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Circulation:经皮冠状动脉介入置入药物洗脱支架后:双重抗血小板治疗到底该持续多久?

2020-10-16 星云 MedSci原创

迄今为止,经皮冠状动脉介入治疗置入药物洗脱支架后双重抗血小板治疗(DAPT)的最佳持续时间仍不确定。本研究比较了经皮冠状动脉介入治疗置入药物洗脱支架后采用短期(<6个月)DAPT后接阿司匹林或P

迄今为止,经皮冠状动脉介入治疗置入药物洗脱支架后双重抗血小板治疗(DAPT)的最佳持续时间仍不确定。本研究比较了经皮冠状动脉介入治疗置入药物洗脱支架后采用短期(<6个月)DAPT后接阿司匹林或P2Y12抑制剂单一治疗、中期(6个月)DAPT、12个月DAPT和延长期(>12个月)DAPT治疗对患者预后的影响。

DAPT干预网络

通过Medline、Embase、Cochrane图书馆和在线数据库筛选了24个2019年9月之前的随机对照试验。主要终点为心肌梗死和大出血(构成净临床效益)。

心肌梗死和大出血的Meta分析结果

共79 073位患者,中位随访了18个月,与其他持续时间的DAPT治疗相比,延长DAPT治疗与心肌梗死风险降低有关(与12个月DAPT的相对风险 0.68 [95% CI, 0.54–0.87],与中期DAPT的相对风险0.61 [0.45–0.83],与短期DAPT接阿司匹林单药的 0.69 [0.51–0.95])。相反,延长DAPT治疗的大出血风险也较其他所有DAPT组的更高。

净临床效益

与12个月DAPT相比,中期或短期DAPT接阿司匹林方案间缺血性终点或大出血的风险无显著差异,除了短期DAPT+P2Y12抑制剂单一治疗与大出血风险降低相关。不同DAPT方案的死亡率无显著差异。在急性冠状动脉综合征中,与12个月DAPT方案相比,延长DAPT方案与心肌梗死风险降低相关,且没有显著增加大出血风险。

临床预后

本次荟萃分析表明,与12个月DAPT方案相比,短期DAPT联合P2Y12抑制剂单一治疗可减少经皮冠状动脉介入置入药物洗脱支架后的大出血风险,而长期DAPT治疗虽然可以减少心肌梗死,但会有更多的出血事件。

原始出处:

Safi U. Khan, et al. Dual Antiplatelet Therapy After Percutaneous Coronary Intervention and Drug-Eluting Stents. Circulation. 2020;142:1425–1436

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    2020-11-02 1477308bm10(暂无昵称)

    学习了

    0

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channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201016/f2e3c0d9e191431c82d27c4d8fa3bcb7/d74d3f71c6b247379d19d88aa40f0acf.jpg, createdBy=dee45426404, createdName=ms2000001541278406, createdTime=Fri Oct 16 00:38:08 CST 2020, time=2020-10-16, status=1, ipAttribution=)]
    2020-10-27 Lexi

    与12个月DAPT方案相比,短期DAPT联合P2Y12抑制剂单一治疗可减少经皮冠状动脉介入置入药物洗脱支架后的大出血风险,而长期DAPT治疗虽然可以减少心肌梗死,但会有更多的出血事件。

    0

  4. 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createdName=咻凡, createdTime=Tue Oct 20 16:58:37 CST 2020, time=2020-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310511, encodeId=ef5f131051173, content=<a href='/topic/show?id=f70e8e78941' target=_blank style='color:#2F92EE;'>#药物洗脱支架#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87789, encryptionId=f70e8e78941, topicName=药物洗脱支架)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=86b7385, createdName=lqrandywkz, createdTime=Sat Oct 17 15:15:16 CST 2020, time=2020-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1402180, encodeId=5a111402180fe, content=<a href='/topic/show?id=26163e63362' target=_blank style='color:#2F92EE;'>#双重抗血小板治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37633, 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channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201016/f2e3c0d9e191431c82d27c4d8fa3bcb7/d74d3f71c6b247379d19d88aa40f0acf.jpg, createdBy=dee45426404, createdName=ms2000001541278406, createdTime=Fri Oct 16 00:38:08 CST 2020, time=2020-10-16, status=1, ipAttribution=)]
    2020-10-20 咻凡

