3rd Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland.
Department of Cardiovascular Disease Prevention, Medical University of Silesia, Bytom, Poland.
Kardiol Pol. 2022;80(10):974-989. doi: 10.33963/KP.a2022.0198. Epub 2022 Aug 29.
This review is a summary of the European Society of Cardiology (ESC) guidelines focused on dual antiplatelet therapy in patients after percutaneous coronary interventions (PCI). Given a large number of recommendations concerning antiplatelet therapy published in various ESC guidelines, the main goal of this paper was to compile these separate recommendations into one document. In addition, we set out to present the current state of knowledge and create an algorithm that would be based on all of these guidelines in hope that it would allow quick navigation when selecting the type and duration of dual antiplatelet therapy (DAPT) depending on the clinical scenario with a special emphasis on evaluating both ischemic and bleeding risks. The review is based on the ESC guidelines on the diagnosis and management of chronic coronary syndromes (2019), revascularization (2018), acute myocardial infarction in patients presenting with ST-segment elevation myocardial infarction (STEMI) (2017), DAPT (2017), and acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTE-ACS) (2020). The review also provides brief information on the most important studies and meta-analyses in this area, as well as practical pointers for management in the case of bleeding complications and before urgent surgery in patients on DAPT.
这篇综述总结了欧洲心脏病学会 (ESC) 关于经皮冠状动脉介入治疗 (PCI) 后双联抗血小板治疗的指南。鉴于 ESC 指南中发表了许多关于抗血小板治疗的建议,本文的主要目标是将这些单独的建议汇编成一份文件。此外,我们还旨在介绍当前的知识状况,并创建一个算法,该算法将基于所有这些指南,希望在根据临床情况选择双联抗血小板治疗 (DAPT) 的类型和持续时间时能够快速导航,特别强调评估缺血和出血风险。该综述基于 ESC 关于慢性冠状动脉综合征的诊断和管理 (2019)、血运重建 (2018)、ST 段抬高型心肌梗死患者的急性心肌梗死 (STEMI) (2017)、DAPT (2017) 和无持续 ST 段抬高的急性冠状动脉综合征 (NSTE-ACS) (2020) 指南。该综述还简要介绍了该领域的一些重要研究和荟萃分析,以及在 DAPT 患者发生出血并发症和紧急手术前的管理实用建议。