合并高出血及缺血风险急性冠脉综合征患者抗血小板治疗进展
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摘要
在急性冠脉综合征(ACS)患者中,出血和缺血事件的危险因素常同时存在,且部分临床特征本身即存在出血与缺血的双重风险。因此,存在相当数量的合并出血及缺血双重高危的ACS患者人群,如老年、女性、糖尿病、慢性肾病、卒中/短暂性脑缺血发作、心房颤动、贫血、消化道出血和复杂冠脉病变等。在ACS患者抗血小板治疗中,出血和缺血的平衡一直是高危患者治疗决策中的严峻挑战,尤其是合并出血及缺血双重高危的ACS患者。对这类患者应慎重选择抗血小板治疗,不仅要综合考虑出血和缺血相关的危险因素并重视出血与缺血的平衡,更需要从患者的临床特征出发,制定个体化的抗血小板治疗方案。本文对合并出血及缺血双重风险ACS患者的抗血小板治疗现状及相关研究进展进行分类综述,帮助早期识别该类患者,并根据风险评估采取个体化的抗血小板治疗,改善预后。
Risk factors of bleeding and ischemic events often coexist in patients with acute coronary syndrome( ACS),and some of the clinical symptoms inherently have a dual risk of bleeding and ischemia. Therefore,there are a considerable number of ACS patients with high dual risk of bleeding and ischemia,e. g.,elderly,women,population with diabetes,chronic kidney disease,stroke/transient ischemic attack,atrial fibrillation,anemia,gastrointestinal hemorrhage,and complex coronary lesions,etc. In the antiplatelet therapy of ACS patients,the balance between bleeding and ischemia has always been a challenge in the decision-making for high-risk patients,especially those with high dual risk of bleeding and ischemia. For these patients,antiplatelet therapy should be selected with caution. Not only comprehensive consideration should be given to the risk factors associated with bleeding and ischemia but also great importance should be attached to the balance between bleeding and ischemia. It is also necessary to develop individualized antiplatelet therapy regimen based on the clinical symptoms of the patient. In this article,the current status of antiplatelet therapy in ACS patients with dual risk of bleeding and ischemia and the progress of related studies are classified and reviewed with the purpose to help early identification of such patients and adopt individualized antiplatelet therapy according to the risk assessment to improve the prognosis.
Risk factors of bleeding and ischemic events often coexist in patients with acute coronary syndrome( ACS),and some of the clinical symptoms inherently have a dual risk of bleeding and ischemia. Therefore,there are a considerable number of ACS patients with high dual risk of bleeding and ischemia,e. g.,elderly,women,population with diabetes,chronic kidney disease,stroke/transient ischemic attack,atrial fibrillation,anemia,gastrointestinal hemorrhage,and complex coronary lesions,etc. In the antiplatelet therapy of ACS patients,the balance between bleeding and ischemia has always been a challenge in the decision-making for high-risk patients,especially those with high dual risk of bleeding and ischemia. For these patients,antiplatelet therapy should be selected with caution. Not only comprehensive consideration should be given to the risk factors associated with bleeding and ischemia but also great importance should be attached to the balance between bleeding and ischemia. It is also necessary to develop individualized antiplatelet therapy regimen based on the clinical symptoms of the patient. In this article,the current status of antiplatelet therapy in ACS patients with dual risk of bleeding and ischemia and the progress of related studies are classified and reviewed with the purpose to help early identification of such patients and adopt individualized antiplatelet therapy according to the risk assessment to improve the prognosis.
引文
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