Аспирин vs клопидогрел через 1 месяц после острого коронарного синдрома у пациентов с высоким риском кровотечения или с подъемом сегмента ST

Предлагаю уникальную научную статью, оформленную по стандартам ВАК, посвященную актуальной проблеме выбора антиагрегантной терапии у пациентов после острого коронарного синдрома (ОКС). Статья объемом 10 страниц (12 кегль) включает:

• Анализ современных клинических исследований (STOPDAPT-3, TWILIGHT-ACS, GLOBAL LEADERS).
• Сравнение рекомендаций ESC 2023 и ACC/AHA/SCAI 2021.
• Оценку эффективности и безопасности монотерапии аспирином и клопидогрелом.
• Российские клинические данные и практические рекомендации.

Дополнительные материалы (4 страницы):

• Расширенные таблицы с характеристиками исследований.
• Визуализация данных (тепловая карта для подгруппового анализа).
• Готовый R-код для воспроизведения анализа.

Преимущества:

• Готовая статья с высокой научной ценностью.
• Уникальный контент, основанный на последних исследованиях.
• Профессиональное оформление, включая рисунки и таблицы.
• Возможность использования для защиты диссертаций, научных публикаций и учебных работ.

Для кого:

• Аспиранты и исследователи в области кардиологии.
• Студенты медицинских вузов.
• Практикующие врачи, желающие углубить свои знания.

1. Byrne R.A., Rossello X., Coughlan J.J. et al. 2023 ESC Guidelines for the management of acute coronary syndromes // European Heart Journal. 2023. Vol. 44, № 38. P. 3720-3826. DOI: 10.1093/eurheartj/ehad191.

2. Lawton J.S., Tamis-Holland J.E., Bangalore S. et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines // Circulation. 2022. Vol. 145, № 3. P. e18-e114. DOI: 10.1161/CIR.0000000000001038.

3. Natsuaki M., Morimoto T., Shiomi H. et al. Effects of Acute Coronary Syndrome and Stable Coronary Artery Disease on Bleeding and Ischemic Risk After Percutaneous Coronary Intervention // Circulation Journal. 2021. Vol. 85, № 11. P. 1928-1941. DOI: 10.1253/circj.CJ-21-0559.

4. Watanabe H., Natsuaki M., Morimoto T. et al. Aspirin versus clopidogrel monotherapy after percutaneous coronary intervention: 1-year follow-up of the STOPDAPT-3 trial // European Heart Journal. 2024. Vol. 45, № 47. P. 5042-5054. DOI: 10.1093/eurheartj/ehad631.

5. Natsuaki M., Watanabe H., Morimoto T. et al. An Aspirin-Free Versus Dual Antiplatelet Strategy for Coronary Stenting: STOPDAPT-3 Randomized Trial // Circulation. 2024. Vol. 149, № 8. P. 585-600. DOI: 10.1161/CIRCULATIONAHA.123.066720.

6. Saito S., Isshiki T., Kimura T. et al. Efficacy and Safety of Adjusted-Dose Prasugrel Compared With Clopidogrel in Japanese Patients With Acute Coronary Syndrome: The PRASFIT-ACS Study // Circulation Journal. 2014. Vol. 78, № 7. P. 1684-1692. DOI: 10.1253/circj.CJ-14-0124.

7. Isshiki T., Kimura T., Ogawa H. et al. Prasugrel, a Third-Generation P2Y12 Receptor Antagonist, in Patients With Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention // Circulation Journal. 2014. Vol. 78, № 12. P. 2926-2934. DOI: 10.1253/circj.CJ-14-0595.

8. Urban P., Mehran R., Colleran R. et al. Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention: A Consensus Document From the Academic Research Consortium for High Bleeding Risk // Circulation. 2019. Vol. 140, № 3. P. 240-261. DOI: 10.1161/CIRCULATIONAHA.119.040167.

9. Obayashi Y., Natsuaki M., Watanabe H. et al. Aspirin-free strategy for percutaneous coronary intervention in acute coronary syndrome based on the subtypes of acute coronary syndrome and high bleeding risk: the STOPDAPT-3 trial // European Heart Journal - Cardiovascular Pharmacotherapy. 2024. Vol. 10, № 5. P. 374-390. DOI: 10.1093/ehjcvp/pvad085.

10. Mehran R., Rao S.V., Bhatt D.L. et al. Standardized Bleeding Definitions for Cardiovascular Clinical Trials: A Consensus Report From the Bleeding Academic Research Consortium // Circulation. 2011. Vol. 123, № 23. P. 2736-2747. DOI: 10.1161/CIRCULATIONAHA.110.009449.

11. Cutlip D.E., Windecker S., Mehran R. et al. Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions // Circulation. 2007. Vol. 115, № 17. P. 2344-2351. DOI: 10.1161/CIRCULATIONAHA.106.685313.

12. Rodriguez F., Harrington R.A. Management of Antithrombotic Therapy After Acute Coronary Syndromes // New England Journal of Medicine. 2021. Vol. 384, № 5. P. 452-460. DOI: 10.1056/NEJMra1607714.

13. Vranckx P., Valgimigli M., Odutayo A. et al. Efficacy and Safety of Ticagrelor Monotherapy by Clinical Presentation: Pre-Specified Analysis of the GLOBAL LEADERS Trial // Journal of the American Heart Association. 2021. Vol. 10, № 18. P. e015560. DOI: 10.1161/JAHA.119.015560.

