{"id":34651,"date":"2024-05-02T17:26:42","date_gmt":"2024-05-02T09:26:42","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=34651"},"modified":"2025-02-11T13:40:07","modified_gmt":"2025-02-11T05:40:07","slug":"diem-tin-hoi-nghi-acc-2024-nghien-cuu-ultimate-dapt-ticagrelor-don-tri-co-vuot-troi-hon-dapt-o-benh-nhan-mac-hoi-chung-vanh-cap","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/diem-tin-hoi-nghi-acc-2024-nghien-cuu-ultimate-dapt-ticagrelor-don-tri-co-vuot-troi-hon-dapt-o-benh-nhan-mac-hoi-chung-vanh-cap\/","title":{"rendered":"\u0110i\u1ec3m tin h\u1ed9i ngh\u1ecb ACC 2024: Nghi\u00ean c\u1ee9u ULTIMATE-DAPT – Ticagrelor \u0111\u01a1n tr\u1ecb c\u00f3 v\u01b0\u1ee3t tr\u1ed9i h\u01a1n DAPT \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p?"},"content":{"rendered":"\n

Nghi\u00ean c\u1ee9u ULTIMATE \u2013 DAPT \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o t\u1ea1i H\u1ed9i ngh\u1ecb Th\u01b0\u1eddng ni\u00ean c\u1ee7a Vi\u1ec7n Tim m\u1ea1ch Hoa K\u1ef3 (ACC) n\u0103m 2024 v\u00e0o \u0111\u1ea7u th\u00e1ng 4. ULTIMATE \u2013 DAPT l\u00e0 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c v\u00e0 m\u00f9 \u0111\u00f4i. ULTIMATE \u2013 DAPT l\u00e0 nghi\u00ean c\u1ee9u thu\u1ed9c ch\u01b0\u01a1ng tr\u00ecnh nghi\u00ean c\u1ee9u IVUS \u2013 ACS v\u00e0 ULTIMATE \u2013 DAPT, ch\u01b0\u01a1ng tr\u00ecnh n\u00e0y nh\u1eb1m so s\u00e1nh li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p trong v\u00f2ng 1 th\u00e1ng so v\u1edbi 12 th\u00e1ng sau khi c\u1ea5y stent ph\u1ee7 thu\u1ed1c theo k\u1ebft qu\u1ea3 si\u00eau \u00e2m l\u00f2ng m\u1ea1ch ho\u1eb7c ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p [1].<\/p>\n\n\n\n

\u0110i\u1ec1u tr\u1ecb trong v\u00f2ng 12 th\u00e1ng v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p (aspirin ph\u1ed1i h\u1ee3p v\u1edbi ch\u1ea5t \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 P2Y12<\/sub>) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p sau khi \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 nh\u1ed3i c\u00e1u c\u01a1 tim v\u00e0 huy\u1ebft kh\u1ed1i trong stent [2, 3]. Ticagrelor ho\u1eb7c prasugrel \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n clopidogrel trong b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng n\u00e0y [4, 5]. Tuy nhi\u00ean, c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 P2Y12<\/sub>\u00a0l\u1ea1i l\u00e0m t\u0103ng nguy c\u01a1 xu\u1ea5t huy\u1ebft. L\u1ee3i \u00edch c\u1ee7a vi\u1ec7c ng\u01b0ng li\u1ec7u ph\u00e1p k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p s\u1edbm sau can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng t\u1ecf qua nhi\u1ec1u nghi\u00ean c\u1ee9u [6 \u2013 9]. Tuy nhi\u00ean, hi\u1ec7u qu\u1ea3 c\u1ee7a P2Y12<\/sub>\u00a0\u0111\u01a1n tr\u1ecb v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p ch\u1ec9 trong v\u00f2ng 1 th\u00e1ng \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p l\u1ea1i ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m r\u00f5. Do v\u1eady, th\u1eed nghi\u1ec7m ULTIMATE \u2013 DAPT \u0111\u00e3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 ph\u00f2ng ng\u1eeba bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh c\u1ee7a ticagrelor \u0111\u01a1n tr\u1ecb so v\u1edbi ticagrelor ph\u1ed5i h\u1ee3p v\u1edbi aspirin [1]. B\u00e0i vi\u1ebft nh\u1eb1m t\u00f3m t\u1eaft k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u ULTIMATE \u2013 DAPT.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

H\u00ecnh 1.<\/strong>\u00a0T\u00f3m t\u1eaft nghi\u00ean c\u1ee9u ULTIMATE \u2013 DAPT<\/p>\n\n\n\n

