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《Cardiovascular Revascularization Medicine》2019,20(12):1134-1139
BackgroundAnti-thrombotic regimen in patients on long term anticoagulation requiring coronary intervention remains a clinical challenge.MethodsWe performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of triple therapy (dual antiplatelet therapy and anticoagulant) with dual therapy (P2Y12 inhibitor and anticoagulant) in patients on long-term anticoagulants after percutaneous coronary intervention (PCI). Major bleeding was the primary outcome.ResultsThree observational studies and 3 randomized controlled trials with a total of 6654 patients met our selection criteria. At a mean follow up of 12.5 months major bleeding was lower in dual therapy cohort compared to triple therapy (2.2% vs 5.2%, RR 0.60, 95% CI 0.44–0.81, P = 0.001). No difference was observed between the two groups for major adverse cardiac events (11.8% vs 13.0%, RR 1.03, CI 0.79–1.34, P = 0.85), all-cause mortality (3.9% vs 5.6%, RR 0.94, CI 0.65–1.36, P = 0.76), myocardial infarction (3.7% vs 3.9%, RR 1.12, CI 0.83–1.50, P = 0.47), target vessel revascularization (6.8% vs 7.1%, RR 1.12, CI 0.72–1.74, P = 0.60), thromboembolic events (1.3% vs 1.6%, RR 0.95, CI 0.55–1.64, P = 0.85) and stent thrombosis (1.3% vs 1.4%, RR1.36, CI 0.84–2.21, P = 0.21).ConclusionFor patients undergoing PCI and requiring long term anticoagulation, a strategy of P2Y12 inhibitor plus anticoagulant confers a benefit of less major bleeding with no difference in major adverse cardiac events, mortality, myocardial infarction, target vessel revascularization, stent thrombosis or thromboembolism compared with triple therapy. 相似文献
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冠心病介入抗栓治疗相关最新进展概要 总被引:1,自引:0,他引:1
近年经皮冠状动脉介入治疗(PCI)相关抗栓领域取得了许多关键性的进展。以TWILIGHT等研究为代表的降阶治疗探索是目前PCI术后抗血小板策略研究的主流方向之一,而在合并心房颤动PCI患者中,联合新型口服抗凝药物的双联或短程三联抗栓方案的有效和安全性已获多项新研究的印证。比伐芦定新的研究结果将更新直接PCI抗凝的循证证... 相似文献
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Patients undergoing percutaneous coronary intervention (PCI) have an increased risk of both ischemic events and bleeding complications resulting from antithrombotic therapy. These events are particularly common in patients with a concomitant indication for oral anticoagulation, such as those with atrial fibrillation, and are associated with a substantial healthcare resource burden. Advances in procedural aspects of PCI have led to marked improvements in outcomes and a consequent reduction in the costs resulting from PCI-associated complications. Furthermore, recent randomized clinical trials have investigated the optimal antithrombotic strategy in the specific case of patients with atrial fibrillation undergoing PCI, leading to a shift toward the tailoring of antithrombotic therapy according to the patient’s individual stroke and bleeding risks. Here we review these recent advances, with a particular focus on the improvements in antithrombotic strategies offered by the non-vitamin K antagonist oral anticoagulants. 相似文献
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Yan YAN Xiao WANG Jing–Yao FAN Shao–Ping NIE Sergio Raposeiras-Roubín Emad Abu-Assi Jose P Simao Henriques Fabrizio D''Ascenzo Jorge Saucedo José R González-Juanatey Stephen B Wilton Wouter J Kikkert Iván Nu?ez-Gil Albert Ari-za-Sole Xian–Tao SONG Dimitrios Alexopoulos Christoph Liebetrau Tetsuma Kawaji Claudio Moretti Zenon Huczek Toshiharu Fujii Luis CL Correi Masa-aki Kawashiri Sasko Kedev 《老年心脏病学杂志》2017,14(11):679-687
Objective The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world setting. Methods We retrospectively analyzed data from an international, multi-center registry between 2003 and 2014 (n = 15,401). Patients with ACS and receiving OAC after PCI were screened. The composite primary endpoint was 1-year all-cause death, re-infarction, or severe bleeding. Results The final analysis enrolled 642 patients including 62 patients (9.7%) with OAC and clopidogrel (dual therapy), and 580 patients (90.3%) with the combination of aspirin, OAC and clopidogrel (triple therapy). Patients on triple therapy were more often female and were more likely to have comorbidities. There was no significant difference regarding the primary end point between dual therapy with triple therapy patients [17.74% vs. 17.24%; unadjusted hazard ratio (HR): 1.035; 95% confidence interval (CI): 0.556–1.929; adjusted HR: 1.026; 95% CI: 0.544–1.937]. However, the re-infarction rate was significantly higher in dual therapy than triple therapy patients (14.52% vs. 5.34%; unadjusted HR: 2.807; 95% CI: 1.329–5.928; adjusted HR: 2.333; 95% CI: 1.078–5.047). In addition, there was no difference between two regimes in all-cause death and severe bleeding. Conclusions In real-life patients with ACS following PCI and with an indication of OAC, triple therapy was not associated with an increased rate of adverse outcomes compared to dual therapy. Moreover, it decreased risk of re-infarction and did not increase risk of severe bleeding. 相似文献
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心房颤动常与冠心病并存,需要联合抗凝和抗血小板治疗以减少卒中和心血管事件风险,但联合抗栓治疗增加出血风险,需权衡抗栓治疗的利弊。目前,尚缺乏大规模临床证据。本文对相关临床证据和国内外指南推荐进行综述。 相似文献
