Lancet:双重抗血小板疗法“减剂量策略”明显改善急性冠脉综合征患者PCI术后预后

2020-09-01 MedSci原创 MedSci原创

接受经皮冠状动脉介入(PCI)治疗的急性冠脉综合征患者被推荐采用长达一年的基于P2Y12抑制剂的双重抗血小板治疗。这种P2Y12抑制剂的最大收益在用药早期阶段,随着用药时间的延长,大出血的风险会随之增

接受经皮冠状动脉介入(PCI)治疗的急性冠脉综合征患者被推荐采用长达一年的基于P2Y12抑制剂的双重抗血小板治疗。这种P2Y12抑制剂的最大收益在用药早期阶段,随着用药时间的延长,大出血的风险会随之增加。但抗血小板疗法的降级可能在缺血和出血之间获得最佳平衡。本研究旨在研究基于普拉格雷的减剂量疗法的安全性和有效性。

HOST-REDUCE-POLYTECH-ACS试验是一项在韩国35家医院开展的多中心的、开放标签的、非劣效性随机试验,招募了接受PCI的、符合普拉格雷适应征的急性冠脉综合征患者,1:1随机分至减剂量组或常规组。采用10 mg普拉格雷+阿司匹林 100 mg(1/日)治疗一个月后,减剂量组的普拉格雷改为5 mg,常规组保存不变。主要终点是一年时的净不良临床事件(全因死亡、非致死性心肌梗死、支架血栓形成、重复血管重建、卒中和≥2级出血)。主要终点的绝对非劣效性界值为2·5%。次要终点为疗效预后(心源性死亡、心肌梗塞、支架血栓形成和缺血性卒中)和安全性预后(≥2级出血)。

2014年9月30日-2018年12月18日,共筛查了3429位患者,其中2338位符合要求被随机分至减剂量组(n=1170)或常规组(n=1168)。减剂量组有82位患者(7.2%)发生了主要终点,而常规组有116位患者(10.1%,绝对风险差 -2.9%,p<0.0001;风险比 0.70,95% CI 0.52-0.92;p<0.012)。与常规组相比,减剂量组的缺血性风险无增加(0.76 [0.40–1.45]; p=0.40),而且出血事件风险显著降低(0.48 [0.32–0.73]; p=0.0007)。

在接受PCI的亚洲急性冠脉综合征患者中,PCI后1个月以普拉格雷为基础的减剂量方案可降低长达1年的净临床预后风险,主要是出血减少且未增加缺血事件。

原始出处:

Hyo-Soo Kim,et al. Prasugrel-based de-escalation of dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (HOST-REDUCE-POLYTECH-ACS): an open-label, multicentre, non-inferiority randomised trial. The Lancet. August 31,2020. https://doi.org/10.1016/S0140-6736(20)31791-8

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    2020-10-29 howi
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    2021-03-07 zxl736
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  4. 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    2020-09-01 qinqiyun

    优秀

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  6. 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    2020-09-01 Psycho.Dr Du

    期待针对我国的替格瑞洛研究😄

    0

  7. 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    2020-09-01 14818eb4m67暂无昵称

    学习

    0

  8. 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    2020-09-01 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

  9. 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topicList=[TopicDto(id=52200, encryptionId=ab99522007b, topicName=急性冠脉综合征), TopicDto(id=13833, encryptionId=36d313833c9, topicName=PCI), TopicDto(id=59934, encryptionId=9a4d599340b, topicName=普拉格雷), TopicDto(id=60349, encryptionId=43666034930, topicName=替格瑞洛), TopicDto(id=64087, encryptionId=5a626408e66, topicName=氯吡格雷)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Tue Sep 01 11:22:41 CST 2020, time=2020-09-01, status=1, ipAttribution=)]
    2020-09-01 lovetcm

    在接受PCI的亚洲#急性冠脉综合征#患者中,#PCI#后1个月以#普拉格雷#为基础的减剂量方案可降低长达1年的净临床预后风险,不过,在国内以#替格瑞洛##氯吡格雷#为主的方案,看来也需要研究

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