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Abstract：
Following percutaneous coronary intervention (PCI), an initial course of dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12 inhibitor ( P2Y 12 -i) is recommended to minimize the risk of thrombotic complications. After the initial period of DAPT, antiplatelet monotherapy, usually consisting of aspirin, is administered for long-term secondary prevention. However, over the last few years there has been accruing evidence on P2Y 12 -i monotherapy, both in the acute (i.e., post-PCI; after a brief period of DAPT, transitioning to monotherapy before six or 12 months in patients with chronic or acute coronary syndrome, respectively) and chronic (i.e., long-term secondary prevention; after completion of six or 12 months of DAPT, in patients with chronic or acute coronary syndrome, respectively) settings. In aggregate, most studies of short DAPT with transition to P2Y 12 -i monotherapy showed a reduced risk of bleeding complications, without any significant increase in ischemic events as compared to standard DAPT. On the other hand, the evidence on long-term P2Y 12 -i monotherapy is scarce, but results from a randomized trial showed that clopidogrel monotherapy outperformed aspirin monotherapy in terms of net benefit, ischemic events and bleeding. Antiplatelet therapy is also recommended for patients undergoing PCI and with an established indication for long-term oral anticoagulation (OAC). In this scenario, a brief period of triple therapy (i.e., aspirin, P2Y 12 -i and OAC) is followed by a course of dual antithrombotic therapy (usually with P2Y 12 -i and OAC) and ultimately by lifelong OAC alone. European and American guidelines have been recently updated to provide new recommendations on antithrombotic therapy, including the endorsement of P2Y 12 -i monotherapy in different settings. However, some areas of uncertainty still remain and further randomized investigations are ongoing to fulfil current gaps in knowledge. In this review, we assess the current knowledge and evidence on P2Y 12 -i monotherapy for the early and long-term secondary prevention in patients undergoing PCI, and explore upcoming research and future directions in the field.
摘要：
经皮冠状动脉介入治疗（PCI）后，推荐使用阿司匹林和P2Y12抑制剂(P2Y12-i)的双重抗血小板治疗(DAPT)的初始疗程,以最大限度地降低血栓并发症的风险.在DAPT的初始阶段之后，抗血小板单药治疗,通常由阿司匹林组成，用于长期二级预防。然而,在过去的几年里，有关于P2Y12-i单一疗法的证据，两者都处于急性状态(即，PCI术后；经过短暂的DAPT，慢性或急性冠状动脉综合征患者在6个月或12个月前过渡到单药治疗，分别)和慢性(即，长期二级预防；完成6个月或12个月的DAPT后，慢性或急性冠脉综合征患者，分别)设置。总的来说,大多数短期DAPT过渡到P2Y12-i单一疗法的研究显示出血并发症的风险降低，与标准DAPT相比，缺血事件没有任何显著增加。另一方面,长期P2Y12-i单一疗法的证据很少，但是一项随机试验的结果表明，氯吡格雷单药治疗在净获益方面优于阿司匹林单药治疗，缺血事件和出血。抗血小板治疗也建议接受PCI和长期口服抗凝（OAC）的患者。在这种情况下，短暂的三联疗法(即，阿司匹林,P2Y12-i和OAC）之后是一个疗程的双重抗血栓治疗（通常使用P2Y12-i和OAC），最后是终身OAC。欧洲和美国的指南最近更新，为抗血栓治疗提供了新的建议。包括在不同情况下批准P2Y12-i单药治疗。然而,一些不确定的领域仍然存在,进一步的随机调查正在进行中,以填补目前的知识空白.在这次审查中,我们评估了目前关于P2Y12-i单药用于PCI患者早期和长期二级预防的知识和证据,并探讨了该领域即将开展的研究和未来的方向.
