复杂经皮冠状动脉介入治疗中的抗血栓治疗。

IF 9.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Domenico Simone Castiello, Angelo Oliva, Giuseppe Andò, Giampaolo Niccoli, Francesco Pelliccia, Elisabetta Moscarella, Rocco Antonio Montone, Felice Gragnano, Italo Porto, Paolo Calabrò, Salvatore De Rosa, Carmen Anna Maria Spaccarotella, Enrico Fabris, Giovanni Esposito, Ciro Indolfi, Gianfranco Sinagra, Pasquale Perrone Filardi, Raffaele Piccolo, On Behalf Of The Working Group Of Interventional Cardiology Of The Italian Society Of Cardiology
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引用次数: 0

摘要

在过去的几十年里,经皮冠状动脉介入治疗(PCI)已成为心肌血运重建术中最常用的方式,并且越来越多地用于晚期冠状动脉疾病患者。抗血栓治疗,包括抗血小板和抗凝药物,起着关键作用,应该是早期和长期预防缺血事件的最佳血运重建策略的一部分。增加强度和/或持续时间的抗血栓治疗方案可能减轻与复杂PCI相关的部分缺血负担。然而,接受复杂PCI的患者往往出血风险增加,因此,决策过程具有挑战性。在这种情况下,最佳的抗血栓治疗仍然是一个有争议的问题,并已成为一个深入研究的领域。在这篇最新的综述中,我们分析了与接受复杂PCI的患者围手术期和长期抗血栓治疗相关的不同方法的证据。由于“一刀切”的方法在这种临床环境中是不合理的,我们的目标是根据每位患者的情况和PCI复杂性量身定制抗血栓策略。我们讨论了可以为接受复杂PCI的患者选择的抗血栓治疗方案的类型和持续时间,重点是长期双重抗血小板治疗,P2Y12受体抑制剂单药治疗和双途径抑制。我们还讨论了特定情况下(左主干疾病、冠状动脉分叉、慢性全闭塞)和需要口服抗凝治疗的复杂PCI患者的抗血栓管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antithrombotic therapy in complex percutaneous coronary intervention.

Over the past decades, percutaneous coronary intervention (PCI) has become the most common modality for myocardial revascularisation, and it is increasingly used in patients with advanced coronary artery disease. Antithrombotic therapy, including antiplatelet and anticoagulant drugs, plays a key role and should be part of the optimal revascularisation strategy in the early phase as well as in the long-term prevention of ischaemic events. An antithrombotic therapy regimen of increased intensity and/or duration may mitigate part of the ischaemic burden associated with complex PCI. However, patients undergoing complex PCI are often at increased bleeding risk, challenging, therefore, the decision-making process. In this setting, the optimal antithrombotic treatment is still a matter of debate and has become a field of intensive research. In this state-of-the-art review, we analyse the evidence related to the different approaches regarding the periprocedural and long-term antithrombotic management of patients undergoing complex PCI. Since a "one-size-fits-all" approach cannot be justified in this clinical setting, our aim is to tailor the antithrombotic strategy to each patient's profile and PCI complexity. We discuss the type and duration of antithrombotic regimens that can be selected for patients undergoing complex PCI, with a focus on prolonged dual antiplatelet therapy, P2Y12 receptor inhibitor monotherapy, and dual pathway inhibition. We also address antithrombotic management in specific scenarios (left main disease, coronary bifurcations, chronic total occlusion) and in patients undergoing complex PCI who require oral anticoagulant therapy.

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来源期刊
Eurointervention
Eurointervention CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
4.80%
发文量
380
审稿时长
3-8 weeks
期刊介绍: EuroIntervention Journal is an international, English language, peer-reviewed journal whose aim is to create a community of high quality research and education in the field of percutaneous and surgical cardiovascular interventions.
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