Jones Davis, Nicolas Johny, Beerkens Frans, Satish Mohan, Feldman Daniel, Cao Davide, Spirito Alessando, Mehran Roxana
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY 10029-6574, US.
Cardiovascular Department, Humanitas Gavazzeni, 24125 Bergamo, Italy.
Rev Cardiovasc Med. 2022 Jun 1;23(6):207. doi: 10.31083/j.rcm2306207. eCollection 2022 Jun.
Historically, prevention from ischemic events with dual antiplatelet therapy (DAPT) post percutaneous coronary intervention (PCI) took precedence over protection from bleeding. However, increasing data suggest that major bleeding complications are as detrimental as ischemic events. Awareness about the prognostic impact of bleeding prompted the search for new strategies aimed at maximizing both ischemic and bleeding protection. This is noteworthy because patients at high bleeding risk (HBR) have generally been underrepresented in clinical trials on DAPT and they often are at increased risk of ischemic events as well. The present review discusses the evidence base for new pharmacotherapeutic strategies to decrease bleeding risk without compromising ischemic protection among HBR patients undergoing PCI, including shortening DAPT duration, early aspirin withdrawal, and inhibitor de-escalation.
从历史上看，经皮冠状动脉介入治疗（PCI）后使用双联抗血小板治疗（DAPT）预防缺血事件比预防出血更为重要。然而，越来越多的数据表明，主要出血并发症与缺血事件一样有害。对出血预后影响的认识促使人们寻找旨在最大化缺血和出血保护的新策略。这一点值得注意，因为高出血风险（HBR）患者在DAPT临床试验中的代表性普遍不足，而且他们发生缺血事件的风险通常也更高。本综述讨论了在接受PCI的HBR患者中，在不影响缺血保护的情况下降低出血风险的新药物治疗策略的证据基础，包括缩短DAPT疗程、早期停用阿司匹林以及抑制剂降阶梯治疗。
