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JACC：双抗治疗怕出血？急性冠状动脉综合征DAPT降阶梯治疗的更佳方案来了！

2021-08-18 MedSci原创 MedSci原创

阿司匹林替格瑞洛
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在强效P2Y12抑制剂时代，平衡DAPT的效果已成为ACS管理的基石。。

据估计，美国每年有72万人因急性冠脉综合征（ACS）住院或发生致死性冠心病。高龄和合并症是ACS患者的典型特征；60%以上的ACS住院发生于65岁以上患者。作为临床指南依据的大规模试验可能无法纳入像临床上那样多样化的患者人群。尤其是在对ACS治疗方法开展的当代临床试验中，老年人、女性和少数族群参与者的人数仍偏少。 双联抗血小板治疗（DAPT）（一般是阿司匹林联合氯吡格雷或替格瑞洛等二磷酸腺苷[ADP]抑制剂）是ACS后治疗方案的核心。多项临床试验表明，上述联合治疗方案可显著降低急性冠脉综合征患者的缺血事件复发风险，包括支架内血栓形成风险。 CURE试验证实了ACS患者应用阿司匹林联合氯吡格雷治疗的益处。虽然氯吡格雷仍然是最常用的P2Y12抑制剂，但由于直接比较试验已证明在减少缺血事件方面，下一代P2Y12抑制剂（例如替格瑞洛）优于氯吡格雷，因此美国和欧洲的临床指南均支持使用更强效的下一代P2Y12抑制剂。 这些药物起效更快，对血小板的抑制作用更易预测且更强效，并且药物相互作用更少。导致CYP2C19同工酶功能丧失的遗传多态性可能导致患者使用氯吡格雷后有较高的血小板反应性，并与较高的主要

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    2022-06-16 124985dbm16(暂无昵称)

    #冠状动脉综合征#

    0

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    2021-11-07 hbwxf

    #JACC#

    0

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    2021-08-20 12498568m50暂无昵称

    #ACC#

    0

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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555692, encodeId=c7d315556924b, content=<a href='/topic/show?id=b6209e64240' target=_blank style='color:#2F92EE;'>#阶梯治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97642, encryptionId=b6209e64240, topicName=阶梯治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b74314654319, createdName=drj2008, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1009493, encodeId=202d100949311, content=又学习一遍, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Thu Aug 19 16:26:26 CST 2021, time=2021-08-19, status=1, ipAttribution=)]
    2021-08-20 mnda

    #DAPT#

    0

  5. 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channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487268, encodeId=7636148e2684d, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555692, encodeId=c7d315556924b, content=<a href='/topic/show?id=b6209e64240' target=_blank style='color:#2F92EE;'>#阶梯治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97642, encryptionId=b6209e64240, topicName=阶梯治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b74314654319, createdName=drj2008, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1009493, encodeId=202d100949311, content=又学习一遍, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Thu Aug 19 16:26:26 CST 2021, time=2021-08-19, status=1, ipAttribution=)]
    2021-08-20 zhangbaojun

    #双抗治疗#

    0

  6. 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channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487268, encodeId=7636148e2684d, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555692, encodeId=c7d315556924b, content=<a href='/topic/show?id=b6209e64240' target=_blank style='color:#2F92EE;'>#阶梯治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97642, encryptionId=b6209e64240, topicName=阶梯治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b74314654319, createdName=drj2008, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1009493, encodeId=202d100949311, content=又学习一遍, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Thu Aug 19 16:26:26 CST 2021, time=2021-08-19, status=1, ipAttribution=)]
    2021-08-20 zhouqu_8

    #综合征#

    0

  7. 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encryptionId=6d5d56912e, topicName=DAPT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a8d381, createdName=mnda, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429125, encodeId=96c41429125ed, content=<a href='/topic/show?id=168a3e464ad' target=_blank style='color:#2F92EE;'>#双抗治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37464, encryptionId=168a3e464ad, topicName=双抗治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4f6a4173831, createdName=zhangbaojun, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432125, encodeId=c7351432125c6, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487268, encodeId=7636148e2684d, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555692, encodeId=c7d315556924b, content=<a href='/topic/show?id=b6209e64240' target=_blank style='color:#2F92EE;'>#阶梯治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97642, encryptionId=b6209e64240, topicName=阶梯治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b74314654319, createdName=drj2008, createdTime=Fri Aug 20 13:46:02 CST 2021, time=2021-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1009493, encodeId=202d100949311, content=又学习一遍, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Thu Aug 19 16:26:26 CST 2021, time=2021-08-19, status=1, ipAttribution=)]
    2021-08-20 yeye5224615

    #双抗#

    0

  8. 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createdName=春江水暖, createdTime=Thu Aug 19 16:26:26 CST 2021, time=2021-08-19, status=1, ipAttribution=)]
    2021-08-20 drj2008

    #阶梯治疗#

    0

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createdName=春江水暖, createdTime=Thu Aug 19 16:26:26 CST 2021, time=2021-08-19, status=1, ipAttribution=)]
    2021-08-19 春江水暖

    又学习一遍

    0

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