Perkütan koroner girişim yapılmış gerçek yaşam hastalarında ikili antitrombosit tedavi kullanımının PRECISE-DAPT, DAPT skorlarına göre değerlendirilmesi ve bu skorların stent trombozu, ciddi kanama ile ilişkisi

Year 2020, , 137 - 147, 21.01.2020

Evrim Şimşek , Yavuz Selim Kılıç Azem Akıllı

https://doi.org/10.31362/patd.646639

Abstract

Amaç:
Perkütan koroner girişim (PKG) sonrası ikili
antitrombosit tedavi (İATT) süresinin belirlenmesinde PRECISE-DAPT ve DAPT
skorlarının kullanılmasını önerilmektedir. Bu risk skorlarını gerçek yaşam
validasyonu ise bulunmamaktadır. Günlük pratikte PKG sonrası İATT alan
hastaların tedavi sürelerinin risk skorlarına göre değerlendirilmesi, stent
trombozu ve ciddi kanama ile bu risk skorlarının ilişkisini araştırılması
amaçlanmıştır.

Gereç
ve Yöntem: Ocak-Mayıs 2019
tarihleri arasında çalışma merkezine başvuran en az 1 yıl önce PKG yapılmış
hastalar incelenmiştir. Hastaların kullandıkları İATT süreleri, takip süresi
içinde gelişen stent trombozu ve ciddi kanama ( BARC³3) olayları sorgulanmış ve gruplar arasında
PRECISE-DAPT ile DAPT skorları karşılaştırılmıştır.

Bulgular:
Çalışmaya 366 hasta dahil edilmiştir. Ortalama takip
süresi 17,57±4,8 aydır. Hastaların ortalama yaşı 61±11 ve %54,4’ü kadındı. Hastaların %81,4’ü akut
koroner sendrom (AKS) tanısına sahipti. Stent trombozu olan 20(%5,5) hasta
saptanmıştır. Ciddi kanama 17(%4,6) hastada izlenmiştir. Stent trombozu
olaylarının %70(14)’i 1. yılın sonunda gelişmiştir. Bu hastaların 12’si yüksek
DAPT, düşük PRECISE-DAPT skoruna sahipken sadece 2’si İATT alırken; 10’u tek
asetilsalisilik asit almaktaydı. Ciddi kanama hastaların %4,6 (17)’sında gelişmiştir.
Hastalardan 15’i yüksek PRECISE-DAPT skoruna sahipti ve 10’u 6 aydan uzun İATT
alırken kanama gerçekleşmiştir. Kanama gelişen hastaların ortalama PRECISE-DAPT
skoru anlamlı olarak daha yüksekti. (40,59±14,7’e karşı 23,80±20       p<0,001) Tromboz gelişen hastalarda
da DAPT skoru anlamlı olarak daha yüksekti. (3,10±1,25’e karşı 1,81±1,27 p<0,001)

Sonuç:
PRECISE-DAPT ve DAPT skorları PKG uygulanmış İATT
altındaki gerçek yaşam hastalarında da sırasıyla artmış kanama ve stent
trombozu ile ilişkilidir. Günlük pratikte hastalarda İATT süresi belirlenirken
mevcut skorların kullanılması hastaların gereksiz uzun ya da kısa İATT almasını
ve kötü sonlanımları önleyebilir.

Keywords

İkili antitrombosit tedavisi, risk skorları, kanama, stent trombozu

Evaluation of the use of dual antiplatelet therapy according to PRECISE-DAPT and DAPT scores in real-life patients undergoing percutaneous coronary intervention and their relationship with stent thrombosis and severe bleeding

Abstract

Purpose: PRECISE-DAPT and DAPT scores are recommended to
determine the duration of dual antiplatelet therapy (DAPT) after percutaneous
coronary intervention (PCI). There is no real-life validation of these risk
scores. The aim of this study was to evaluate the duration of treatment
according to risk scores and to investigate the relationship between stent
thrombosis, severe hemorrhage and these risk scores.

Materials and Methods: Patients who had undergone
PCI at least 1 year ago and admitted to study hospital were evaluated for the
study. DAPT duration, stent thrombosis, severe hemorrhage (BARC³3) events were investigated
and PRECISE-DAPT, DAPT scores were compared between the groups.

Results: Three hundred and sixty-six patients were included
in the study. Mean follow-up was 17.57±4.8 months, mean age was 61±11 and 54.4% of the patients were female. 81.4% of the patients had acute
coronary syndrome. 5.5% (20) of them had stent thrombosis. 14 of the stent
thrombosis occurred 1 year after PCI. Even 12 of these patients had high DAPT
and low PRECISE-DAPT scores, only 2 received DAPT; 10 of them were taking only
acetylsalicylic acid. 4.6% (17) of the patients had severe bleeding
and 15 of them had a high PRECISE-DAPT score and 10 of them had bleeding while
receiving DAPT for more than 6 months. The mean PRECISE-DAPT score of the patients with bleeding was
significantly higher. (40.59±14.7 vs. 23.80±20 p<0.001) DAPT score was
also significantly higher in patients with thrombosis. (3.10±1.25 vs. 1.81±1.27 p<0.001)

Conclusion: PRECISE-DAPT and DAPT
scores are associated with increased bleeding and stent thrombosis also in
real-life patients, respectively.
During clinical practice, the use of current scores for DAPT duration may prevent
unnecessary long or short treatment periods and this approach could prevent
poor outcomes.

Keywords

Dual antiplatelet therapy, risk scores, bleeding, stent thrombosis

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