EVRİM ŞİMŞEK, Yavuz Selim KILIÇ, Azem AKILLI

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

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.

Anahtar Kelimeler:

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

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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