冠脉支架置入术后三联抗栓塞治疗效果及其安全性的系统评价  

Efficacy and Safety of Triple Antithrombotic Treatment for Patients Undergoing Coronary Stenting:A Systematic Review

作　　者：袁园[1] 唐其柱[1] 甘华文[1] 纵静[1] 代佳[1] 

机构地区：[1]武汉大学人民医院心血管内科,430060

出　　处：《医学研究杂志》2013年第1期33-36,共4页Journal of Medical Research

基　　金：中央高校基本科研业务费专项基金资助项目(20103020201000193);中央高校基本科研业务费专项基金资助项目(201130202020007)

摘　　要：目的我们纳入4篇文献进行Meta分析,将二联抗血小板治疗(阿司匹林联合氯吡格雷)与三联抗栓塞治疗(华法林、阿司匹林联合氯吡格雷)进行抗栓塞治疗的安全性和有效性的评价。方法计算机检索Pubmed(1966～2012年1月)、Co-chrane图书馆2012年第1期、重庆维普中文科技期刊全文数据库(1989～2012年1月)文献中关于冠脉支架置入术后抗栓塞治疗效果及其安全性的研究,同时筛检纳入文献的参考文献。由两名研究者对文献质量进行严格评价和资料提取,对符合质量标准的研究进行Meta分析。结果共纳入4篇文献。结果显示,与二联抗血小板治疗(阿司匹林联合氯吡格雷),三联抗栓塞治疗(华法林、阿司匹林联合氯吡格雷)减少脑卒中风险,具有统计学意义(OR=0.22,95%CI:0.05～0.98,P=0.05)。但三联抗栓塞治疗增加了出血的风险(OR=2.24,95%CI:1.07～4.70,P=0.03)。另外,两种治疗的远期死亡(OR=0.84,95%CI:0.27～2.61,P=0.76)没有统计学意义,而三联抗栓塞治疗再发急性冠脉综合征风险(OR=0.77,95%CI:0.37～1.61,P=0.49)低于二联抗血小板治疗。结论三联抗栓塞治疗相比于二联抗血小板治疗,可以减少患者缺血性脑卒中和再发急性冠脉综合征风险,但增加了患者出血的风险。两种治疗的远期病死率没有显著差异。Objective To assess the efficacy and safety of antithrombotic treatment for patients undergoing coronary stenting. Methods We searched Pubmed （1966 to 2012） , Cochrane library （2012,No. 1 ） and Chongqing VIP Chinese Science and Technology Academic Journal（ 1989 to 2012）to collect researchs about antithrombotic therapy in patients undergoing coronary stenting. Results Four researchs with a total of 1080 patients were analyzed. The use of triple antithrombotic regimen （TT -wafarin,asparin and clopidogrel） significantly reduced risk of ischemic stroke （ odds ratio OR = 0.22, 95 % C1：0.05 - 0.98,P = 0.05 ） and acute coronary syndromes （ OR = 0.77, 95% C1：0.37 -1.61 ,P = 0.49 ） as compared with dual antiplatelet therapy （DT- asparin and Clopidogrel）, while there was an increased risk of major bleeding in patients with triple antithrombotic regimen（ OR = 2.24, 95% CI ： 1.07 - 4.70,P = 0.03 ）. The overall incidence of death （ OR = 0.84,95% C1：0.27 - 2.61 ,P = 0.76） was not significantly different between the two regimens. Conclusion Our study demonstrated the increased risk of major bleeding of triple antithrombotic regimen. And we confirmed the cardiovascular benefits of triple antithrombotic regimen by reducing risk of ischemic stroke and acute coronary syndromes.

关 键 词：冠脉支架置入 三联抗栓塞治疗 二联抗血小板治疗 系统评价 

分 类 号：R735.705[医药卫生—肿瘤]