重视动脉粥样硬化性心血管疾病合并静脉血栓栓塞症的抗栓治疗——2021美国心脏病学会抗栓决策路径专家共识解读

Interpretation of 2021 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease

抗血小板治疗是动脉粥样硬化性心血管疾病(ASCVD)抗栓治疗的主要手段,而抗凝治疗是静脉血栓栓塞症(VTE)和心房颤动抗栓治疗的必由之路。在临床上,抗血小板治疗与抗凝治疗常联合应用,然而联合抗栓治疗的出血发生风险显著增加,需仔细平衡出血与血栓栓塞的发生风险。目前,ASCVD合并心房颤动的抗栓治疗方案已得到深入研究并不断更新完善。目前仍然缺乏ASCVD合并VTE抗栓治疗的循证医学证据,2021年美国心脏病学会发布了抗栓决策路径专家共识,针对ASCVD合并VTE的抗栓治疗路径和方案提出了合理化建议,对于指导临床实践具有重要意义。

Antiplatelet therapy is the major antithrombotic method for atherosclerotic cardiovascular disease(ASCVD), and anticoagulation is essential for the treatment of venous thromboembolism(VTE) and atrial fibrillation. Antiplatelet and anticoagulant therapy are often jointly used in the clinical practice, for instance, these strategies are commonly used for patients with VTE or atrial fibrillation undergoing percutaneous coronary intervention or with ASCVD. Clinicians are challenged to balance the potential risk of hemorrhage and thrombosis when dual anticoagulant therapy and antiplatelet therapy are applied—so called “triple therapy”. The antithrombotic treatment of ASCVD combined with atrial fibrillation has been thoroughly studied and recommended, however, evidence-based research for ASCVD combined with VTE are still insufficient. The American College of Cardiology published an expert consensus decision pathway for anticoagulant and antiplatelet therapy in patients with VTE undergoing percutaneous coronary intervention or with ASCVD in 2021, which provided reasonable suggestions on the combined antithrombotic therapy and exerted great significance for guiding the clinical practice. Present interpretation highlights the main points of this important clinical document.