Thomas Alexander, Gitto Mauro, Shah Samit, Saito Yuichi, Tirziu Daniela, Chieffo Alaide, Stefanini Giulio G, Lansky Alexandra J
Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy.
J Soc Cardiovasc Angiogr Interv. 2023 Mar 6;2(3):100607. doi: 10.1016/j.jscai.2023.100607. eCollection 2023 May-Jun.
Dual antiplatelet therapy (DAPT) has been paramount in preventing thrombosis following percutaneous coronary intervention for nearly 3 decades. However, over the years, DAPT has seen significant changes in the agents utilized and duration of therapy as trials have raced to keep up with advancements made in stent technology and our understanding of bleeding and ischemic risk. Recently, there have been a number of trials demonstrating significant reductions in bleeding events with shorter DAPT durations, which are not yet reflected in practice guidelines. Further, there has been a shift toward more individualized antiplatelet regimens to meet patient-specific risk profiles. This review provides a comprehensive summary of the major trials that have informed current DAPT strategies, puts into context recent trials driving a shift toward more tailored antiplatelet regimens, and highlights gaps in knowledge that remain and the ongoing trials designed to address them.
近30年来,双联抗血小板治疗(DAPT)在经皮冠状动脉介入治疗后预防血栓形成方面一直至关重要。然而,多年来,随着试验竞相跟上支架技术的进步以及我们对出血和缺血风险的认识,DAPT在所用药物和治疗持续时间方面发生了重大变化。最近,有多项试验表明,缩短DAPT持续时间可显著减少出血事件,但这尚未反映在实践指南中。此外,已转向更个体化的抗血小板治疗方案,以满足患者特定的风险特征。本综述全面总结了为当前DAPT策略提供依据的主要试验,结合近期推动向更具针对性的抗血小板治疗方案转变的试验进行阐述,并强调了仍然存在的知识空白以及为解决这些问题而正在进行的试验。