Eur Heart J: 急性冠脉综合征后双重抗血小板治疗中,普拉格雷+替卡格雷vs氯吡格雷

2017-05-22 MedSci MedSci原创

近年来急性冠脉综合征(ACS)的发病率呈上升趋势。ACS发生的关键是血小板活化聚集,我国目前治疗ACS使用最广泛的是低剂量阿司匹林联合P2Y12受体拮抗剂的方案。氯吡格雷是目前我国应用最广的P2Y12受体拮抗剂,但它是一种前体药物,存在起效 慢、药物抵抗、对P2Y12受体不逆性抑制、停药后血小板功能恢复时间长等缺点。既往的研究证明在缺血性ACS后使用新型P2Y12受体阻滞剂(普拉格雷和替卡格

近年来急性冠脉综合征(ACS)的发病率呈上升趋势。ACS发生的关键是血小板活化聚集,我国目前治疗ACS使用最广泛的是低剂量阿司匹林联合P2Y12受体拮抗剂的方案。氯吡格雷是目前我国应用最广的P2Y12受体拮抗剂,但它是一种前体药物,存在起效 慢、药物抵抗、对P2Y12受体不逆性抑制、停药后血小板功能恢复时间长等缺点。

既往的研究证明在缺血性ACS后使用新型P2Y12受体阻滞剂(普拉格雷和替卡格雷)明显优于氯吡格雷。然而,这两种药物都存在出血并发症的增加。本研究的目的是评估ACS后将双联抗血小板治疗(DAPT)从阿司匹林合并新的P2Y12受体阻滞剂治疗1个月后转换成阿司匹林联合氯吡格雷的预后情况。

研究人员进行了一项开放性、单中心、随机试验。从2014年3月至2016年四月,需要冠状动脉介入治疗ACS患者被纳入研究,这些患者接受阿司匹林合并新P2Y12受体拮抗剂且在1个月内没有出现新的不良事件。研究人员将参与者分配到药物治疗转换为阿司匹林合并氯吡格雷(转换DAPT组)治疗组或药物治疗方案不变组(不变DAPT组)。主要复合终点为ACS后1年的心血管死亡、紧急血运重建,卒中和出血(由欧美出血学术研究协会[BARC]定义)≥2型。

646名患者被随机分组,但只分析了645名患者,转换DAPT组322名患者及不变DAPT组323名。主要终点发生情况:转换DAPT组有43(13.4%)例,而不变DAPT组有85例(26.3%)(HR 95%CI,0.48[0.34-0.68],P < 0.01)。二组间的缺血性终点无显著差异,而BARC分型 ≥ 2的出血发生率在转换DAPT组出现了13(4%)例,在不变DAPT组出现了48例(14.9%)例(HR 95%CI,0.30[0.18-0.50],P < 0.01)。

ACS后没有缺血事件增加时为预防出血事件的发生,转换DAPT组优于不变DAPT组。

原始出处:


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    2017-06-25 周周人

    学习。

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    2017-06-17 周周人

    学习。

    0

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    2017-06-14 周周人

    学习。

    0

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    2017-05-25 ylzr123

    认真学习,不断进步,把经验分享给同好。点赞了!

    0

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    2017-05-24 zhaojie88
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  7. 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    2017-05-24 zhouqu_8
  9. 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    2017-05-24 slcumt
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    2017-05-23 杨利洪

    学习了,分享了

    0

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