Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
JACC Cardiovasc Interv. 2022 Apr 25;15(8):797-806. doi: 10.1016/j.jcin.2022.01.300.
The purpose of this study was to assess the extent to which the association between premature dual antiplatelet therapy (DAPT) discontinuation and excess risk of thrombotic events varies according to the reason and timing of DAPT discontinuation and whether high on-treatment platelet reactivity (HPR) influences the risk of thrombotic events after premature DAPT discontinuation.
DAPT after percutaneous coronary intervention (PCI) suppresses platelet reactivity, and HPR on clopidogrel after PCI is associated with an increased risk of thrombotic events.
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of 8,582 patients successfully treated with coronary drug-eluting stents that assessed HPR on clopidogrel. For patients who discontinued aspirin or clopidogrel at any time during the study, the reasons for discontinuation were systematically categorized.
Planned DAPT discontinuation occurred within 2 years in 3,203 (37.3%) patients. One thousand four hundred eighteen (16.5%) patients discontinued DAPT for unplanned reasons, including surgery or trauma (n = 768 [8.9%]), patient nonadherence (n = 321 [3.7%]), bleeding complications (n = 264 [3.1%]), and drug allergy or hypersensitivity (n = 113 [1.3%]). Unplanned but not planned DAPT discontinuation was associated with an increased risk of a major adverse cardiac event (MACE, defined as the composite of cardiac death, myocardial infarction, or stent thrombosis); with highest risk within 3 months after PCI (adjusted HR: 7.65, 95% CI: 2.77-21.10 vs adjusted HR: 2.47, 95% CI: 1.70-3.58 for unplanned DAPT discontinuation ≥3 weeks after PCI). MACE risk after DAPT discontinuation was not moderated by HPR (P = 0.91).
In this large-scale all-comers registry, premature DAPT discontinuation for unplanned reasons occurred in approximately 1 of 6 patients after DES implantation and was associated with a markedly increased risk of MACEs. (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents [ADAPT-DES]; NCT00638794).
本研究旨在评估过早双重抗血小板治疗（DAPT）停药与血栓形成事件风险增加之间的关联程度，这种关联取决于停药的原因和时间，以及高血小板反应性（HPR）是否会影响过早 DAPT 停药后血栓形成事件的风险。
经皮冠状动脉介入治疗（PCI）后的 DAPT 抑制血小板反应性，PCI 后氯吡格雷的 HPR 与血栓形成事件风险增加相关。
ADAPT-DES（药物洗脱支架双重抗血小板治疗评估）是一项前瞻性、多中心登记研究，共纳入 8582 例成功接受冠状动脉药物洗脱支架治疗的患者，评估氯吡格雷的 HPR。对于研究期间任何时候停用阿司匹林或氯吡格雷的患者，系统分类停药原因。
3203 例（37.3%）患者在 2 年内计划停用 DAPT。1418 例（16.5%）患者因非计划原因停用 DAPT，包括手术或外伤（n=768[8.9%]）、患者不遵医嘱（n=321[3.7%]）、出血并发症（n=264[3.1%]）和药物过敏或超敏反应（n=113[1.3%]）。无计划但非计划的 DAPT 停药与主要不良心脏事件（MACE，定义为心脏死亡、心肌梗死或支架血栓形成的复合事件）风险增加相关；PCI 后 3 个月内风险最高（调整后的 HR：7.65，95%CI：2.77-21.10 vs 调整后的 HR：2.47，95%CI：1.70-3.58，无计划 DAPT 停药>PCI 后 3 周）。DAPT 停药后 MACE 风险不受 HPR 调节（P=0.91）。
在这项大规模的所有患者登记研究中，DES 植入后约 1/6 的患者因非计划原因过早停用 DAPT，与 MACEs 的风险显著增加相关。（药物洗脱支架双重抗血小板治疗评估[ADAPT-DES]；NCT00638794）。
