Natsuaki Masahiro, Kimura Takeshi
Department of Cardiovascular Medicine, Saga University Hospital.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Circ J. 2022 Apr 25;86(5):741-747. doi: 10.1253/circj.CJ-21-0751. Epub 2021 Sep 23.
Optimal antiplatelet therapy after percutaneous coronary intervention (PCI) has been changed in parallel with the improvements of coronary stent and antiplatelet therapy. Over the past 25 years, dual antiplatelet therapy (DAPT) with aspirin plus P2Yinhibitor has been the standard of care used after coronary stent implantation. First-generation drug-eluting stent (DES) appeared to increase the risk of late stent thrombosis, and duration of DAPT was prolonged to 12 months. DAPT duration up to 12 months was the dominant strategy after DES implantation in the subsequent >10 years, although there was no dedicated randomized controlled trial supporting this recommendation. The current recommendation of DAPT duration is getting shorter due to the development of new-generation DES, use of a P2Yinhibitor as a monotherapy, and the increasing prevalence of high-bleeding risk patients. Furthermore, an aspirin-free strategy is now emerging as one of the novel strategies of antiplatelet therapy after PCI. This review gives an overview of the history of antiplatelet therapy and provides current and future perspectives on antiplatelet therapy after PCI.
经皮冠状动脉介入治疗（PCI）后的最佳抗血小板治疗已随着冠状动脉支架和抗血小板治疗的改进而发生变化。在过去25年中，阿司匹林联合P2Y抑制剂的双联抗血小板治疗（DAPT）一直是冠状动脉支架植入术后的标准治疗方案。第一代药物洗脱支架（DES）似乎增加了晚期支架血栓形成的风险，DAPT疗程延长至12个月。尽管没有专门的随机对照试验支持这一建议，但在随后的10多年里，DAPT疗程长达12个月一直是DES植入后的主要策略。由于新一代DES的发展、P2Y抑制剂作为单一疗法的使用以及高出血风险患者的患病率增加，目前关于DAPT疗程的建议正变得越来越短。此外，无阿司匹林策略目前正作为PCI后抗血小板治疗的新策略之一出现。本综述概述了抗血小板治疗的历史，并提供了PCI后抗血小板治疗的当前和未来观点。
