01).
P2Y inhibitor monotherapy might be an effective strategy for lowering severe bleeding complications and simultaneously preserving the ischemic benefit in patients receiving PCI.
长期双联抗血小板治疗（DAPT）显著降低了经皮冠状动脉介入治疗（PCI）后心肌梗死和支架血栓形成的风险，但代价是大出血风险增加。我们假设，对于同时存在高缺血和出血风险的患者，短期 DAPT 后延长 P2Y 抑制剂单药治疗可能是合适的。
我们检索了 Pubmed、EMBASE、Cochrane 中央对照试验注册库和 ClinicalTrials.gov 数据库，以确定评估 PCI 后抗血小板策略的随机试验。主要安全性终点是出血学术研究联合会（BARC）3 型或 5 型出血。疗效终点是全因死亡率/心血管疾病（CVD）死亡、心肌梗死或中风的复合事件。使用随机效应模型计算合并的危险比（HR）及其 95%置信区间（CI）。
我们确定了 5 项比较 P2Y 抑制剂单药治疗与标准 DAPT（12 个月）的随机试验（16057 例与 16088 例）。与标准 DAPT 相比，短期 DAPT（1-3 个月）后 P2Y 抑制剂单药治疗显著降低了 BARC 3 型或 5 型出血的风险（合并 HR：0.63，95%CI：0.46-0.86）。P2Y 抑制剂单药治疗与标准 DAPT 在降低复合 CVD 结局方面的差异无统计学意义（HR：0.88，95%CI：0.77-1.01）。
P2Y 抑制剂单药治疗可能是一种有效的策略，可以降低接受 PCI 治疗的患者严重出血并发症的风险，同时保留缺血获益。