14. Song P.S., Park Y.H., Oh J.-H. et al. P2Y12 Inhibitor Monotherapy Versus Conventional Dual Antiplatelet Therapy or Aspirin Monotherapy in Acute Coronary Syndrome: A Pooled Analysis of the SMART-DATE and SMART-CHOICE Trials // American Journal of Cardiology. 2021. Vol. 150. P. 47-54. DOI: 10.1016/j.amjcard.2021.03.048.

15. Baber U., Dangas G., Angiolillo D.J. et al. Ticagrelor Alone vs. Ticagrelor Plus Aspirin Following Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: TWILIGHT-ACS // European Heart Journal. 2020. Vol. 41, № 37. P. 3533-3545. DOI: 10.1093/eurheartj/ehaa739.

16. Smits P.C., Frigoli E., Vranckx P. et al. Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk // Journal of the American College of Cardiology. 2022. Vol. 80, № 13. P. 1220-1237. DOI: 10.1016/j.jacc.2022.07.023.

17. Valgimigli M., Hong S.-J., Gragnano F. et al. De-escalation to Ticagrelor Monotherapy Versus 12 Months of Dual Antiplatelet Therapy in Patients With and Without Acute Coronary Syndromes: A Systematic Review and Individual Patient-Level Meta-Analysis of Randomised Trials // The Lancet. 2024. Vol. 404, № 10456. P. 937-948. DOI: 10.1016/S0140-6736(24)00473-2.

18. Watanabe H., Morimoto T., Natsuaki M. et al. Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial // JAMA Cardiology. 2022. Vol. 7, № 4. P. 407-417. DOI: 10.1001/jamacardio.2021.5244.

19. Angiolillo D.J., Galli M., Alexopoulos D. et al. International Consensus Statement on Platelet Function and Genetic Testing in Percutaneous Coronary Intervention: 2024 Update // JACC: Cardiovascular Interventions. 2024. Vol. 17, № 22. P. 2639-2663. DOI: 10.1016/j.jcin.2024.04.039.

20. Carvalho P.E.P., Gewehr D.M., Nascimento B.R. et al. Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stenting in Patients With Acute Coronary Syndromes: A Systematic Review and Network Meta-Analysis // JAMA Cardiology. 2024. Vol. 9, № 12. P. 1094-1105. DOI: 10.1001/jamacardio.2024.2815.

21. Yamamoto K., Watanabe H., Morimoto T. et al. Clopidogrel Monotherapy After 1-Month DAPT in Patients With High Bleeding Risk or Complex PCI // JACC: Asia. 2023. Vol. 3, № 1. P. 31-46. DOI: 10.1016/j.jacasi.2022.11.010.

22. Costa F., Montalto C., Branca M. et al. Dual Antiplatelet Therapy Duration After Percutaneous Coronary Intervention in High Bleeding Risk: A Meta-Analysis of Randomized Trials // European Heart Journal. 2023. Vol. 44, № 11. P. 954-968. DOI: 10.1093/eurheartj/ehac571.

23. Lee Y.J., Suh Y., Kim J.S. et al. Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO Trial // Korean Circulation Journal. 2022. Vol. 52, № 4. P. 324-337. DOI: 10.4070/kcj.2021.0413.

24. Escaned J., Cao D., Baber U. et al. Ticagrelor Monotherapy in Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention: TWILIGHT-HBR // European Heart Journal. 2021. Vol. 42, № 45. P. 4624-4634. DOI: 10.1093/eurheartj/ehab702.

25. Yang S., Kang J., Park K.W. et al. Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks // Journal of the American College of Cardiology. 2023. Vol. 82, № 16. P. 1565-1578. DOI: 10.1016/j.jacc.2023.08.010.

26. Galli M., Gragnano F., Berteotti M. et al. Antithrombotic Therapy in High Bleeding Risk, Part I: Percutaneous Cardiac Interventions // JACC: Cardiovascular Interventions. 2024. Vol. 17, № 19. P. 2197-2215. DOI: 10.1016/j.jcin.2024.06.017.

27. Gragnano F., van Klaveren D., Heg D. et al. Derivation and Validation of the PRECISE-HBR Score to Predict Bleeding After Percutaneous Coronary Intervention // Circulation. 2024. Vol. 151, № 6. P. 343-355. DOI: 10.1161/CIRCULATIONAHA.123.066356.

28. Biswas S., Andrianopoulos N., Papapostolou S. et al. Does the Subtype of Acute Coronary Syndrome Treated by Percutaneous Coronary Intervention Predict Long-Term Clinical Outcomes? // European Heart Journal - Quality of Care and Clinical Outcomes. 2018. Vol. 4, № 4. P. 318-327. DOI: 10.1093/ehjqcco/qcy027.

29. Galli M., Laudani C., Occhipinti G. et al. P2Y12 Inhibitor Monotherapy After Short DAPT in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis // European Heart Journal - Cardiovascular Pharmacotherapy. 2024. Vol. 10, № 7. P. 588-598. DOI: 10.1093/ehjcvp/pvae032.

30. Galli M., Laborante R., Occhipinti G. et al. Impact of Ethnicity on Antiplatelet Treatment Regimens for Bleeding Reduction in Acute Coronary Syndromes: A Systematic Review and Pre-Specified Subgroup Meta-Analysis // European Heart Journal - Cardiovascular Pharmacotherapy. 2024. Vol. 10, № 2. P. 158-169. DOI: 10.1093/ehjcvp/pvad077