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Eur Heart J：ACS后使用抗血小板治疗MI和出血的利弊并不难测

2017-05-10 贾朝娟 环球医学

急性冠脉综合征抗血小板出血
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双联抗血小板用于急性冠脉综合征（ACS）患者是一把双刃剑，如何权衡预防缺血事件的获益和出血事件的危害，一直是临床医生面临的难题。2017年3月，发表在《Eur Heart J》的一项研究显示，ACS后使用抗血小板治疗的患者中，MI和出血均显着影响死亡率且具有相似的时间依赖性。目的：双联抗血小板治疗能减少急性冠脉综合征（ACS）的非致命性缺血事件，但会相同程度的增加出血。研究者试图考察在延长的随访期

双联抗血小板用于急性冠脉综合征（ACS）患者是一把双刃剑，如何权衡预防缺血事件的获益和出血事件的危害，一直是临床医生面临的难题。2017年3月，发表在《Eur Heart J》的一项研究显示，ACS后使用抗血小板治疗的患者中，MI和出血均显着影响死亡率且具有相似的时间依赖性。

目的：双联抗血小板治疗能减少急性冠脉综合征（ACS）的非致命性缺血事件，但会相同程度的增加出血。研究者试图考察在延长的随访期内心肌梗塞（MI） vs 出血对预后的影响，权衡双抗在ACS患者中的有效性和安全性。

方法和结果：在来自凝血酶受体拮抗剂减少急性冠脉综合征临床事件（TRACER）研究的12944名非ST段抬高的ACS患者中，研究者调查了ACS后＞30日时MI和出血的相对影响以及随后的全因死亡率。根据出血学术研究联合会（BARC）标准对出血进行分级。MI与死亡率的5倍增加相关。BARC的2级和3级出血对死亡具有显着影响，但1级没有。MI同BARC 2[相对风险（RR） 3.5；95%置信区间（CI） 2.08～4.77；P＜0.001]和BARC 3a出血[RR 2.23；95%CI 1.36～3.64；P=0.001]相比具有较大的死亡风险，但同BARC 3b出血相比具有相似的风险（RR 1.37；95% CI 0.81～2.30；P=0.24）。MI后的死亡风险明显低于BARC 3c出风后的风险（RR 0.22；95% CI 0.13～0.36；P＜0.001）。MI和出血与死亡率具有相似的时间关联性，在事件后早期较高，几个月内仍然显着，。

结论：ACS后使用抗血小板治疗的患者中，MI和出血均显着影响死亡率且具有相似的时间依赖性。尽管BARC 2和3a的死亡预后低于MI，但BARC 3b出血和MI之间的死亡风险是相同的，并且在BARC 3c出血后会高些。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1744808, encodeId=66691e4480841, content=<a href='/topic/show?id=d8c6322986a' target=_blank style='color:#2F92EE;'>#利弊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32298, encryptionId=d8c6322986a, topicName=利弊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a8135449354, createdName=lujian, createdTime=Fri Sep 15 07:37:00 CST 2017, time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200578, encodeId=1f5b2005e898, content=学习了，多谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Sat May 20 22:45:33 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197382, encodeId=c8aa19e3825c, content=认真学习，把间接经验应用到临床实践中去，然后再总结出新思路。给点赞啦……, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat May 13 07:03:18 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279166, encodeId=a24912e91660b, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356264, encodeId=ebb41356264cb, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562518, encodeId=177f1562518b2, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196427, encodeId=ca2b19642e6c, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 11 06:27:56 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
    2017-09-15 lujian

    #利弊#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1744808, encodeId=66691e4480841, content=<a href='/topic/show?id=d8c6322986a' target=_blank style='color:#2F92EE;'>#利弊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32298, encryptionId=d8c6322986a, topicName=利弊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a8135449354, createdName=lujian, createdTime=Fri Sep 15 07:37:00 CST 2017, time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200578, encodeId=1f5b2005e898, content=学习了，多谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Sat May 20 22:45:33 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197382, encodeId=c8aa19e3825c, content=认真学习，把间接经验应用到临床实践中去，然后再总结出新思路。给点赞啦……, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat May 13 07:03:18 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279166, encodeId=a24912e91660b, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356264, encodeId=ebb41356264cb, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562518, encodeId=177f1562518b2, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196427, encodeId=ca2b19642e6c, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 11 06:27:56 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
    2017-05-20 1e1263e3m20(暂无匿称)

    学习了，多谢分享

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1744808, encodeId=66691e4480841, content=<a href='/topic/show?id=d8c6322986a' target=_blank style='color:#2F92EE;'>#利弊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32298, encryptionId=d8c6322986a, topicName=利弊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a8135449354, createdName=lujian, createdTime=Fri Sep 15 07:37:00 CST 2017, time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200578, encodeId=1f5b2005e898, content=学习了，多谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Sat May 20 22:45:33 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197382, encodeId=c8aa19e3825c, content=认真学习，把间接经验应用到临床实践中去，然后再总结出新思路。给点赞啦……, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat May 13 07:03:18 CST 2017, time=2017-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279166, encodeId=a24912e91660b, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356264, encodeId=ebb41356264cb, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562518, encodeId=177f1562518b2, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Fri May 12 09:37:00 CST 2017, time=2017-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=196427, encodeId=ca2b19642e6c, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu May 11 06:27:56 CST 2017, time=2017-05-11, status=1, ipAttribution=)]
    2017-05-13 ylzr123

    认真学习，把间接经验应用到临床实践中去，然后再总结出新思路。给点赞啦……

    0

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    2017-05-12 yaanren

    #ACS#

    0

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    2017-05-12 zhaojie88

    #ART#

    0

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    2017-05-12 slcumt

    #HEART#

    0

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    2017-05-11 龙胆草

    学习了，谢谢分享

    0

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