NEJM:高出血风险患者PCI后双重抗血小板治疗

2021-10-28 MedSci原创 MedSci原创

就净不良临床事件和主要不良心脏或大脑事件的发生情况而言,1个月的双重抗血小板治疗不劣于2个月以上的持续治疗;缩短治疗可使大出血或临床相关的非大出血发生率降低。

对于植入药物洗脱冠状动脉支架后较高出血风险的患者,双联抗血小板治疗合适的持续时间尚未明确。

近日,顶级医学期刊NEJM上发表了一篇研究文章,在植入可生物降解聚合物西罗莫司洗脱冠状动脉支架一个月后,研究人员随机分配高出血风险患者立即停止双重抗血小板治疗(简化治疗)或继续双重抗血小板治疗至少2个月(标准治疗)。

排名前三的主要结局为净不良临床事件(包括任何原因死亡、心肌梗死卒中或大出血)、主要不良心脏或大脑事件(包括任何原因死亡、心肌梗塞或卒中),以及大出血或临床相关的非大出血;在第335天时对受试者累积发生率进行了评估。前两项结局在符合方案人群中评估非劣效性,第三项结局在意向治疗人群中评估优效性。

在符合方案人群的4434名患者中,简化治疗组165名患者(7.5%)和标准治疗组172名患者(7.7%)发生净不良临床事件(差异为-0.23个百分点;95%置信区间[CI]为-1.80至1.33;非劣效性P<0.001)。简化治疗组中共有133名患者(6.1%)和标准治疗组中共有132名患者(5.9%)发生严重的心脏或脑部不良事件(差异为0.11个百分点;95%CI为-1.29至1.51;非劣效性P=0.001)。在意向治疗人群的4579名患者中,简化治疗组148名(6.5%)患者和标准治疗组211名(9.4%)患者发生大出血或临床相关的非大出血(差异为-2.82个百分点;95%CI为-4.40至-1.24;优势P<0.001)。

由此可见,就净不良临床事件和主要不良心脏或大脑事件的发生情况而言,1个月的双重抗血小板治疗不劣于2个月以上的持续治疗;缩短治疗可使大出血或临床相关的非大出血发生率降低。

原始出处:
 
Marco Valgimigli,et al.Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk.NEJM.2021.https://www.nejm.org/doi/full/10.1056/NEJMoa2108749

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    2021-10-28 ms1000000198775473

    1个月的双重抗血小板治疗不劣于2个月以上的持续治疗;缩短治疗可使大出血或临床相关的非大出血发生率降低。

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