行经皮冠状动脉介入治疗的心房颤动患者的抗栓治疗优化
Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.
作者信息
Gragnano Felice, Capolongo Antonio, Micari Antonio, Costa Francesco, Garcia-Ruiz Victoria, De Sio Vincenzo, Terracciano Fabrizia, Cesaro Arturo, Moscarella Elisabetta, Coletta Silvio, Raucci Pasquale, Fimiani Fabio, De Luca Leonardo, Gargiulo Giuseppe, Andò Giuseppe, Calabrò Paolo
机构信息
Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy.
Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale "Sant'Anna e San Sebastiano", 81100 Caserta, Italy.
出版信息
J Clin Med. 2023 Dec 23;13(1):98. doi: 10.3390/jcm13010098.
The antithrombotic management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) poses numerous challenges. Triple antithrombotic therapy (TAT), which combines dual antiplatelet therapy (DAPT) with oral anticoagulation (OAC), provides anti-ischemic protection but increases the risk of bleeding. Therefore, TAT is generally limited to a short phase (1 week) after PCI, followed by aspirin withdrawal and continuation of 6-12 months of dual antithrombotic therapy (DAT), comprising OAC plus clopidogrel, followed by OAC alone. This pharmacological approach has been shown to mitigate bleeding risk while preserving adequate anti-ischemic efficacy. However, the decision-making process remains complex in elderly patients and those with co-morbidities, significantly influencing ischemic and bleeding risk. In this review, we discuss the available evidence in this area from randomized clinical trials and meta-analyses for post-procedural antithrombotic therapies in patients with non-valvular AF undergoing PCI.
接受经皮冠状动脉介入治疗(PCI)的心房颤动(AF)患者的抗栓治疗面临诸多挑战。三联抗栓治疗(TAT)将双联抗血小板治疗(DAPT)与口服抗凝治疗(OAC)相结合,可提供抗缺血保护,但会增加出血风险。因此,TAT一般仅限于PCI术后的短时期(1周),随后停用阿司匹林并继续6 - 12个月的双联抗栓治疗(DAT),即OAC加氯吡格雷,之后仅使用OAC。这种药物治疗方法已被证明可降低出血风险,同时保持足够的抗缺血疗效。然而,在老年患者和合并症患者中,决策过程仍然复杂,这显著影响缺血和出血风险。在本综述中,我们讨论了来自随机临床试验和荟萃分析的关于接受PCI的非瓣膜性AF患者术后抗栓治疗这一领域的现有证据。
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