Novedades en la evaluación del riesgo hemorrágico del paciente con cardiopatía isquémica

Sergio Raposeiras Roubín , Albert Ariza Solé
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引用次数: 2

Abstract

The assessment of bleeding risk is the limiting factor in determining the balance between the risk of ischemia and hemorrhage, which must be determined before the type and duration of antithrombotic therapy can be selected. The best data for estimating bleeding risk are available during hospitalization and several suitable risk scores have been developed and have undergone extensive validation and comparison. The CRUSADE bleeding score appears to be the most useful. In addition, several risk scores for assessing bleeding risk over the medium to long term after hospital discharge or after coronary artery revascularization have recently appeared, such as the PRECISE-DAPT (PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy), the PARIS (Patterns of non-Adherence to Anti-Platelet Regimens in Stented Patients), the DAPT (Dual AntiPlatelet Therapy) and the TRILOGY-ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) risk scores. All have demonstrated reasonably good predictive power but they have some important limitations, which mean that they will have to undergo comparative validation studies before their usefulness can be extended to patients treated with new antiplatelet agents (e.g. ticagrelor and prasugrel) and oral anticoagulants, including both vitamin K antagonists and direct-acting oral anticoagulants.

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缺血性心脏病患者出血风险评估的新进展
出血风险的评估是确定缺血和出血风险平衡的限制因素,必须在选择抗血栓治疗的类型和持续时间之前确定。估计住院期间出血风险的最佳数据是可用的,并且已经开发了几个合适的风险评分,并经过了广泛的验证和比较。CRUSADE出血评分似乎是最有用的。此外,最近出现了一些用于评估出院后或冠状动脉血运重建术后中长期出血风险的风险评分,如precision - dapt(预测接受支架植入和随后的双重抗血小板治疗的患者的出血并发症),PARIS(支架患者不遵守抗血小板方案的模式),DAPT(双重抗血小板治疗)和TRILOGY-ACS(靶向血小板抑制以阐明医学管理急性冠脉综合征的最佳策略)风险评分。所有这些方法都显示出相当好的预测能力,但它们有一些重要的局限性,这意味着它们必须经过比较验证研究,才能将其应用于使用新的抗血小板药物(例如替格瑞洛和普拉格雷)和口服抗凝剂(包括维生素K拮抗剂和直接作用口服抗凝剂)治疗的患者。
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来源期刊
Revista Espanola de Cardiologia Suplementos
Revista Espanola de Cardiologia Suplementos Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
1
期刊介绍: Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.
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