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Complexity of Antiplatelet Therapy in Coronary Artery Disease Patients.
American Journal of Cardiovascular Drugs ( IF 3 ) Pub Date : 2020-05-12 , DOI: 10.1007/s40256-020-00414-0
Pierre Sabouret 1 , Michael P Savage 2 , David Fischman 2 , Francesco Costa 3
Affiliation  

Patients with coronary artery disease (CAD) presenting with acute coronary syndrome or undergoing coronary stenting are indicated to treatment with dual antiplatelet therapy (DAPT) combining aspirin with a P2Y12 receptor inhibitor. The management of patients with CAD who present with a complex clinical profile due to multiple comorbidities, and/or undergoing complex interventional procedures, remains challenging as a high risk for both ischemic and bleeding events is often present; hence, the risk-benefit balance on the optimal DAPT duration is difficult to evaluate. The complexity of antiplatelet therapy in CAD patients is due to the fact that this complexity embraces several aspects: the coronary anatomy, the number of vascular districts at risk for atherothrombosis, and patient comorbidities, including global frailty. Recent randomized and epidemiological studies have highlighted subgroups that could benefit from prolonged antithrombotic treatment, as well as frail patients, who may be better suited to a shorter course of therapy. We provide an overview of the current knowledge regarding treatment with DAPT, along with suggestions on its management.

中文翻译:

冠状动脉疾病患者抗血小板治疗的复杂性。

患有急性冠状动脉综合征或接受冠状动脉支架置入术的冠状动脉疾病 (CAD) 患者需要联合阿司匹林和 P2Y12 受体抑制剂的双重抗血小板治疗 (DAPT) 进行治疗。因多种合并症而呈现复杂临床特征和/或接受复杂介入手术的 CAD 患者的管理仍然具有挑战性,因为缺血和出血事件的高风险经常存在;因此,难以评估最佳 DAPT 持续时间的风险收益平衡。CAD 患者抗血小板治疗的复杂性是由于这种复杂性包括几个方面:冠状动脉解剖结构、存在动脉粥样硬化血栓形成风险的血管区数量,以及患者的合并症,包括全身虚弱。最近的随机和流行病学研究强调了可以从长期抗血栓治疗中受益的亚组,以及可能更适合较短疗程的虚弱患者。我们概述了有关 DAPT 治疗的当前知识,以及对其管理的建议。
更新日期:2020-05-12
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