Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA.
Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
EuroIntervention. 2022 Apr 1;17(17):e1371-e1396. doi: 10.4244/EIJ-D-21-00904.
Antiplatelet therapy is key to reducing local thrombotic complications and systemic ischaemic events among patients undergoing percutaneous coronary interventions (PCI), but it is inevitably associated with increased bleeding. The continuous refinement in stent technologies, together with the high incidence of ischaemic recurrences after PCI and the understanding of prognostic implications associated with bleeding, have led to a substantial evolution in antiplatelet treatment regimens over the past decades. Numerous investigations have been conducted to better stratify patients undergoing PCI according to their ischaemic and bleeding risks and to implement antithrombotic regimens accordingly. Evidence from these investigations have resulted in a number of antithrombotic treatment options as recommended by recent guidelines. In this State-of-the-Art review we provide the rationale, summarise the evidence, and discuss current and future directions of antiplatelet treatment regimens after PCI.
抗血小板治疗是减少经皮冠状动脉介入治疗(PCI)患者局部血栓并发症和全身缺血事件的关键,但不可避免地会增加出血风险。支架技术的不断改进,加上 PCI 后缺血复发的高发生率以及对与出血相关的预后影响的理解,导致过去几十年中抗血小板治疗方案发生了重大变化。已经进行了许多研究,以便根据缺血和出血风险对接受 PCI 的患者进行更好的分层,并相应地实施抗血栓形成方案。这些研究的证据导致了一些抗血栓治疗选择,最近的指南也推荐了这些选择。在这篇最新综述中,我们提供了抗血小板治疗方案的基本原理、总结了证据,并讨论了 PCI 后的抗血小板治疗方案的当前和未来方向。