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Background:The efficacy of double antithrombotic therapy (DAT) vs. triple antithrombotic therapy (TAT) for prevention of bleeding and ischemic events in patients with atrial fibrillation following percutaneous coronary intervention (PCI) is unclear in those subgroups defined by the 5 factors (i.e., sex, age, race, history of diabetes, and type of P2Y12 inhibitor). We aimed to assess the efficacy of DAT vs TAT in these patient subgroups.Methods:We searched PubMed and relevant websites to include related randomized controlled trials (RCTs). Two endpoints of interest were clinically significant bleeding and major adverse cardiac events (MACE). Meta-analysis was performed stratified by 5 factors of interest (i.e., sex, age, race, history of diabetes, and type of P2Y12 inhibitor) to obtain pooled hazard ratio (HR) and 95% confidence interval (CI). Meta-regression analysis was conducted to evaluate subgroup effects. We detected publication bias by Egger test and funnel plots.Results:We included 4 RCTs for meta-analysis. DAT vs TAT significantly reduced the risk of clinically significant bleeding (HR 0.56, 95% CI 0.50–0.63). This effect of DAT was observed in most subgroups of interest (HR ranged from 0.54 to 0.69), and was consistent across various subgroups defined by each of the 5 factors of interest (Psubgroup ranged from 0.290 to 0.794). DAT vs TAT led to the similar risk of MACE (HR 0.98, 95% CI 0.89–1.08). This effect of DAT was observed in all subgroups of interest (all 95% CIs of HRs were across 1.0), and was consistent across various subgroups defined by each of the 5 factors of interest (Psubgroup ranged from 0.308 to 0.828). Publication bias was found only in one subgroup.Conclusions:Compared with TAT, DAT significantly reduces the risk of clinically significant bleeding and leads to the similar risk of MACE in patients with atrial fibrillation following PCI, irrespective of sex, age, race, history of diabetes, and type of P2Y12 inhibitor used at baseline. 相似文献
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Journal of Thrombosis and Thrombolysis - Patients with atrial fibrillation who undergo percutaneous coronary intervention are at increased risk for both coronary and cerebral thrombotic events. As... 相似文献
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Coronary artery disease coexists in a clinically relevant number of patients with atrial fibrillation and it often requires percutaneous coronary intervention. These patients represent a particular challenge for clinicians in terms of antithrombotic management. They require combined antiplatelet–anticoagulant therapy to reduce the risk of recurrent ischemic cardiac events and stroke; however, this antithrombotic strategy is associated with an increased risk of bleeding complications. In the absence of randomized, controlled clinical trials, the majority of current recommendations rely on the results of cohort studies, meta-analyses, post-hoc analyses and subgroup analyses of large, phase III studies. Based on the available evidence, the present review discusses the optimal antithrombotic strategy for patients receiving chronic anticoagulant therapy due to atrial fibrillation who require antiplatelet treatment after acute coronary syndrome and/or percutaneous coronary intervention, and discusses the issue of dental procedures. The correct planning of therapy significantly reduces the risk of bleeding complications and thromboembolic events.Key messagesIn order to reduce the occurrence of recurrent cardiac ischemic events and stroke, anticoagulated patients with acute coronary syndrome and/or percutaneous coronary intervention require a combination of therapies including anticoagulants and antiplatelet drugs.Using the newest optimal combination of therapeutic strategies reduces the risk of haemorrhagic complications. 相似文献
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Gerald Chi Megan K. Yee Arzu Kalayci Mathieu Kerneis Fahad AlKhalfan Roxana Mehran Christoph Bode Jonathan L. Halperin Freek W. A. Verheugt Peter Wildgoose Martin van Eickels Gregory Y. H. Lip Marc Cohen Eric D. Peterson Keith A. A. Fox C. Michael Gibson 《Journal of thrombosis and thrombolysis》2018,46(3):346-350
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Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients(more than 60 years old) with non-valvular atrial fibrillation(NVAF) and acute coronary syndrome(ACS) / percutaneous coronary intervention(PCI).Methods This study enrolled 381 elderly patients [mean age(69.95 ± 8.41) years; 289 males, 92 females]with NVAF and ACS / PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups: triple therapy(TT) group, dual antiplatelet therapy(DAT) group,vitamin K antagonist(VKA) plus single antiplatelet therapy(SAT) group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients(9.97%) received TT and 300 patients(78.74%) received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2-VASc≥2 and HAS-BLED 3. Conclusions Elderly patients who suffered NVAF and ACS / PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT. 相似文献
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目的对于我院>75岁老年非瓣膜病心房颤动(房颤)患者抗血栓药物治疗的情况进行调查,了解用药现状。方法调查>75岁非瓣膜病房颤患者125例,对其危险因素及抗血栓药物使用情况进行分析。结果125例患者中,合并多种危险因素者多见,其中应用华法林者只有30例(24.0%),应用阿司匹林者54例(43.2%),其他抗血小板药物29例(23.2%),未应用抗血栓药物12例(9.6%)。阿司匹林及其他抗血小板口服药剂量为每天75~100 mg。结论>75岁老年非瓣膜病房颤患者华法林应用率低,抗血小板药使用率高,但用药剂量偏小。 相似文献
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心房颤动(房颤)是经皮冠状动脉介入治疗(PCI)术后常见的并发症,PCI术后罹患房颤的高危因素有年龄、性别、冠心病类型、再灌注以及PCI术的操作.除去这些因素的统计学分析发现PCI术后新发房颤与院内死亡率无关,但可以预示1年死亡率的增加.通过适当的临床干预可以明显减少PCI术后房颤的并发症. 相似文献