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Combination antiplatelet treatment in coronary artery disease patients: A necessary evil or an overzealous practice?

机译:组合抗血小板治疗在冠状动脉疾病患者中:必要的邪恶或过多的做法?

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In seeking to improve care in coronary artery disease patients, further platelet inhibition has been occasionally applied beyond that provided by aspirin and a P2Y(12) receptor antagonist. This review aims to offer insights about the rationale, the efficacy and safety of combination antiplatelet therapy, involving three or more agents. Overall, the use of glycoprotein (GP) IIb/IIIa inhibitors did not significantly modify the treatment effect of different antiplatelet strategies, including double vs standard clopidogrel, prasugrel vs clopidogrel, ticagrelor vs clopidogrel, cangrelor vs clopidogrel, and vorapaxar vs placebo. With the caveat that the use of GP IIb/IIIa inhibitor was not randomized, adding such an agent to aspirin and a P2Y(12) receptor antagonist appears to carry a significantly increased bleeding potential. Moreover, adding vorapaxar to aspirin-and clopidogrel-treated patients is associated with more bleeding events, while the bleeding potential is further exacerbated in cases of quadruplicate antiplatelet treatment including aspirin, clopidogrel, vorapaxar, and a GP IIb/IIIa inhibitor. In ST-segment elevation, myocardial infarction patients' administration of an intravenous antiplatelet agent (GP IIb/IIIa inhibitor or cangrelor), in addition to aspirin and a P2Y(12) receptor antagonist, efficiently bridges the pharmacodynamic gap of oral agents. Cilostazol on top of aspirin and clopidogrel appears to be safe, although of questionable clinical benefit. In conclusion, combination antiplatelet therapy should be reserved only for selected cases and following thoughtful consideration of the associated risk/benefit ratio.
机译:在寻求改善冠状动脉疾病患者的护理时,偶尔施加进一步的血小板抑制超过阿司匹林和P2Y(12)受体拮抗剂提供的。该审查旨在提供关于理由,组合抗血小板治疗的疗效和安全性的见解,涉及三种或更多种药剂。总体而言,糖蛋白(GP)IIB / IIIA抑制剂的使用没有显着改变不同抗血小板策略的治疗效果,包括双与标准氯吡格雷,普拉西氏菌,丙吡咯与Clopidogrel,Cangrelor Vs Clopidogrel和Vorapaxar VS安慰剂。对于未随机化的使用GP IIB / IIIa抑制剂的警告,将这种试剂加入阿司匹林和P2Y(12)受体拮抗剂似乎携带显着增加的出血潜力。此外,将Vorapaxar添加到阿司匹林和氯吡格雷治疗的患者与更高的出现事件相关,而在包括阿司匹林,氯吡格雷,Vorapaxar和GP IIB / IIIa抑制剂的二份抗血小板治疗的情况下,出血潜力进一步加剧。在ST段抬高,心肌梗死患者施用静脉内抗血小板剂(GP IIB / IIIA抑制剂或植物),除阿司匹林和P2Y(12)受体拮抗剂外,有效地桥接口服剂的药效间隙。阿司匹林和氯吡格雷的西洛司唑似乎是安全的,尽管有可疑的临床效益。总之,组合抗血小板治疗仅适用于所选病例,并在周到考虑相关的风险/益效率。

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