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Thromb Haemostasis:12个月和30个月双联抗血小板治疗对死亡率和癌症有何影响?

2017-05-31 xing.T MedSci原创

这一分析表明PCI术后患者常规进行12个月DAPT后再额外接受18个月的治疗患者患癌症的风险稍有增加,但不能改善死亡率。这些数据并不支持在东亚人中进行DAPT超过1年。未来研究中分析癌症发生类型和评估潜在的癌症相关出血是必要的。

经皮冠状动脉介入治疗(PCI)后抗血小板治疗的最佳时间和癌症风险尚不清楚。近日,血栓和凝血疾病权威杂志Thrombosis and Haemostasis上发表了一篇研究文章,研究人员比较了采用氯吡格雷联合阿司匹林(ASA)进行双联抗血小板治疗(DAPT)或单独使用阿司匹林治疗的患者癌症和死亡率风险。

研究人员选择了12个月事件发生并保持了持续抗血小板治疗方案超过18个月的PCI患者。该研究的主要终点为PCI术后30个月时任何癌症和全因死亡率。研究人员对320351份PCI术后患者健康保险审查和评估(HIRA)记录进行筛查,排除了294413例参与者,纳入了25938例符合条件的参与者,构建了DAPT组(n=10992)和ASA组(n=14946)。

倾向评分匹配(PSM)和逆处理概率加权(IPTW)显示在DAPT与ASA组患者基础的人口学和临床特征无显著差异。在PCI后30个月,排除了多数(>91%)参与者后,癌症风险在持续DAPT的患者中较高 [455例(4.15 %) vs. 606例(4.04 %);风险比为1.221;95%CI为1.061-1.405;P=0.005],这一变化在PSM(P=0.006)或IPTW(P=0.007)后仍然显著,而全因死亡率具有相似的变化[136例(1.24 %) vs. 192例(1.28 %);风险比为0.999;95%CI为0.736-1.135;P=0.993]。

这一分析表明PCI术后患者常规进行12个月DAPT后再额外接受18个月的治疗患者患癌症的风险稍有增加,但不能改善死亡率。这些数据并不支持在东亚人中进行DAPT超过1年。未来研究中分析癌症发生类型和评估潜在的癌症相关出血是必要的。

原始出处:

V. L. Serebruany,et al. Mortality and cancer after 12 versus 30 months dual antiplatelet therapy The Korean Outcomes Registry Evaluating Antithrombotics (KOREA).Thrombosis and Haemostasis.2017. https://th.schattauer.de/en/contents/archive/issue/2480/issue/special/manuscript/27278/show.html

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    2018-04-29 changfy
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    2017-06-05 mhm289
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    2017-06-01 tanxingdoctor

    学习啦谢谢分享

    0

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    2017-05-31 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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