Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Expert Rev Cardiovasc Ther. 2022 Aug;20(8):637-645. doi: 10.1080/14779072.2022.2104248. Epub 2022 Aug 2.
P2Y-inhibitor monotherapy following 1-3 months of dual antiplatelet therapy (DAPT) reduces (major) bleeding without an apparent increase in ischemic events and has therefore emerged as an alternative to 6-12 months of DAPT following percutaneous coronary intervention (PCI). However, there are important differences between the available P2Y-inhibitors (clopidogrel, prasugrel, and ticagrelor) as agents of choice for P2Y-inhibitor monotherapy.
This review critically appraises the evidence for P2Y-inhibitor monotherapy after PCI using either clopidogrel, prasugrel, or ticagrelor. Furthermore, we discuss ongoing trials and future directions for research.
P2Y-inhibitor monotherapy following 1-3 months of DAPT is an alternative to 6-12 months of DAPT following PCI. Ticagrelor may be considered the current preferred option due to its reliable effect on platelet reactivity and its predominant use in clinical trials. Prasugrel could serve as a useful substitute for those not tolerating ticagrelor, but more research into prasugrel monotherapy is warranted. Alternatively, clopidogrel can be used, although there are concerns of high platelet reactivity, especially when genotyping and/or platelet function testing are not used. Future research will need to address the minimal duration of DAPT before switching to P2Y-inhibitor monotherapy and what the optimal antithrombotic therapy beyond 12 months is.
在双联抗血小板治疗（DAPT）1-3 个月后，使用 P2Y 抑制剂单药治疗可降低（主要）出血风险，而不会明显增加缺血事件，因此已成为经皮冠状动脉介入治疗（PCI）后 6-12 个月 DAPT 的替代方案。然而，在选择用于 P2Y 抑制剂单药治疗的药物（氯吡格雷、普拉格雷和替格瑞洛）之间存在重要差异。
本综述批判性地评估了使用氯吡格雷、普拉格雷或替格瑞洛进行 PCI 后 1-3 个月 DAPT 后进行 P2Y 抑制剂单药治疗的证据。此外，我们还讨论了正在进行的试验和未来的研究方向。
在 DAPT 1-3 个月后，使用 P2Y 抑制剂单药治疗是 PCI 后 6-12 个月 DAPT 的替代方案。替格瑞洛可能因其对血小板反应性的可靠作用及其在临床试验中的主要应用而被认为是目前的首选方案。普拉格雷可以作为不耐受替格瑞洛患者的有用替代药物，但需要更多的研究来评估普拉格雷单药治疗。或者，可以使用氯吡格雷，但在不进行基因分型和/或血小板功能检测的情况下，存在血小板反应性高的问题，特别是在不进行基因分型和/或血小板功能检测的情况下。未来的研究需要解决在切换至 P2Y 抑制剂单药治疗之前 DAPT 的最短持续时间以及 12 个月后最佳抗血栓治疗方案是什么的问题。
