【醫心有道 抗栓大咖談】ACC 2024引領下的冠心病抗栓治療新動向
*僅供醫學專業人士閱讀參考
冠心病患者的DAPT策略一直是熱議的話題。隨著新型P2Y12受體抑制劑的問世，DAPT的升階和降階成為目前研究的熱點。
冠狀動脈粥樣硬化性心臟病（）是我國心血管疾病患者死亡的首位原因[1]，經皮冠狀動脈介入術（PCI）是重要的治療手段之一。阿司匹林和P2Y12受體抑制劑組成的雙聯抗血小板治療 (DAPT) 則是PCI後預防支架內血栓形成的標準治療，但這可能增加出血風險[2-3]。縮短DAPT的持續時間旨在降低出血風險，尤其是在支架內低血栓形成風險的患者中[4-5]。除DAPT的最佳持續時間外，另一個問題是DAPT後是否能用P2Y12受體抑制劑替代阿司匹林[6-9]。對此，今年的美國心臟病學會（ACC 2024）為最佳化抗血小板策略提供了新思路。
基於此，“醫心有道”內科臨床診療思維提升專案“PCI 巡講重慶第三期”將於2024年6月21日（週五）19:30-21:00重磅推出，特邀陸軍特色醫學中心王紅勇教授、重慶醫科大學附屬第一醫院陳明教授、重慶市急救醫療中心沈鈞樂教授、重慶醫科大學附屬第一醫院王曦教授、重慶市大足區人民醫院宋文信教授深入解讀ACC 2024的熱點議題，並探討DAPT持續時間和需要遵循的單一抗血小板藥物的證據，旨在助力臨床診療，提高患者的生活質量。
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參考文獻：
[1]中國心血管健康與疾病報告編寫組. 中國心血管健康與疾病報告2022概要.中國迴圈雜誌, 2023, 38(6): 583-612.
[2]Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998;339(23):1665-1671.
[3]Schömig A, Neumann FJ, Kastrati A, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med. 1996;334(17):1084-1089.
[4]Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet. 2012;379(9824):1393-1402.
[5]Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012;125(23):2873-2891.
[6]Hahn JY, Song YB, Oh JH, et al. Effect of P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention: The SMART-CHOICE Randomized Clinical Trial [published correction appears in JAMA. 2019 Oct 1;322(13):1316. doi: 10.1001/jama.2019.14331]. JAMA. 2019;321(24):2428-2437.
[7]Watanabe H, Domei T, Morimoto T, et al. Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI: The STOPDAPT-2 Randomized Clinical Trial. JAMA. 2019;321(24):2414-2427.
[8]Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med. 2019;381(21):2032-2042.
[9]Vranckx P, Valgimigli M, Jüni P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet. 2018;392(10151):940-949.
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