AHA观点：放支架以后只吃一个月的双抗药物是安全可行的！
“ PCI置入支架后的抗凝治疗与生存链中的康复一环息息相关！”
教授你今天刷屏了！
本文援引在AmericanHeart Association Scientific Sessions 2020 – Late-Breaking Science（美国心脏协会2020科学会议最新科学进展），2020年11月15日美国心脏协会发布了韩国医生Myeong-KiHong M.D. Ph.D.的科研报告，Professor of cardiology at YonseiUniversity College of Medicine, Severance Cardiovascular Hospital, Seoul, Korea其同时是韩国首尔延世大学医学院教授，延世大学附属塞布伦斯心血管医院医生。其主要观点为: PCI治疗后服用双抗药物一个月停药是安全有效可行的。
01
—
先听听教授自己怎么说
'This study is the first randomized trial comparing one-year clinical outcomes of one-month ofdual anti-platelet therapy followed by aspirin monotherapy to the currently recommended dual anti-platelet therapy regimen in patients with coronary artery disease who are recovering from stent placement.’（这项研究是第一个随机对照比较双重抗血小板药物治疗一个月后服用血小板进行后期治疗以及现行推荐的双抗治疗对于冠状动脉疾病并进行了支架治疗的患者进行的疗效比较性研究。）
冠脉支架
教授认为，'Patients recovering from artery-opening procedures involving a stent are prescribed one or more anti-platelet medications (to help keep platelets from stickingtogether), typically for months, along with aspirin to prevent blood from clotting in the stent. This is known as dual anti-platelet therapy. Dualanti-platelet therapy, also known as DAPT, can pose a significant risk ofbleeding for patients who are already taking blood thinners.’（患者在接受了PCI治疗放置指教后往往会服用一种或多种抗血小板药物来避免血小板的粘集，一半疗程都会维持数月，同时服用阿司匹林来预防血液在支架上形成血凝块。这就是众所周知的双抗疗法。但是DAPT双抗疗法也会让患者处于出血风险之中，且风险较高。）
双抗到底要多久？争论声音挺大！
Most studies evaluating a shorter course of DAPT have focused on patients at high-risk for bleeding. Additionally, many recent studies have also focused on patients receiving a class of antiplatelet known as a P2Y12 inhibitor monotherapy rather than aspirin monotherapy after a shorter course of DAPT.（长期以来大部分的研究都在着重更短的DPAT治疗疗程，这主要是由于患者较高的出血风险。另外近期很多研究也同样关注于P2Y12类的单一治疗药物可以比阿司匹林更加容易见效的DAPT疗程。）
置入导管
造影看清楚哪里堵塞
血管成形术
导丝来导引
球囊充盈
支架置入
DES支架
02
—
这项研究的具体细节
Researchers inthis study evaluated and compared the safety and effectiveness of two durations of dual anti-platelet therapy in patients who had drug-eluting stent placementor polymer-free drug-coated stent placement and were not at a high-risk of bleeding.（这项研究主要评价和比较了药物洗脱支架植入或无聚合物药物涂层支架植入后分别用两种不同的疗程来服用双抗类药物之后的出血风险比较。）
药物洗脱支架
Across 23 medical centers in Korea, 3,020 Korean patients (mean age 67; 31% women) were randomly assigned to receive either:（在韩国主要的23个医学中心，3020名患者，其中31%为女性随机分配到了不同的组别）：
Severance Cardiovascular Hospital
one-month of dual anti-platelet therapy after polymer-free drug-coated stent placement followed by 11 months of aspirin alone;（一组为无聚合物药物涂层支架植入后服用一个月的双抗药物，然后在随后的11个月仅服用阿司匹林）or 6-12 months duration of anti-platelet therapy followed by 0-6 months of aspirin alone after drug-eluting stent placement procedure.（另一组为药物洗脱支架植入后6-12个月的双抗药物治疗伴随0-6个月的仅阿司匹林治疗疗程）。
无聚合物药物涂层支架
Most of thepatients (2,969) completed a one-year follow-up. Analysis found there was no significant difference in the number of cardiac events between the two groups: 5.9% of patients in the one-month treatment group died or had a heart attack, stroke, major bleeding or stent/ angioplasty procedure, compared to 6.5% in the 6- to 12-month treatment group.（大部分患者大约2969名完成了为期一年的随访，分析认为这两组之间的心血管事件在随后的一年内没有显著差异，只接受1个月双抗治疗的患者中有5.9%的患者发生死亡、心脏骤停、卒中、大出血或血管成形术过程中，而后一组则由6.5%的比例。）
DES支架
所以结论是，'It is encouraging to see that one-month dual anti-platelet therapy, followed by aspirin monotherapy after polymer-free drug-coated stent is effective and safe in adiverse group of patients with coronary artery disease. These results also could lead to the suggestion for some patients to discontinue a P2Y12 inhibitor, rather than aspirin, in daily clinical practice, which could result in better patient compliance, lower costs, a lower risk of bleeding, and overall, more convenience for both patients and physicians.（所以我们非常高兴地看到无聚合物药物涂层支架植入后进服用1个月的双抗再服用阿司匹林是有效并安全的。当然也同样建议一些患者无需继续每日进行P2Y12抑制剂的服用，这样可以获得更好的患者依从性，更低的药物消耗支出，减少出血的风险，最后让患者及医生都更加方便。）’
很有力！
扫描二维码
获取医养精彩
关注作者