Zhou Xuan, Angiolillo Dominick J, Ortega-Paz Luis
Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
Department of Internal Medicine, University of Alabama at Birmingham Montgomery, Montgomery, AL 36116, USA.
J Cardiovasc Dev Dis. 2022 Oct 6;9(10):340. doi: 10.3390/jcdd9100340.
In patients with acute and chronic coronary artery disease undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) has been the cornerstone of pharmacotherapy for the past two decades. Although its antithrombotic benefit is well established, DAPT is associated with an increased risk of bleeding, which is independently associated with poor prognosis. The improvement of the safety profiles of drug-eluting stents has been critical in investigating and implementing shorter DAPT regimens. The introduction into clinical practice of newer generation oral P2Y inhibitors such as prasugrel and ticagrelor, which provide more potent and predictable platelet inhibition, has questioned the paradigm of standard DAPT durations after coronary stenting. Over the last five years, several trials have assessed the safety and efficacy of P2Y inhibitor monotherapy after a short course of DAPT in patients treated with PCI. Moreover, ongoing studies are testing the role of P2Y inhibitor monotherapy immediately after PCI in selected patients. In this review, we provide up-to-date evidence on the efficacy and safety of P2Y inhibitor monotherapy after a short period of DAPT compared to DAPT in patients undergoing PCI as well as outcomes associated with P2Y inhibitor monotherapy compared to aspirin for long-term prevention.
在接受经皮冠状动脉介入治疗（PCI）的急性和慢性冠状动脉疾病患者中，双联抗血小板治疗（DAPT）在过去二十年一直是药物治疗的基石。尽管其抗血栓形成益处已得到充分证实，但DAPT与出血风险增加相关，而出血又与不良预后独立相关。药物洗脱支架安全性的改善对于研究和实施更短疗程的DAPT方案至关重要。新一代口服P2Y抑制剂如普拉格雷和替格瑞洛引入临床实践，它们能提供更强效和可预测的血小板抑制作用，这对冠状动脉支架置入术后标准DAPT疗程的模式提出了质疑。在过去五年中，多项试验评估了PCI治疗患者在短疗程DAPT后使用P2Y抑制剂单药治疗的安全性和有效性。此外，正在进行的研究正在测试P2Y抑制剂单药治疗在PCI后立即用于特定患者的作用。在本综述中，我们提供了最新证据，对比了PCI患者在短疗程DAPT后使用P2Y抑制剂单药治疗与DAPT的疗效和安全性，以及P2Y抑制剂单药治疗与阿司匹林用于长期预防的相关结局。
