Lancet:支持使用血小板功能或基因检测来优化PCI患者的药物选择

2021-04-17 MedSci原创 MedSci原创

与标准的氯吡格雷预防方案相比, PCI患者术后根据肝细胞色素p4502c19基因特征选择抗血小板治疗可改善疗效,提高安全性,减少小出血风险。支持使用血小板功能或基因检测来优化PCI患者的药物选择

双重抗血小板治疗方案,是接受经皮冠状动脉介入治疗(PCI)患者血栓预防标准护理方案,由阿司匹林和P2Y12抑制剂组成,其中氯吡格雷是最常用的P2Y12抑制剂,但患者服用氯吡格雷后药效学个体差异大,服药后发生血小板高反应性(HPR)患者比例较高,导致这部分患者的血栓风险增加。产生氯吡格雷抵抗的根本原因是肝细胞色素P4502c19(cyp2c19)基因多态性,突变人群将氯吡格雷代谢成为活性代谢产物的能力差,导致血栓风险增加。因此,根据患者p4502c19基因特征指导的抗血小板治疗应运而生。

近日研究人员比较了在PCI患者中,标准抗血小板治疗方案vs选择性指导方案的安全性及有效性。

本次研究为系统综述及荟萃分析,收集截至2020年10月MEDLINE、Cochrane、Embase和Web of Science数据库相关研究,涉及通过血小板功能检测或基因检测指导的抗血小板方案与标准抗血小板方案对PCI患者血栓预防效果的研究。研究的主要终点是主要血管事件和任何出血。次要终点包括全因死亡、心血管死亡、心肌梗死、中风、明确或可能的支架血栓、大出血和小出血。

3656篇相关文章纳入本次荟萃分析,包括11项随机对照试验和3项观察研究,包含20743名患者数据。与标准治疗方案相比,指导性选择抗血小板治疗方案与主要心血管不良事件风险降低相关(RR= 0.78),与出血风险降低相关但无统计学意义(RR =0.88)。与标准治疗相比,指导性选择抗血小板治疗方案可减少患者心血管死亡(RR=0.77)、心肌梗死(RR=0.76)、支架血栓形成(RR=0.64)、中风(RR=0.66)和轻微出血(RR= 0.78)风险。方案间,患者全因死亡和大出血风险没有差异。

研究认为,与标准的氯吡格雷预防方案相比, PCI患者术后根据肝细胞色素p4502c19基因特征选择抗血小板治疗可改善疗效,提高安全性,减少小出血风险。支持使用血小板功能或基因检测来优化PCI患者的药物选择

原始出处:

Mattia Galli et al. Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.Lancet. April 17, 2021.

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    2022-01-01 howi
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    2021-05-16 zhmscau
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    2021-04-17 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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    2021-04-17 ms8000001383156651

    学习了

    0

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