医学
经皮冠状动脉介入治疗
传统PCI
心脏病学
内科学
心房颤动
心肌梗塞
华法林
氯吡格雷
达比加群
临床终点
随机对照试验
作者
Uwe Zeymer,Orly Leiva,Stefan H. Hohnloser,Philippe Gabriel Steg,Jonas Oldgren,Georg Nickenig,Róbert Gábor Kiss,Zeki Öngen,José Navarro Estrada,Ton Oude Ophuis,Gregory Y.H. Lip,Matias Nordaby,Corinna Miede,Jurriën M. ten Berg,Deepak L. Bhatt,Christopher P. Cannon
出处
期刊:Eurointervention
[Europa Digital and Publishing]
日期:2021-08-01
卷期号:17 (6): 474-480
被引量:5
标识
DOI:10.4244/eij-d-20-00799
摘要
Little is known about the optimal antithrombotic therapy in patients with atrial fibrillation undergoing PCI for ST-elevation myocardial infarction (STEMI).The aim of this study was to investigate the safety and efficacy of dabigatran dual therapy (110 or 150 mg twice daily, plus clopidogrel or ticagrelor) versus warfarin triple therapy in patients with atrial fibrillation and STEMI.In the RE-DUAL PCI trial, 305 patients with STEMI were randomised to dabigatran 110 mg (n=113 versus 106 warfarin) or 150 mg (n=86 versus 84 warfarin). The primary endpoint was the time to first major/clinically relevant non-major bleeding event (MBE/CRNMBE). The thrombotic endpoint was a composite of death, thromboembolic events, or unplanned revascularisation.In STEMI patients, dabigatran 110 mg (HR 0.39, 95% CI: 0.20-0.74) and 150 mg (0.43, 0.21-0.89) dual therapy reduced the risk of MBE/CRNMBE versus warfarin triple therapy (p for interaction vs all other patients=0.31 and 0.16). The risk of thrombotic events for dabigatran 110 mg (HR 1.61, 95% CI: 0.85-3.08) and 150 mg (0.56, 0.20-1.51) had p interactions of 0.20 and 0.33, respectively. For net clinical benefit, the HRs were 0.74 (95% CI: 0.46-1.17) and 0.49 (0.27-0.91) for dabigatran 110 and 150 mg (p for interaction=0.80 and 0.12), respectively.After PCI for STEMI, patients on dabigatran dual therapy had lower risks of bleeding events versus warfarin triple therapy with similar risks of thromboembolic events, supporting dabigatran dual therapy even in patients with high thrombotic risk.
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