Sammut Mark A, Rahman Mohammed E F, Bridge Claire, Hanson Jessica, Judge Heather, Lynch Bethany, Maz Emily, McMellon Hannah, Middle Janet, Williamson Georgia, Parker William A E, Lee Justin, Storey Robert F
Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
NIHR Sheffield Biomedical Research Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK and.
Platelets. 2025 Dec;36(1):2507037. doi: 10.1080/09537104.2025.2507037. Epub 2025 May 23.
Dual antithrombotic therapy (DAT) without aspirin reduces bleeding compared with triple antithrombotic therapy (TAT) in patients with atrial fibrillation who have undergone percutaneous coronary intervention, without apparently increasing ischemic events. A prospective pharmacodynamic study was performed to investigate the impact of aspirin on bleeding time, platelet function and fibrin clot analysis in this population. Patients receiving TAT ( = 16), comprising aspirin, ticagrelor/prasugrel and a direct-acting oral anticoagulant (DOAC), were compared with those receiving DAT without aspirin ( = 18). Bleeding time was reduced with DAT compared with TAT (median 27.8 vs 30.0 minutes, = .005). Assessed by light transmission aggregometry, median platelet aggregation was significantly increased with DAT compared with TAT in response to arachidonic acid (63 vs 3%, = .002) and collagen (72 vs 37%, < .001) but not 5-μmol/L adenosine diphosphate (25 vs 27%, = .966) or thrombin-receptor-activating peptide (37 vs 24%, = .086). VerifyNow P2Y assay showed > 70% inhibition in all patients. Fibrin clot lysis time and maximum turbidity were similar between groups. Using P2Y inhibitors of consistent potency, DAT improves hemostasis through sparing cyclooxygenase-1-mediated platelet activation but has a comparable effect to TAT on other pathways and fibrin clot properties. DAT with ticagrelor/prasugrel and DOAC may provide sufficient antithrombotic effect without excessive anti-hemostatic effect.
在接受经皮冠状动脉介入治疗的心房颤动患者中，与三联抗栓治疗（TAT）相比，不使用阿司匹林的双联抗栓治疗（DAT）可减少出血，且未明显增加缺血事件。进行了一项前瞻性药效学研究，以调查阿司匹林对该人群出血时间、血小板功能和纤维蛋白凝块分析的影响。将接受TAT（n = 16）（包括阿司匹林、替格瑞洛/普拉格雷和直接口服抗凝剂（DOAC））的患者与接受不使用阿司匹林的 DAT（n = 18）的患者进行比较。与TAT相比，DAT可缩短出血时间（中位数27.8分钟对30.0分钟，P = 0.005）。通过光透射聚集法评估，与TAT相比，DAT对花生四烯酸（63%对3%，P = 0.002）和胶原（72%对37%，P < 0.001）的反应中，血小板聚集中位数显著增加，但对5 μmol/L二磷酸腺苷（25%对27%，P = 0.966）或凝血酶受体激活肽（37%对24%，P = 0.086）无明显增加。VerifyNow P2Y检测显示所有患者的抑制率均> 70%。两组之间的纤维蛋白凝块溶解时间和最大浊度相似。使用效力一致的P2Y抑制剂，DAT通过减少环氧化酶-1介导的血小板激活来改善止血，但对其他途径和纤维蛋白凝块特性的影响与TAT相当。使用替格瑞洛/普拉格雷和DOAC的DAT可能提供足够的抗栓效果而无过度的抗止血作用。
