Pelliccia Francesco, Gragnano Felice, Pasceri Vincenzo, Cesaro Arturo, Zimarino Marco, Calabrò Paolo
Department of Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, 00166 Rome, Italy.
Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale 'Sant'Anna e San Sebastiano', 81100 Caserta, Italy.
J Clin Med. 2022 Jun 21;11(13):3574. doi: 10.3390/jcm11133574.
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y receptor inhibitor in patients undergoing percutaneous coronary intervention (PCI) reduces the risk of ischemic events but reduces the risk of ischemic events but increases the risk of bleeding, which in turn is associated with increased morbidity and mortality. With the aim to offer personalized treatment regimens to patients undergoing PCI, much effort has been devoted in the last decade to improve the identification of patients at increased risk of bleeding complications. Several clinical scores have been developed and validated in large populations of patients with coronary artery disease (CAD) and are currently recommended by guidelines to evaluate bleeding risk and individualize the type and duration of antithrombotic therapy after PCI. In clinical practice, these risk scores are conventionally computed at the time of PCI using baseline features and risk factors. Yet, bleeding risk is dynamic and can change over time after PCI, since patients can worsen or improve their clinical status and accumulate comorbidities. Indeed, evidence now exists that the estimated risk of bleeding after PCI can change over time. This concept is relevant, as the inappropriate estimation of bleeding risk, either at the time of revascularization or subsequent follow-up visits, might lead to erroneous therapeutic management. Serial evaluation and recalculation of bleeding risk scores during follow-up can be important in clinical practice to improve the identification of patients at higher risk of bleeding while on DAPT after PCI.
对于接受经皮冠状动脉介入治疗（PCI）的患者，使用阿司匹林和P2Y受体抑制剂进行双重抗血小板治疗（DAPT）可降低缺血事件的风险，但会增加出血风险，而出血又与发病率和死亡率的增加相关。为了为接受PCI的患者提供个性化治疗方案，在过去十年中人们付出了很多努力来改进对出血并发症风险增加患者的识别。已经开发了几种临床评分并在大量冠状动脉疾病（CAD）患者中进行了验证，目前指南推荐使用这些评分来评估出血风险并使PCI后抗栓治疗的类型和持续时间个体化。在临床实践中，这些风险评分通常在PCI时根据基线特征和危险因素进行计算。然而，出血风险是动态的，在PCI后可能会随时间变化，因为患者的临床状况可能会恶化或改善，并且会出现更多合并症。事实上，现在有证据表明PCI后估计的出血风险会随时间变化。这一概念很重要，因为在血运重建时或后续随访中对出血风险的不恰当估计可能会导致错误的治疗管理。在随访期间对出血风险评分进行连续评估和重新计算在临床实践中可能很重要，有助于更好地识别PCI后接受DAPT时出血风险较高的患者。
