Department of Cardiology, Xijing Hospital, Changle West Road 127, Xi'an 710032, China.
Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.
Eur Heart J Cardiovasc Pharmacother. 2021 Nov 3;7(6):547-556. doi: 10.1093/ehjcvp/pvab035.
Historically, aspirin has been the primary treatment for the prevention of ischaemic events in patients with coronary artery disease. For patients undergoing percutaneous coronary intervention (PCI) standard treatment has been 12 months of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, followed by aspirin monotherapy; however, DAPT is undeniably associated with an increased risk of bleeding. For over a decade novel P2Y12 inhibitors, which have increased specificity, potency, and efficacy have been available, prompting studies which have tested whether these newer agents can be used in aspirin-free antiplatelet regimens to augment clinical benefits in patients post-PCI. Among these studies, the GLOBAL LEADERS trial is the largest by cohort size, and so far has provided a wealth of evidence in a variety of clinical settings and patient groups. This article summarizes the state-of-the-art evidence obtained from the GLOBAL LEADERS and other trials of aspirin-free strategies.
从历史上看，阿司匹林一直是预防冠心病患者发生缺血事件的主要治疗方法。对于接受经皮冠状动脉介入治疗（PCI）的患者，标准治疗是使用阿司匹林和氯吡格雷进行 12 个月的双联抗血小板治疗（DAPT），然后使用阿司匹林单药治疗；然而，DAPT 确实会增加出血风险。十多年来，新型 P2Y12 抑制剂的特异性、效力和疗效都有所提高，促使研究人员测试这些新型药物是否可以用于无阿司匹林的抗血小板治疗方案，以增加 PCI 后患者的临床获益。在这些研究中，GLOBAL LEADERS 试验是队列规模最大的试验，迄今为止在各种临床环境和患者群体中提供了丰富的证据。本文总结了来自 GLOBAL LEADERS 试验和其他无阿司匹林策略试验的最新证据。
