Laudani Claudio, Giacoppo Daniele, Greco Antonio, Ortega-Paz Luis, El Khoury Georges, Capodanno Davide, Angiolillo Dominick J
Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", University of Catania, 95124 Catania, Italy.
Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
J Clin Med. 2025 Aug 6;14(15):5536. doi: 10.3390/jcm14155536.
In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), antiplatelet therapy is the cornerstone of treatment for secondary prevention. Although dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y inhibitor is the current standard of care, being, respectively, recommended for 6 and 12 months in patients with chronic and acute coronary syndrome without a need for oral anticoagulation, the continuous improvement in PCI technology and pharmacology have significantly reduced the need for long-term DAPT. Mounting evidence supports the administration of P2Y inhibitor monotherapy, particularly ticagrelor, after a short period of DAPT following PCI as a strategy to reduce bleeding without a trade-off in ischemic events compared to standard DAPT. In addition, there is a growing literature supporting P2Y inhibitor monotherapy also for long-term secondary prevention of ischemic events. However, the data to this extent are not as robust as compared to the first-year post-PCI period, with aspirin monotherapy still remaining the mainstay of treatment for most patients. This review aims to summarize the rationale for long-term antiplatelet therapy, the pharmacology of current antiplatelet drugs tested for long-term administration as monotherapy, and current evidence on the available comparisons between different long-term antiplatelet monotherapies in patients with CAD.
在接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者中，抗血小板治疗是二级预防的基石。尽管由阿司匹林和P2Y抑制剂组成的双联抗血小板治疗（DAPT）是目前的标准治疗方案，分别推荐用于慢性和急性冠状动脉综合征且无需口服抗凝治疗的患者6个月和12个月，但PCI技术和药理学的不断改进已显著减少了长期DAPT的需求。越来越多的证据支持在PCI术后短期DAPT后给予P2Y抑制剂单药治疗，尤其是替格瑞洛，作为一种在不增加缺血事件风险的情况下减少出血的策略，与标准DAPT相比。此外，越来越多的文献支持P2Y抑制剂单药治疗也用于缺血事件的长期二级预防。然而，与PCI术后第一年的数据相比，这方面的数据并不那么有力，阿司匹林单药治疗仍然是大多数患者的主要治疗方法。本综述旨在总结长期抗血小板治疗的基本原理、作为单药进行长期给药测试的当前抗血小板药物的药理学，以及目前关于CAD患者不同长期抗血小板单药治疗之间可用比较的证据。
