Singh Balbir, Prabhakar D, Shah Jay, R Keshava, Sinha Nakul, Kerkar Prafulla, Kumar Sahoo Prasant, Kumar Premchand Jain Rajendra, Chandra Subhash, Ray Shuvanan, Sarda Shital
Max Healthcare, 1, 2, Press Enclave Marg, Saket Institutional Area, Hauz Rani, Saket, New Delhi, Delhi 110017, India.
Ashwin Clinic, A G Block Old No 25 New 53, Shanthi Main Road, Anna Nagar, Chennai, Tamil Nadu 600040, India.
Int J Cardiol Heart Vasc. 2024 Oct 20;55:101526. doi: 10.1016/j.ijcha.2024.101526. eCollection 2024 Dec.
Atherosclerotic plaque formation is a leading cause of arterial thrombosis that significantly impacts global health by instigating major adverse cardiovascular events (MACE) like myocardial infarction (MI) and stroke. Platelets are central to this process, leading to the development of antiplatelet therapies, to mitigate MACE risks. The combination of aspirin with a potent P2Y inhibitor known as dual antiplatelet therapy (DAPT) is the standard for post-percutaneous coronary intervention (PCI) aimed at reducing ischemic events. However, DAPT's associated bleeding risks, particularly in high bleeding risk (HBR) patients, require a balanced approach to optimize therapeutic outcomes. Recent advancements have led to the exploration of ticagrelor monotherapy as a promising strategy after short-term DAPT to reduce bleeding risks while preserving ischemic protection. This review manuscript focuses on ticagrelor monotherapy for HBR patients with discussion on optimal timing, patient selection, and treatment duration. It highlights ticagrelor's broad efficacy in diverse patient sub-groups and outlines its superiority over aspirin (ASA) and clopidogrel monotherapies. Trials such as TICO, TWILIGHT, GLOBAL LEADERS, and ULTIMATE-DAPT as well as literature -analyses validate ticagrelor monotherapy's role in lowering mortality and clinical adverse events versus conventional DAPT. The review endorses a personalized treatment regimen, beginning with DAPT before moving to ticagrelor monotherapy, as a balanced method for managing both bleeding and ischemic risks in post-PCI acute coronary syndrome (ACS) patients, especially those facing higher bleeding threats.
动脉粥样硬化斑块形成是动脉血栓形成的主要原因，通过引发心肌梗死（MI）和中风等主要不良心血管事件（MACE），对全球健康产生重大影响。血小板在这一过程中起着核心作用，促使了抗血小板治疗的发展，以降低MACE风险。阿司匹林与一种强效P2Y抑制剂联合使用的双重抗血小板治疗（DAPT）是经皮冠状动脉介入治疗（PCI）后旨在减少缺血事件的标准治疗方法。然而，DAPT相关的出血风险，尤其是在高出血风险（HBR）患者中，需要采取平衡的方法来优化治疗效果。最近的进展促使人们探索替格瑞洛单药治疗，作为短期DAPT后一种有前景的策略，以降低出血风险同时保留缺血保护作用。这篇综述文章聚焦于HBR患者的替格瑞洛单药治疗，讨论了最佳时机、患者选择和治疗持续时间。它强调了替格瑞洛在不同患者亚组中的广泛疗效，并概述了其优于阿司匹林（ASA）和氯吡格雷单药治疗的优势。TICO、TWILIGHT、GLOBAL LEADERS和ULTIMATE-DAPT等试验以及文献分析证实了替格瑞洛单药治疗相对于传统DAPT在降低死亡率和临床不良事件方面的作用。该综述支持一种个性化治疗方案，即在PCI后急性冠状动脉综合征（ACS）患者，尤其是那些面临较高出血威胁的患者中，先采用DAPT，然后过渡到替格瑞洛单药治疗，作为平衡管理出血和缺血风险的方法。
