Antithrombotic therapy in patients with atrial fibrillation after percutaneous coronary intervention.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2024-09-01 Epub Date: 2024-10-20 DOI:10.1080/14779072.2024.2388265
Mark Anthony Sammut, Robert F Storey
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Abstract

Introduction: Patients who undergo percutaneous coronary intervention (PCI) with stenting usually require a period of dual antiplatelet therapy (DAPT) but, when an indication for long-term oral anticoagulation (OAC) such as atrial fibrillation (AF) coexists, triple antithrombotic therapy (TAT) with DAPT and OAC causes concern for excessive bleeding. Achieving the right balance between bleeding and adequate protection from ischemic events remains an issue of debate and subject to ongoing investigation of various antithrombotic regimens and durations.

Areas covered: This review describes the landmark clinical trials comparing TAT to a period of dual antithrombotic therapy (DAT) and subsequent meta-analyses. It also describes the international recommendations that have been derived from this evidence and identifies outstanding issues that could be addressed in upcoming or future trials.

Expert opinion: The current recommended default strategy of a short period of TAT with clopidogrel followed by the withdrawal of aspirin faces a challenge from the prospect of more consistent P2Y12 inhibition provided by ticagrelor and prasugrel. Ticagrelor monotherapy has already been trialed in patients after PCI without an indication for OAC. DAT with ticagrelor or prasugrel immediately post-procedure could emerge as a comparably safe and more efficacious regimen than one involving clopidogrel in the right setting.

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经皮冠状动脉介入术后心房颤动患者的抗血栓治疗。
导言:接受经皮冠状动脉介入治疗(PCI)和支架植入术的患者通常需要一段时间的双重抗血小板治疗(DAPT),但当心房颤动(AF)等长期口服抗凝药(OAC)的适应症同时存在时,DAPT 和 OAC 的三重抗血栓治疗(TAT)会导致出血过多的问题。如何在出血和充分预防缺血性事件之间取得适当的平衡仍是一个争论不休的问题,各种抗血栓治疗方案和持续时间的研究仍在进行中:本综述介绍了具有里程碑意义的临床试验,这些试验将 TAT 与一段时间的双重抗血栓治疗 (DAT) 进行了比较,并进行了后续的荟萃分析。本综述还介绍了从这些证据中得出的国际建议,并指出了在即将进行的或未来的试验中可以解决的未决问题:目前推荐的默认策略是使用氯吡格雷进行短期 TAT,然后停用阿司匹林,这一策略面临着挑战,因为替卡格雷和普拉格雷具有更稳定的 P2Y12 抑制作用。替卡格雷单药疗法已在无 OAC 适应症的 PCI 后患者中试用。在合适的情况下,术后立即使用替卡格雷或普拉格雷的 DAT 可能会成为比使用氯吡格雷更安全、更有效的治疗方案。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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