稳定型缺血性心脏病应该使用阿司匹林还是 P2Y12 抑制剂单药治疗?

IF 5.7 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Current Atherosclerosis Reports Pub Date : 2024-11-01 Epub Date: 2024-09-07 DOI:10.1007/s11883-024-01234-2
Rishi Chandiramani, Adhya Mehta, Roger S Blumenthal, Marlene S Williams
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引用次数: 0

摘要

综述目的:总结有关稳定型缺血性心脏病患者阿司匹林或 P2Y12 抑制剂单药治疗的最新证据和指南建议,并就这一主题的未来发展方向提供见解,其中涉及向出血和血栓风险的个性化评估过渡:阿司匹林作为冠心病患者二级预防的基础成分的证据是否与当代药物干预策略相一致,一直是个问题。最近的HOST-EXAM研究将接受双联抗血小板治疗6至18个月而未发生缺血性或大出血事件的患者随机分配到氯吡格雷或阿司匹林治疗24个月,结果显示氯吡格雷治疗组患者的血栓和出血并发症发生率明显低于阿司匹林治疗组。患者层面的PANTHER荟萃分析表明,对于已确诊的冠心病患者,与阿司匹林单药治疗相比,P2Y12抑制剂单药治疗可降低心肌梗死、支架血栓以及消化道出血和出血性中风的发生率,尽管全因死亡率、心血管死亡率和大出血的发生率相似。建议将长期小剂量阿司匹林用于稳定型缺血性心脏病患者的二级预防,氯吡格雷单药疗法被认为是一种可行的替代疗法。经皮冠状动脉介入治疗后 6 个月的双联抗血小板疗法仍是稳定型缺血性心脏病患者的标准建议。不过,根据对患者风险状况的个体化评估,可以缩短双联抗血小板疗法的持续时间,然后使用 P2Y12 抑制剂单药治疗或延长治疗时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Should We Use Aspirin or P2Y<sub>12</sub> Inhibitor Monotherapy in Stable Ischemic Heart Disease?

Should We Use Aspirin or P2Y12 Inhibitor Monotherapy in Stable Ischemic Heart Disease?

Purpose of review: To summarize the recent evidence and guideline recommendations on aspirin or P2Y12 inhibitor monotherapy in patients with stable ischemic heart disease and provide insights into future directions on this topic, which involves transition to a personalized assessment of bleeding and thrombotic risks.

Recent findings: It has been questioned whether the evidence for aspirin as the foundational component of secondary prevention in patients with coronary artery disease aligns with contemporary pharmaco-invasive strategies. The recent HOST-EXAM study randomized patients who had received dual antiplatelet therapy for 6 to 18 months without ischemic or major bleeding events to either clopidogrel or aspirin for a further 24 months, and demonstrated that the patients in the clopidogrel arm had significantly lower rates of both thrombotic and bleeding complications compared to those in the aspirin arm. The patient-level PANTHER meta-analysis showed that in patients with established coronary artery disease, P2Y12 inhibitor monotherapy was associated with lower rates of myocardial infarction, stent thrombosis as well as gastrointestinal bleeding and hemorrhagic stroke compared to aspirin monotherapy, albeit with similar rates of all-cause mortality, cardiovascular mortality and major bleeding. Long-term low-dose aspirin is recommended for secondary prevention in patients with stable ischemic heart disease, with clopidogrel monotherapy being acknowledged as a feasible alternative. Dual antiplatelet therapy for six months after percutaneous coronary intervention remains the standard recommendation for patients with stable ischemic heart disease. However, the duration of dual antiplatelet therapy may be shortened and followed by P2Y12 inhibitor monotherapy or prolonged based on individualized evaluation of the patient's risk profile.

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来源期刊
CiteScore
9.00
自引率
3.40%
发文量
87
审稿时长
6-12 weeks
期刊介绍: The aim of this journal is to systematically provide expert views on current basic science and clinical advances in the field of atherosclerosis and highlight the most important developments likely to transform the field of cardiovascular prevention, diagnosis, and treatment. We accomplish this aim by appointing major authorities to serve as Section Editors who select leading experts from around the world to provide definitive reviews on key topics and papers published in the past year. We also provide supplementary reviews and commentaries from well-known figures in the field. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.
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