冠心病患者药物涂层支架置入术后双抗血小板疗程的系统评价  

Different Durations of Dual Anti-platelet Therapy after Percutaneous Coronary Intervention with Drug-eluting Stents in Patients with Coronary Disease: A Systematic Review

作　　者：谢诚[1] 丁肖梁[1] 缪丽燕[1] 

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215006

出　　处：《中国药学杂志》2016年第9期762-768,共7页Chinese Pharmaceutical Journal

基　　金：国家自然科学基金资助项目(81173132);江苏省医学重点人才资助项目(RC2011110);苏州市科技计划项目资助课题(SYS2011137)

摘　　要：目的系统评价冠心病患者药物涂层支架置入术后不同疗程双抗血小板治疗的有效性和安全性,为临床确定最佳抗血小板疗程提供证据和参考。方法通过检索英文数据库Pub Med、Embase和Cochrane Library,中文数据库CBM、CNKI、VIP和万方数据库,临床试验注册平台数据库Clinical Trials和ICTRP,获得冠心病患者药物涂层支架置入术后不同疗程双抗血小板治疗的随机对照试验。采用Cochrane推荐的偏倚风险评估工具评估纳入研究的偏倚风险。网络Meta分析采用Win BUGS 1.4.3和STATA 12.0完成。结果共检索到文献3 230篇,最终纳入10个随机对照试验,31 643例患者。网络Meta分析显示,除6个月[OR 10.56,95%CI(1.62,9.17)]与12个月[OR 4.05,95%CI(1.01,11.46)]和30个月相比可增加支架血栓的发生率外,其余疗程组间支架血栓、心肌梗死、全因死亡和严重出血的发生率无统计学差异。累积概率排序显示,对于支架血栓和心肌梗死双抗血小板30个月和36个月时的发生风险最低,而对于全因死亡和严重出血双抗血小板则是3个月和6个月时的发生风险最低。结论临床在为冠心病患者制定药物涂层支架置入术后最佳双抗血小板疗程时应结合患者个体情况综合评估其发生支架血栓和出血的风险,对于出血风险较低的患者可适当延长双抗血小板疗程。OBJECTIVE To evaluate the benefits and risks of different durations of dual anti-platelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with coronary disease. METHODS PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, Wanfang Data, Clinical Trials and ICTRP were searched for randomized controlled trials（RCTs） comparing differ- ent DAPT durations after PCI with DES in patients with coronary disease. Risk of bias was assessed with the tool recommended by Co- chrane Collaboration. Network Meta-analysis was performed with WinBUGS 1.4. 3 and STATA 12. 0. RESULTS A total of 3 230 ar- ticles were found and 10 RCTs including 31 643 patients were systematically reviewed. Network Meta-analysis showed there was no sig- nificantly difference among the 6 different durations in the rates of stent thrombosis, myocardial infarction, all-cause mortality and ma- jor bleeding, except that the durations of 6 months [ OR 10. 56,95% CI（ 1.62, 9. 17） 1 and 12 months [ OR 4. 05,95% CI（ 1.01, 11.46） ] were different with 30 months in the rate of stent thrombosis. Ranking of cumulative probabilities showed that 30 months and 36 months of DAFF had the lowest risk of stent thrombosis and myocardial infarction, meanwhile duration of 3 months and 6 months had the lowest risk of all-cause mortality and major bleeding. CONCLUSION Clinicians should assess the risks of stent thrmnbosis and bleeding according to patient＇s individual condition and determine the optimal duration of DAPT. It is considered feasible to appropri- ately extend the duration of DAPT in patients at lower bleeding risk.

关 键 词：冠心病 双抗血小板 药物涂层支架 疗程 随机对照试验 系统评价 

分 类 号：R969.3[医药卫生—药理学]