AHA 2014:郭艺芳:冠脉药物支架术后双抗治疗需多久?

2014-11-18 河北省人民医院 郭艺芳 郭艺芳微博

按照现行指南建议,冠状动脉植入药物支架术后患者需要接受为期12个月阿司匹林与氯吡格雷(或其他噻吩吡啶类药物)双联抗血小板治疔。继续延长双抗时间是否能继续获益?缩短双抗时间是否会增加支架内栓风险?这些问题均受到广泛关注,但迄今尚无明确答案。本届AHA年会期间将公布3项相关研究,其中双联抗血小板研究(DAPT)与药物支架术后6个月双联抗血小板治疗安全性和有效性研究(ISAR-SAFE)最值得关注,

按照现行指南建议,冠状动脉植入药物支架术后患者需要接受为期12个月阿司匹林与氯吡格雷(或其他噻吩吡啶类药物)双联抗血小板治疔。继续延长双抗时间是否能继续获益?缩短双抗时间是否会增加支架内栓风险?这些问题均受到广泛关注,但迄今尚无明确答案。本届AHA年会期间将公布3项相关研究,其中双联抗血小板研究(DAPT)与药物支架术后6个月双联抗血小板治疗安全性和有效性研究(ISAR-SAFE)最值得关注,且有可能对将来指南的修订产生重要影响。

DAPT研究拟入选20000余例受试者,均为植入冠脉支架术后并完成为期12个月双联抗血小板治疗者。将其随机分为两组,其中安慰剂对照组予以阿司匹林加安慰剂治疗18个月,双抗组予以阿司匹林联合氯吡格雷或普拉格雷治疗18个月。亦即,本研究旨在比较植入冠脉支架术后患者应用为期12个月或30个月双联抗血小板治疗对患者预后的影响。主要终点为:(1)全因死亡、心肌梗死卒中发生率;(2)支架内血栓发生率;(3)严重出血事件发生率。本研究结果将有助于明确冠脉支架术后患者是否有必要延长双抗时间。此外,本研究中有少数患者植入了裸金属支架,研究者也将对裸支架与药物支架之间的终点事件差异进行分析。

ISAR-SAFE研究拟入选4000余例受试者,均为植入冠脉药物支架术后且已完成为期6个月的双联抗血小板药物治疗(阿司匹林联合氯吡格雷)者。将其随机分为两组,分别接受为期6个月的阿司匹林联合氯吡格雷治疗或阿司匹林加安慰剂治疗。亦即,本研究旨在比较冠脉药物支架术后患者接受为期6个月或12个月双联抗血小板治疗对预后影响有无差异。主要终点为由死亡、心肌梗死、支架血栓、卒中或严重出血所组成的复合终点。

由于冠脉支架术后最佳双联抗血小板疗程与临床工作密切相关,因此这两项研究结果很值得期待。


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    2015-03-26 qindq
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    2015-01-24 gujh
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    2014-11-20 zhaohui6731
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