T\u00f3m t\u1eaft nghi\u00ean c\u1ee9u ULTIMATE – DAPT<\/strong><\/h2>\n\n\n\n

Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf 58 b\u1ec7nh vi\u1ec7n t\u1ea1i nhi\u1ec1u qu\u1ed1c gia nh\u01b0 Trung Qu\u1ed1c, Pakistan, V\u01b0\u01a1ng qu\u1ed1c Anh v\u00e0 Italy. B\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u c\u1ea7n ho\u00e0n th\u00e0nh \u0111\u1ea7y \u0111\u1ee7 2 pha nghi\u00ean c\u1ee9u: (i) \u0111\u00e1nh gi\u00e1 l\u1ee3i \u00edch c\u1ee7a si\u00eau \u00e2m l\u00f2ng m\u1ea1ch \u0111\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da v\u00e0 (ii) ticagrelor \u0111\u01a1n tr\u1ecb sau 1 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da (ULTIMATE \u2013 DAPT).<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u bao g\u1ed3m b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00ean trong v\u00f2ng 30 ng\u00e0y tr\u01b0\u1edbc khi \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean.Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da v\u1edbi stent ph\u1ee7 thu\u1ed1c th\u1ebf h\u1ec7 2. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn cho nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean \u0111\u1ec3 \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng si\u00eau \u00e2m l\u00f2ng m\u1ea1ch ho\u1eb7c d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng ch\u1ee5p m\u1ea1ch m\u00e1u (nghi\u00ean c\u1ee9u IVUS \u2013 ACS). Sau khi \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da, trong v\u00f2ng 1 th\u00e1ng \u0111\u1ea7u ti\u00ean, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u \u0111\u1ec1u \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p v\u1edbi ticagrelor 90 mg x 2 l\u1ea7n\/ng\u00e0y v\u00e0 aspirin bao tan trong ru\u1ed9t (enteric-coated aspirin) 100 mg\/ng\u00e0y. Li\u1ec1u \u0111\u1ea7u c\u1ee7a li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p \u0111\u01b0\u1ee3c b\u1eaft \u0111\u1ea7u tr\u01b0\u1edbc khi can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da.<\/p>\n\n\n\n

Sau 1 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p, nh\u1eefng b\u1ec7nh nh\u00e2n s\u1ed1ng s\u00f3t m\u00e0 kh\u00f4ng c\u00f3 bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft nghi\u00eam tr\u1ecdng, kh\u00f4ng c\u00f3 bi\u1ebfn c\u1ed1 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 kh\u00f4ng ng\u01b0ng li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p trong nhi\u1ec1u h\u01a1n 48 ti\u1ebfng \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c ph\u00e2n ng\u1eabu nhi\u00ean th\u00e0nh 2 nh\u00f3m (t\u1ef7 l\u1ec7 1:1) \u0111\u1ec3 ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p (ticagrelor 90 mg x 2 l\u1ea7n\/ng\u00e0y v\u00e0 aspirin 100 mg\/ng\u00e0y) ho\u1eb7c ticagrelor \u0111\u01a1n tr\u1ecb (90 mg x 2 l\u1ea7n\/ng\u00e0y v\u1edbi placebo gi\u1ea3 d\u01b0\u1ee3c 1 l\u1ea7n\/ng\u00e0y) trong 11 th\u00e1ng ti\u1ebfp theo.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 theo 2 ti\u00eau ch\u00ed \u0111\u00e1nh gi\u00e1 ch\u00ednh:<\/p>\n\n\n\n

    \n
  • Bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft l\u00e2m s\u00e0ng<\/li>\n\n\n\n
  • Bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh (bi\u1ebfn c\u1ed1 g\u1ed9p t\u1eed vong do tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u, huy\u1ebft kh\u1ed1i trong stent x\u00e1c \u0111\u1ecbnh v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u m\u1ea1ch m\u00e1u do l\u00e2m s\u00e0ng)<\/li>\n<\/ul>\n\n\n\n

    K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u ULTIMATE \u2013 DAPT<\/strong><\/h2>\n\n\n\n

    K\u1ebft qu\u1ea3 c\u00f3 3400 b\u1ec7nh nh\u00e2n tham gia ph\u00e2n b\u1ed1 ng\u1eabu nhi\u00ean cho nghi\u00ean c\u1ee9u ULTIMATE \u2013 DAPT sau 1 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p. Tu\u1ed5i trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u l\u00e0 63 tu\u1ed5i, 31.6% b\u1ec7nh nh\u00e2n m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, 59.% b\u1ec7nh nh\u00e2n b\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p. Th\u1eddi gian trung v\u1ecb \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p (ticagrelor 90 mg x 2 l\u1ea7n\/ng\u00e0y v\u00e0 aspirin 100 mg\/ng\u00e0y) \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ticagrelor \u0111\u01a1n tr\u1ecb trong 11 th\u00e1ng ti\u1ebfp theo l\u1ea7n l\u01b0\u1ee3t l\u00e0 28 ng\u00e0y v\u00e0 365 ng\u00e0y \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p trong 11 th\u00e1ng ti\u1ebfp theo. Trong 12 th\u00e1ng theo d\u00f5i, c\u00f3 0.7% b\u1ec7nh nh\u00e2n nh\u00f3m ticagrelor \u0111\u01a1n tr\u1ecb ph\u1ea3i gi\u1ea3m li\u1ec1u ticagrelor t\u1eeb 90 mg x 2 l\u1ea7n\/ng\u00e0y xu\u1ed1ng c\u00f2n 60 mg x 2 l\u1ea7n\/ng\u00e0y, t\u1ef7 l\u1ec7 n\u00e0y \u1edf nh\u00f3m ticagrelor\/aspirin l\u00e0 0.9%.<\/p>\n\n\n\n

