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Intracranial Hemorrhage During Dual Antiplatelet Therapy
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2021-09-20 , DOI: 10.1016/j.jacc.2021.07.048
Andrew C T Ha 1 , Deepak L Bhatt 2 , James T Rutka 3 , S Claiborne Johnston 4 , C David Mazer 5 , Subodh Verma 5
Affiliation  

Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 inhibitor is an established therapy for a broad spectrum of patients with cardiovascular disease. The ischemic benefit of DAPT is partially offset by its increased bleeding risk, with intracranial hemorrhage (ICH) being the most serious complication. Although uncommon (0.2%-0.3% annually), its cumulative burden can be substantial given the number of patients afflicted by cardiovascular disease worldwide. Patients with a history of stroke or transient ischemic attack harbor a particularly high risk for ICH when treated with DAPT. Prediction rules may assist clinicians when weighing the risk/benefit ratio of prescribing DAPT for patients with stroke/transient ischemic attack in the nonacute, ambulatory setting. Currently, there are no reversal agents that can rapidly and effectively reverse the effect of P2Y12 inhibitors in routine practice, although a reversal agent for ticagrelor is under clinical investigation.



中文翻译:

双重抗血小板治疗期间的颅内出血

使用乙酰水杨酸和 P2Y 12 的双重抗血小板治疗 (DAPT)抑制剂是一种适用于广泛心血管疾病患者的既定疗法。DAPT 的缺血益处被其增加的出血风险部分抵消,颅内出血 (ICH) 是最严重的并发症。尽管不常见(每年 0.2%-0.3%),但考虑到全世界患有心血管疾病的患者数量,其累积负担可能很大。有中风或短暂性脑缺血发作病史的患者在接受 DAPT 治疗时发生 ICH 的风险特别高。预测规则可以帮助临床医生权衡在非急性、非卧床环境中为卒中/短暂性脑缺血发作患者开具 DAPT 处方的风险/收益比。目前还没有能够快速有效逆转P2Y 12作用的逆转剂 尽管替格瑞洛的逆转剂正在临床研究中,但在常规实践中使用抑制剂。

更新日期:2021-09-21
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