PDF(Pubmed)
Abstract：
Dual antiplatelet therapy (DAPT) with the combination of clopidogrel and aspirin is recommended for preventing secondary ischemic events in patients with acute coronary syndrome (ACS) or acute ischemic stroke (AIS). Proton pump inhibitors (PPIs) are suggested as preventive treatment for these patients. Due to clopidogrel-PPI interactions, separating their administration might be considered. However, a paucity of studies has been conducted to investigate the outcome differences between concurrent and interval-based use in ACS and AIS patients. Our study aimed to evaluate clinical outcomes based on administration timing. This study included patients with ACS or AIS onset or recurrence of within the last month. Patients who were expected to receive DAPT for at least 6 months and who were currently taking or planning to take esomeprazole were included. Patients were divided into Group 1 (interval administration group, IA group) and Group 2 (concurrent administration group, CA group) according to the interval between esomeprazole and DAPT administration. The time interval was based on 12 hours. The primary outcome was the occurrence of major adverse cardiocerebrovascular events (MACCEs), and safety outcomes were defined as major bleeding, minor bleeding and gastrointestinal bleeding and intracranial hemorrhage. A total of 3600 patients completed this study. The proportions of patients in the 2 groups were as follows: CA group, 99% (n = 3489) and IA group, 1% (n = 111). The primary outcome occurred in 0.9% of patients in the IA group and 1.8% of patients in the CA group (P = .51). There was no significant distinction in the overall bleeding risk of the CA group compared to that of the IA group (2.75% in the CA group and 2.70% in the IA group). Additionally, there was no significant difference observed between the 2 groups for safety outcomes. This multicenter, prospective, observational study that enrolled patients with ACS or AIS demonstrated that there was no significant difference in the occurrence of MACCEs and bleeding issues within 6 months according to the medication administration interval. The majority of patients with DAPT were taking PPIs simultaneously in real-world practice.
摘要：
在急性冠脉综合征（ACS）或急性缺血性卒中（AIS）患者中，推荐联合使用氯吡格雷和阿司匹林的双重抗血小板治疗（DAPT）用于预防继发性缺血事件。建议将质子泵抑制剂（PPI）作为这些患者的预防性治疗。由于氯吡格雷-PPI相互作用，可以考虑将他们的管理分开。然而,在ACS和AIS患者中,很少有研究调查同时使用和基于间期使用之间的结局差异.我们的研究旨在根据给药时机评估临床结果。这项研究包括ACS或AIS发病或复发的患者。纳入预期接受DAPT至少6个月且目前正在服用或计划服用埃索美拉唑的患者。患者分为第1组（间隔给药组，IA组）和第2组（同时给药组，CA组）根据埃索美拉唑和DAPT给药之间的间隔。时间间隔基于12小时。主要结局是主要不良心脑血管事件（MACCEs）的发生，安全性结果定义为大出血，轻微出血和消化道出血及颅内出血。共有3600名患者完成了这项研究。两组患者的比例如下：CA组，99%(n=3489)和IA组，1%(n=111)。主要结局发生在IA组中0.9%的患者和CA组中1.8%的患者(P=0.51)。与IA组相比，CA组的总体出血风险没有显着差异（CA组为2.75％，IA组为2.70％）。此外,两组的安全性结局无显著差异.这个多中心，prospective,纳入ACS或AIS患者的观察性研究表明,根据用药间隔,6个月内MACCEs和出血问题的发生率无显著差异.大多数DAPT患者在现实世界的实践中同时服用PPI。
