Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk.

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Opinion in Cardiology Pub Date : 2023-11-01 Epub Date: 2023-07-28 DOI:10.1097/HCO.0000000000001075
Zaid I Almarzooq, Nora M Al-Roub, Scott Kinlay
{"title":"Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk.","authors":"Zaid I Almarzooq, Nora M Al-Roub, Scott Kinlay","doi":"10.1097/HCO.0000000000001075","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI).</p><p><strong>Recent findings: </strong>Patients with HBR after PCI include those with advanced age (e.g. >75 years of age), a prior history of major bleeding, anemia, chronic kidney disease, and those with indications for long-term anticoagulation. Strategies that successfully decrease bleeding risk in this population include shorter durations of dual antiplatelet therapy (DAPT; of 1-3 months) followed by single antiplatelet therapy with aspirin or a P2Y 12 inhibitor, or de-escalating from a more potent P2Y 12 inhibitor (prasugrel or ticagrelor) to less potent antiplatelet regimens (aspirin with clopidogrel or half-dose ticagrelor or half-dose prasugrel). Patients on DAPT, and a full dose anticoagulation for other indications, have a lower risk of major bleeding without an increase in 1-2-year adverse ischemic events, when rapidly switched from DAPT to a single antiplatelet therapy (within a week after PCI) with aspirin or clopidogrel. Longer term data on the benefits and risks of these strategies is lacking.</p><p><strong>Summary: </strong>In patients with HBR after PCI, shorter durations of DAPT (1-3 months) decrease the risk of major bleeding without increasing the risk of adverse ischemic events.</p>","PeriodicalId":55197,"journal":{"name":"Current Opinion in Cardiology","volume":" ","pages":"515-520"},"PeriodicalIF":2.0000,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592282/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HCO.0000000000001075","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/28 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose of review: Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI).

Recent findings: Patients with HBR after PCI include those with advanced age (e.g. >75 years of age), a prior history of major bleeding, anemia, chronic kidney disease, and those with indications for long-term anticoagulation. Strategies that successfully decrease bleeding risk in this population include shorter durations of dual antiplatelet therapy (DAPT; of 1-3 months) followed by single antiplatelet therapy with aspirin or a P2Y 12 inhibitor, or de-escalating from a more potent P2Y 12 inhibitor (prasugrel or ticagrelor) to less potent antiplatelet regimens (aspirin with clopidogrel or half-dose ticagrelor or half-dose prasugrel). Patients on DAPT, and a full dose anticoagulation for other indications, have a lower risk of major bleeding without an increase in 1-2-year adverse ischemic events, when rapidly switched from DAPT to a single antiplatelet therapy (within a week after PCI) with aspirin or clopidogrel. Longer term data on the benefits and risks of these strategies is lacking.

Summary: In patients with HBR after PCI, shorter durations of DAPT (1-3 months) decrease the risk of major bleeding without increasing the risk of adverse ischemic events.

高出血风险患者经皮冠状动脉介入治疗后的抗凝治疗。
综述目的:回顾经皮冠状动脉介入治疗(PCI)后高出血风险(HBR)患者不同抗血栓策略的临床结果。最近的研究结果:PCI后的HBR患者包括高龄患者(例如>75 年龄),既往有大出血、贫血、慢性肾脏疾病史,以及有长期抗凝适应症的患者。成功降低该人群出血风险的策略包括缩短双重抗血小板治疗(DAPT;1-3 月),然后用阿司匹林或P2Y12抑制剂进行单次抗血小板治疗,或从更强效的P2Y12抑制物(普拉格雷或替卡格雷)降级为药效较低的抗血小板方案(阿司匹林加氯吡格雷或半剂量替卡格雷或半剂量普拉格雷)。当从DAPT快速转换为阿司匹林或氯吡格雷的单一抗血小板治疗(PCI后一周内)时,接受DAPT和针对其他适应症的全剂量抗凝治疗的患者发生大出血的风险较低,且1-2年的不良缺血事件不会增加。缺乏关于这些战略的益处和风险的长期数据。总结:在经皮冠状动脉介入治疗后的HBR患者中,DAPT持续时间较短(1-3 月)降低大出血的风险,而不增加不良缺血性事件的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信