Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
J Cardiovasc Transl Res. 2021 Aug;14(4):790-798. doi: 10.1007/s12265-020-10094-5. Epub 2021 Jan 8.
Antithrombotic drug use for acute coronary syndromes (ACS) varies considerably. The number of antithrombotic drugs (excluding oral anticoagulants) used pre- and in-hospital was recorded in ACS survivors enrolled at hospital discharge in the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry ( NCT01171404 ), a prospective cohort study. Among 10,568 patients, the number of antithrombotic drugs used early/patient ranged from 0 to 8 (interquartile range = 3-4). Overall, 250 patients (2.4%) experienced ≥ 1 in-hospital ischemic event and 343 (3.2%) ≥ 1 non-fatal bleeding event. While there was no difference in the rate of ischemic events (p = 0.75 for-trend) according to the number of antithrombotic drugs, a significantly higher incidence of non-fatal bleeds was observed (p < 0.0001 for-trend), with OR = 1.68 (95%CI = 1.51-1.88) per additional antithrombotic drug, which remained after adjustment by patient characteristics. In conclusion, careful balancing of the short-term risks for ischemic and bleeding events should be considered when adding new antithrombotic drugs.
抗血栓药物在急性冠脉综合征（ACS）中的应用存在较大差异。在长期随访抗血栓治疗模式下，急性冠脉综合征患者（EPICOR）登记研究（NCT01171404）中，记录了出院时 ACS 幸存者住院前和住院期间使用的抗血栓药物（不包括口服抗凝剂）数量。在 10568 名患者中，早期/患者使用的抗血栓药物数量从 0 到 8 不等（四分位间距=3-4）。总体而言，250 名患者（2.4%）发生≥1 例院内缺血事件，343 名患者（3.2%）发生≥1 例非致命性出血事件。虽然根据抗血栓药物的数量，缺血事件的发生率没有差异（p=0.75 趋势），但观察到非致命性出血的发生率显著增加（p<0.0001 趋势），每增加一种抗血栓药物，OR=1.68（95%CI=1.51-1.88），调整患者特征后仍然如此。总之，在添加新的抗血栓药物时，应仔细权衡短期缺血和出血事件的风险。