    迄今为止,经皮冠状动脉介入治疗置入药物洗脱支架后双重抗血小板治疗(DAPT)的最佳持续时间仍不确定。本研究比较了经皮冠状动脉介入治疗置入药物洗脱支架后采用短期(<6个月)DAPT后接阿司匹林或P

    0

  5. 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  6. 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  7. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bb45125889, createdName=146465bem06暂无昵称, createdTime=Fri Oct 16 02:56:13 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892370, encodeId=85318923e0de, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200828/5ead122f9ace4344b58402de23c9289a/ba455281a1d84c4fa6feaa6689f0898b.jpg, createdBy=80c12474234, createdName=Arvin0001, createdTime=Fri Oct 16 02:11:08 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892362, encodeId=9f7f89236204, content=顶, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201016/f2e3c0d9e191431c82d27c4d8fa3bcb7/d74d3f71c6b247379d19d88aa40f0acf.jpg, createdBy=dee45426404, createdName=ms2000001541278406, createdTime=Fri Oct 16 00:38:08 CST 2020, time=2020-10-16, status=1, ipAttribution=)]
    2020-10-16 ms4000000799709505

    冠状动脉

    0

  8. 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encryptionId=26163e63362, topicName=双重抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTL6ka7cRR8xsokbAYjhg0mZeBm79vHeyXiaMibkYndHaibgmfg1JDA0AXlGaY8Og4IiaREUFYuBwekPoQ/132, createdBy=19852392148, createdName=bioon4, createdTime=Sat Oct 17 15:15:16 CST 2020, time=2020-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892431, encodeId=c82d89243138, content=冠状动脉, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=87fa5426430, createdName=ms4000000799709505, createdTime=Fri Oct 16 11:26:54 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892371, encodeId=d0318923e189, content=抗板时间,双重, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bb45125889, createdName=146465bem06暂无昵称, createdTime=Fri Oct 16 02:56:13 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892370, encodeId=85318923e0de, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200828/5ead122f9ace4344b58402de23c9289a/ba455281a1d84c4fa6feaa6689f0898b.jpg, createdBy=80c12474234, createdName=Arvin0001, createdTime=Fri Oct 16 02:11:08 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892362, encodeId=9f7f89236204, content=顶, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201016/f2e3c0d9e191431c82d27c4d8fa3bcb7/d74d3f71c6b247379d19d88aa40f0acf.jpg, createdBy=dee45426404, createdName=ms2000001541278406, createdTime=Fri Oct 16 00:38:08 CST 2020, time=2020-10-16, status=1, ipAttribution=)]
    2020-10-16 146465bem06暂无昵称

    抗板时间,双重

    0

  9. 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encryptionId=26163e63362, topicName=双重抗血小板治疗)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTL6ka7cRR8xsokbAYjhg0mZeBm79vHeyXiaMibkYndHaibgmfg1JDA0AXlGaY8Og4IiaREUFYuBwekPoQ/132, createdBy=19852392148, createdName=bioon4, createdTime=Sat Oct 17 15:15:16 CST 2020, time=2020-10-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892431, encodeId=c82d89243138, content=冠状动脉, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=87fa5426430, createdName=ms4000000799709505, createdTime=Fri Oct 16 11:26:54 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892371, encodeId=d0318923e189, content=抗板时间,双重, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bb45125889, createdName=146465bem06暂无昵称, createdTime=Fri Oct 16 02:56:13 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892370, encodeId=85318923e0de, content=<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200828/5ead122f9ace4344b58402de23c9289a/ba455281a1d84c4fa6feaa6689f0898b.jpg, createdBy=80c12474234, createdName=Arvin0001, createdTime=Fri Oct 16 02:11:08 CST 2020, time=2020-10-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=892362, encodeId=9f7f89236204, content=顶, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201016/f2e3c0d9e191431c82d27c4d8fa3bcb7/d74d3f71c6b247379d19d88aa40f0acf.jpg, createdBy=dee45426404, createdName=ms2000001541278406, createdTime=Fri Oct 16 00:38:08 CST 2020, time=2020-10-16, status=1, ipAttribution=)]
    2020-10-16 Arvin0001

    #学习#学习了

    0

  10. 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    2020-10-16 ms2000001541278406

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