房颤患者PCI术后三联抗栓及双联抗血小板治疗安全性的Meta分析
发布时间：2018-11-15 08:44
【摘要】：目的:对比房颤患者PCI术后三联抗栓(阿司匹林、氯吡格雷及华法林)及双联抗血小板(阿司匹林及氯吡格雷)治疗的临床相关终点事件发生率。方法:分别检索Pubmed、EMBASE、Cochrane Library、中国知网、万方数据、维普数据库自建库以来至2016年12月31日的所有相关文献,严格依据纳入排除标准完成筛选,并使用NOS量表进行质量评价,运用review manager 5.3软件进行数据处理与分析。结果:共纳入13项观察性临床研究,合计样本量19807人,其中11662人予以双联抗血小板治疗(dual antiplatelet therapy,DAPT),另6251人予三联抗栓治疗(triple therapy,TT)。纳入研究NOS评分均为6-9分的高质量文献。合并结果显示:1)TT相较于DAPT可显著增加患者术后大出血发生风险(OR=0.66,95%CI(0.53,0.83),P=0.0003),而在亚洲人群中,两者所致大出血发生风险无显著性差异(OR=0.57,95%CI(0.19,1.77),P=0.33);2)TT及DAPT所致术后心梗发生几率相当(OR=1.23,95%CI(0.85,1.77),P=0.27),在亚洲人群中,TT相较于DAPT可显著降低心梗发生风险(OR=2.16,95%CI(1.32,3.53),P=0.002);3)对随访时间较长(12个月)患者,TT及DAPT治疗对患者术后卒中发生风险相当(OR=1.02,95%CI(0.81,1.27),P=0.88);对随访时间较短(≤12个月)患者,TT对比DAPT治疗可显著降低患者术后卒中发生率(OR=2.42,95%CI(1.76,3.32),P0.00001),且该组内随访时间长短为异质性来源;4)TT及DAPT所致术后全因死亡率发生风险相当(OR=1.36,95%CI(0.98,1.90),P=0.07);5)TT较DAPT治疗可降低患者术后发生支架内血栓风险,但差异无统计学意义(OR=1.92;95%CI(0.98,3.75),P=0.06)。结论:TT相较于DAPT可降低患者术后发生支架内血栓风险(差异无统计学意义),却可显著增加大出血发生风险,而两者在心梗、卒中及全因死亡率方面风险相当,显示DAPT较TT治疗对PCI术后的房颤患者更为安全。
[Abstract]:Objective: to compare the incidence of related end point events between triple antithrombotic therapy (aspirin, clopidogrel and warfarin) and dual antiplatelet therapy (aspirin and clopidogrel) after PCI in patients with atrial fibrillation. Methods: the data of Pubmed,EMBASE,Cochrane Library, China knowledge Network, Wanfang data, and all the relevant documents from Weip database to December 31, 2016 were searched separately. The screening was completed strictly according to the inclusive exclusion criteria, and the quality was evaluated by NOS scale. Data processing and analysis are carried out with review manager 5.3 software. Results: a total of 13 observational clinical studies were conducted. A total of 19807 patients were enrolled, 11662 of whom were treated with dual antiplatelet therapy (dual antiplatelet therapy,DAPT) and 6251 received triple antithrombotic therapy (triple therapy,TT). High quality literature with NOS score of 6-9 was included in the study. The combined results showed that: 1) compared with DAPT, TT significantly increased the risk of postoperative massive hemorrhage in patients (OR=0.66,95%CI (0.530.83), Pu 0.0003), while in Asian population, the risk of massive hemorrhage was significantly higher than that of DAPT (P < 0.05). There was no significant difference in the risk of haemorrhage between the two groups (OR=0.57,95%CI (0.191.77), P < 0.33). 2) the incidence of myocardial infarction induced by TT and DAPT was the same (OR=1.23,95%CI (0.851.77), P = 0.27). TT significantly decreased the risk of myocardial infarction compared with DAPT (OR=2.16,95%CI (1.32m3.53) in Asian population. P0. 002); 3) for the patients with longer follow-up time (12 months), TT and DAPT treatment had the same risk of postoperative stroke (OR=1.02,95%CI (0.81 卤1.27), P = 0.88). For the patients with shorter follow-up time (鈮，
本文编号：2332802
[Abstract]:Objective: to compare the incidence of related end point events between triple antithrombotic therapy (aspirin, clopidogrel and warfarin) and dual antiplatelet therapy (aspirin and clopidogrel) after PCI in patients with atrial fibrillation. Methods: the data of Pubmed,EMBASE,Cochrane Library, China knowledge Network, Wanfang data, and all the relevant documents from Weip database to December 31, 2016 were searched separately. The screening was completed strictly according to the inclusive exclusion criteria, and the quality was evaluated by NOS scale. Data processing and analysis are carried out with review manager 5.3 software. Results: a total of 13 observational clinical studies were conducted. A total of 19807 patients were enrolled, 11662 of whom were treated with dual antiplatelet therapy (dual antiplatelet therapy,DAPT) and 6251 received triple antithrombotic therapy (triple therapy,TT). High quality literature with NOS score of 6-9 was included in the study. The combined results showed that: 1) compared with DAPT, TT significantly increased the risk of postoperative massive hemorrhage in patients (OR=0.66,95%CI (0.530.83), Pu 0.0003), while in Asian population, the risk of massive hemorrhage was significantly higher than that of DAPT (P < 0.05). There was no significant difference in the risk of haemorrhage between the two groups (OR=0.57,95%CI (0.191.77), P < 0.33). 2) the incidence of myocardial infarction induced by TT and DAPT was the same (OR=1.23,95%CI (0.851.77), P = 0.27). TT significantly decreased the risk of myocardial infarction compared with DAPT (OR=2.16,95%CI (1.32m3.53) in Asian population. P0. 002); 3) for the patients with longer follow-up time (12 months), TT and DAPT treatment had the same risk of postoperative stroke (OR=1.02,95%CI (0.81 卤1.27), P = 0.88). For the patients with shorter follow-up time (鈮，
本文编号：2332802
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