Guideline versus clinician recommended duration of dual antiplatelet therapy following acute coronary syndrome (ANZACS-QI 78).

Sophie J Rees, Andrew J Kerr
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Abstract

AIM The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) for patients without atrial fibrillation varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. Patients on DAPT with a high risk of gastrointestinal bleeding are also recommended to receive a proton pump inhibitor (PPI). Our aim was to audit current practice against the 2020 European Society of Cardiology (ESC) guideline recommendations. METHODS One hundred consecutive ACS patients treated with percutaneous coronary intervention discharged from Middlemore Hospital and without atrial fibrillation in the first quarter of 2023 were studied. ANZACS-QI ischaemic (I) and bleeding (B) risk scores were calculated, with patients categorised in four groups based on ESC recommendations-low I/low B risk, low I/high B, high I/low B and high I/high B. Guideline and clinician recommended duration of DAPT and prescription of PPI were compared. RESULTS All patients were planned for DAPT at discharge and 91% a PPI. Up to four out of five ACS patients could have been planned for shorter DAPT durations based on the ESC guideline recommendations. Over half of included patients (53%) had a high bleeding risk, yet 85% of these patients received 12 months of DAPT despite ESC recommendations of 1-3 months. CONCLUSIONS There was a divergence between clinical practice and the recommendations of the 2020 ESC guidelines. We discuss these results in relation to the updated August 2023 ESC guidelines, which have reaffirmed a 12-month duration of DAPT as the default position.
急性冠状动脉综合征(ANZACS-QI 78)后双联抗血小板疗法的指南与临床医生推荐的持续时间。
摘要:根据缺血和大出血风险的平衡,建议无心房颤动的急性冠状动脉综合征(ACS)患者接受双联抗血小板疗法(DAPT)的时间从 1 个月到 1 年不等。此外,还建议胃肠道出血风险较高的 DAPT 患者服用质子泵抑制剂 (PPI)。我们的目的是对照 2020 年欧洲心脏病学会 (ESC) 指南的建议,对目前的做法进行审核。方法研究了 2023 年第一季度从米德尔摩医院出院的 100 例经皮冠状动脉介入治疗的连续 ACS 患者,这些患者均无心房颤动。研究人员计算了ANZACS-QI缺血(I)和出血(B)风险评分,并根据ESC建议将患者分为四组--低I/低B风险、低I/高B风险、高I/低B风险和高I/高B风险。结果所有患者出院时均计划接受DAPT治疗,91%的患者接受了PPI治疗。根据ESC指南的建议,多达五分之四的ACS患者可计划缩短DAPT持续时间。结论临床实践与 2020 年 ESC 指南的建议之间存在分歧。我们结合 2023 年 8 月更新的 ESC 指南对这些结果进行了讨论,该指南重申了 12 个月的 DAPT 疗程是默认情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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