    T\u1eeb th\u00e1ng 1 \u2013 th\u00e1ng 12, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft l\u00e2m s\u00e0ng th\u1ea5p h\u01a1n c\u00f3 \u00fd ngh\u0129a \u1edf nh\u00f3m \u0111\u01a1n tr\u1ecb v\u1edbi ticagrelor so v\u1edbi nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ti\u1ec3u c\u1ea7u k\u00e9p. C\u1ee5 th\u1ec3 ch\u1ec9 2.1% b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m ticagrelor \u0111\u01a1n tr\u1ecb c\u00f3 bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft l\u00e2m s\u00e0ng, trong khi \u0111\u00f3 t\u1ef7 l\u1ec7 n\u00e0y \u1edf nh\u00f3m ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p l\u00e0 l\u00e0 4.6%. K\u1ebft qu\u1ea3 so s\u00e1nh kh\u00f4ng kh\u00e1c bi\u1ec7t khi ph\u00e2n t\u00edch intention \u2013 to \u2013 treat v\u00e0 per \u2013 protocol.<\/p>\n\n\n\n

    \u0110\u1ed1i v\u1edbi bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh, ticagrelor \u0111\u01a1n tr\u1ecb kh\u00f4ng thua k\u00e9m li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p ticagrelor\/aspirin trong vi\u1ec7c ph\u00f2ng ng\u1eeba bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh. C\u1ee5 th\u1ec3 t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh \u1edf 2 nh\u00f3m nghi\u00ean c\u1ee9u l\u1ea7n l\u01b0\u1ee3t l\u00e0 3.6% v\u00e0 3.7%. K\u1ebft qu\u1ea3 ph\u00e2n t\u00edch c\u0169ng t\u01b0\u01a1ng t\u1ef1 gi\u1eefa intention \u2013 to \u2013 treat v\u00e0 per \u2013 protocol. Khi \u0111\u00e1nh gi\u00e1 ri\u00eang t\u1eebng th\u00e0nh ph\u1ea7n trong bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh g\u1ed9p, t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ebfn c\u1ed1 (g\u1ed9p t\u1eed vong do tim m\u1ea1ch ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c \u0111\u1ed9t qu\u1ef5 thi\u1ebfu m\u00e1u ho\u1eb7c huy\u1ebft kh\u1ed1i trong stent x\u00e1c \u0111\u1ecbnh ho\u1eb7c t\u00e1i t\u01b0\u1edbi m\u00e1u m\u1ea1ch m\u00e1u do l\u00e2m s\u00e0ng) c\u0169ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa 2 nh\u00f3m ticagrelor \u0111\u01a1n tr\u1ecb v\u00e0 li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p ticagrelor\/aspirin.<\/p>\n\n\n\n

    Nh\u01b0 v\u1eady, k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m ULTIMATE \u2013 DAPT cho th\u1ea5y r\u1eb1ng \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p v\u1edbi ticagrelor\/aspirin trong v\u00f2ng 1 th\u00e1ng, \u0111\u01a1n tr\u1ecb v\u1edbi ticagrelor trong 11 th\u00e1ng ti\u1ebfp theo l\u00e0m gi\u1ea3m bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft l\u00e2m s\u00e0ng m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 c\u1ee7a bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh so v\u1edbi ti\u1ebfp t\u1ee5c li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p cho cho \u0111\u1ebfn h\u1ebft 12 th\u00e1ng.<\/p>\n\n\n\n

    Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u c\u1ee7a Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Ch\u00e2u \u00c2u (ESC) \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p<\/strong><\/h2>\n\n\n\n

