急性冠状动脉综合征后双联抗血小板疗程的研究进展

急性冠状动脉综合征(ACS)发生后,无论是否进行血运重建治疗,国内外指南均建议患者接受阿司匹林联合P2Y12抑制剂的双联抗血小板治疗策略(DAPT)至少12个月以降低复发性动脉粥样硬化血栓风险。然而,现有证据表明ACS患者的残余缺血风险将持续超过12个月,在合并高危出血风险等特殊类型的ACS患者中延长DAPT疗程的获益存在争论。通过回顾近年国内外指南及文献,文章旨在提出以ACS病理生理机制为导向,结合新型药物支架技术及危险分层体系评估DAPT的出血风险与抗缺血事件获益,最大化获益/风险比,最终给予患者个体化、精准化的治疗方案。

Advances in duration of dual anti-platelet therapy after acute coronary syndrome

In order to reduce the risk of recurrent atherothrombotic thrombus, domestic and international guidelines recommend that patients receive aspirin combined with P2Y12 inhibitor dual antiplatelet therapy (DAPT) for at least 12 months after the occurrence of acute coronary syndrome (ACS). However, the existing evidence suggests that the risk of residual ischemia in ACS patients will last for more than 12 months, and the benefits of prolonging DAPT treatment in patients with special ACS (with high risk of bleeding) are still controversial. The purpose of this review is to provide an individualized and accurate treatment plan for the patients based on the pathophysiological mechanism of ACS, combined with stent type and risk stratification system to fully evaluate the bleeding risk and anti-ischemic event benefit of DAPT, and maximize the benefit/risk ratio.