Antithrombotic therapy and bleeding risk in the era of aggressive lipid-lowering:current evidence,clinical implications,and future perspectives  

作　　者：Xin Zhou Ziping Li Hangkuan Liu Yongle Li Dong Zhao Qing Yang 

机构地区：[1]Department of Cardiology,Tianjin Medical University General Hospital,Tianjin 300052,China [2]Department of Epidemiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China

出　　处：《Chinese Medical Journal》2023年第6期645-652,共8页中华医学杂志（英文版）

基　　金：National Key Research and Experimental Development Program of China(Nos.2020YFC2004700 and 2020YFC2004706);the National Natural Science Foundation of China(No.81970304);the Tianjin Municipal Science and Technology Commission(No.18ZXZNSY00290)

摘　　要：The clinical efficacy of proprotein convertase subtilisin/kexin type 9 inhibitors(PCSK9i)in reducing major cardiovascular adverse events related to atherosclerotic cardiovascular disease(ASCVD)has been well established in recent large randomized outcome trials.Although the cardiovascular and all-cause mortality benefit of PCSK9i remains inconclusive,current cholesterol management guidelines have been modified toward more aggressive goals for lowering low-density lipoprotein cholesterol(LDL-C).Consequently,the emerging concept of"the lower the better"has become the paradigm of ASCVD prevention.However,there is evidence from observational studies of a U-shaped association between baseline LDL-C levels and all-cause mortality in population-based cohorts.Among East Asian populations,low LDL-C was associated with an increased risk for hemorrhagic stroke in patients not on antithrombotic therapy.Accumulating evidence showed that low LDL-C was associated with an enhanced bleeding risk in patients on dual antiplatelet therapy following percutaneous coronary intervention.Additionally,low LDL-C was associated with a higher risk for incident atrial fibrillation and thereby,a possible increase in the risk for intracranial hemorrhage after initiation of anticoagulation therapy.The mechanism of low-LDL-C-related bleeding risk has not been fully elucidated.This review summarizes recent evidence of low-LDL-C-related bleeding risk in patients on antithrombotic therapy and discusses potential measures for reducing this risk,underscoring the importance of carefully weighing the pros and cons of aggressive LDL-C lowering in patients on antithrombotic therapy.

关 键 词：Cholesterol-lowering drugs BLEEDING ANTITHROMBOTIC LDL cholesterol Proprotein convertase subtilisin/kexin type 9 inhibitors 

分 类 号：R543.5[医药卫生—心血管疾病]