    Trong h\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p n\u0103m 2023, ESC \u0111\u00e3 \u0111\u01b0a ra m\u1ed9t s\u1ed1 chi\u1ebfn l\u01b0\u1ee3c thay th\u1ebf cho li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p trong v\u00f2ng 12 th\u00e1ng nh\u01b0 r\u00fat ng\u1eafn th\u1eddi gian \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p xu\u1ed1ng c\u00f2n 3 \u2013 6 th\u00e1ng v\u00e0 xu\u1ed1ng thang li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p, t\u1eeb li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u v\u1edbi prasugrel ho\u1eb7c ticagrelor xu\u1ed1ng clopidogrel [10]. Xu\u1ed1ng thang li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong v\u00f2ng 30 ng\u00e0y \u0111\u1ea7u ti\u00ean. Xu\u1ed1ng thang li\u1ec7u ph\u00e1p ti\u1ec3u c\u1ea7u k\u00e9p b\u1eb1ng ch\u1ea5t \u1ee9c ch\u1ebf P2Y12<\/sub> \u0111\u01a1n tr\u1ecb sau 30 ng\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111\u1ec3 l\u00e0m gi\u1ea3m bi\u1ebfn c\u1ed1 xu\u1ea5t huy\u1ebft [10].<\/p>\n\n\n\n

    B\u1ea3ng 1.<\/strong> Khuy\u1ebfn c\u00e1o li\u1ec7u ph\u00e1p ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u \u1edf b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p c\u1ee7a ESC 2023<\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    K\u1ebft lu\u1eadn<\/strong><\/h2>\n\n\n\n

    \u1ede b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da b\u1eb1ng stent ph\u1ee7 thu\u1ed1c v\u00e0 \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p trong v\u00f2ng 1 th\u00e1ng, \u0111\u01a1n tr\u1ecb v\u1edbi ticagrelor trong 11 th\u00e1ng ti\u1ebfp theo l\u00e0m gi\u1ea3m nguy c\u01a1 xu\u1ea5t huy\u1ebft nh\u01b0ng kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 c\u1ee7a c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch ch\u00ednh. C\u00f9ng v\u1edbi k\u1ebft qu\u1ea3 t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00e2y, k\u1ebft qu\u1ea3 th\u1eed nghi\u1ec7m ULTIMATE – DAPT kh\u1eb3ng \u0111\u1ecbnh l\u1ee3i \u00edch c\u1ee7a ticagrelor \u0111\u01a1n tr\u1ecb.<\/p>\n\n\n\n

    \n\n\n\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/h3>\n\n\n\n
      \n
    1. Ge Z, Kan J, Gao X, et al; ULTIMATE-DAPT investigators. Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. Lancet. 2024 Apr 5:S0140-6736(24)00473-2. doi: 10.1016\/S0140-6736(24)00473-2.<\/li>\n\n\n\n
    2. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44: 3720\u2013826.<\/li>\n\n\n\n
    3. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA\/ACC guideline for the management of patients with non\u2013ST-elevation ACS: executive summary. Circulation 2014; 130: 2354\u201394.<\/li>\n\n\n\n
    4. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009; 361: 1045\u201357.<\/li>\n\n\n\n
    5. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med Overseas Ed 2007; 357: 2001\u201315.<\/li>\n\n\n\n
    6. Tomaniak M, Chichareon P, Onuma Y, et al. Benefit and risks of aspirin in addition to ticagrelor in acute coronary syndromes: a post hoc analysis of the randomized GLOBAL LEADERS trial. JAMA Cardiol 2019; 4: 1092\u2013101.<\/li>\n\n\n\n
    7. 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 syndromes: the STOPDAPT-2 ACS randomized clinical trial. JAMA Cardiol 2022; 7: 407\u201317.<\/li>\n\n\n\n
    8. Song PS, Park YH, Oh JH, et al. P2Y12 inhibitor monotherapy versus conventional dual antiplatelet therapy or aspirin monotherapy in acute coronary syndromes: a pooled analysis of the SMART-DATE and SMART-CHOICE trials. Am J Cardiol 2021; 150: 47\u201354.<\/li>\n\n\n\n
    9. Baber U, Dangas G, Angiolillo DJ, et al. Ticagrelor alone vs ticagrelor plus aspirin following percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: TWILIGHT-ACS. Eur Heart J 2020; 41: 3533\u201345.<\/li>\n\n\n\n
    10. Byrne RA, Rossello X, Coughlan JJ, et al; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-3826. doi: 10.1093\/eurheartj\/ehad191.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      Nghi\u00ean c\u1ee9u ULTIMATE \u2013 DAPT \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o t\u1ea1i H\u1ed9i ngh\u1ecb Th\u01b0\u1eddng ni\u00ean c\u1ee7a Vi\u1ec7n Tim m\u1ea1ch Hoa K\u1ef3 (ACC) n\u0103m 2024 v\u00e0o \u0111\u1ea7u th\u00e1ng 4.<\/p>\n","protected":false},"author":123,"featured_media":34711,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1436],"articles_languages":[1375],"articles_filters":[],"class_list":["post-34651","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/34651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=34651"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/34651\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/34711"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=34651"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=34651"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=34651"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=34651"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=34651"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=34651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}