不同冠心病患者药物涂层支架置入术后双抗血小板疗程的Meta分析  

Meta analysis of different durations of dual anti-platelet therapy after percutaneous coronary intervention with drug eluting stents in patients with coronary disease

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：《中国医院药学杂志》2017年第10期955-961,共7页Chinese Journal of Hospital Pharmacy

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

摘　　要：目的:系统评价不同冠心病患者药物涂层支架置入术后双抗血小板疗程的有效性和安全性。方法:检索MEDLINE、EMBASE和Cochrane Library数据库,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RevMan 5.2软件分别对性别、年龄、冠心病类型、是否合并糖尿病及置入不同药物涂层支架患者短疗程相对长疗程双抗血小板治疗的有效性和安全性进行Meta分析。结果:共检索到文献4 322篇,最终纳入9个随机对照试验,共30 244例患者。Meta分析显示非老年患者[RR1.42,95%CI(1.20~1.70)]、置入紫杉醇[RR1.70,95%CI(1.26~2.29)]和西罗莫司药物涂层支架[RR1.71,95%CI(1.07~2.74)]的患者短疗程相对长疗程可增加未合并出血的主要复合终点发生率,而不同性别、老年患者、冠心病类型、是否合并糖尿病及置入依维莫司和佐他莫司药物涂层支架的患者短疗程相对长疗程双抗血小板治疗的主要复合终点发生率无显著性差异。结论:临床在为冠心病患者制定药物涂层支架置入术后双抗血小板疗程时应结合患者个体情况进行综合评估,对于非老年患者、置入紫杉醇和西罗莫司药物涂层支架的患者可在指南推荐的基础上适当延长双抗血小板疗程。OBJECTIVE To evaluate the benefits and risks of different durations of dual antiplatelet therapy （DAPT） after percutaneous coronary intervention （PCI） with drug eluting stents （DES） in patients with coronary disease. METIIODS MEDLINE, EMBASE and Cochrane Library were searched for random controlled trials （RCT） comparing different DAPT durations after PCI with DES in patients with coronary disease. Meta analysis was performed with RevMan 5.2 for sex, age, coronary diseases, whether combined with diabetes and implanted with different DESs. RESULTS Totally 4322 articles were retrieved, 9 RCTs were found out, including 30 244 patients. Meta analysis showed significantly increased primary composite endpoints without hemorrahge in shorter than in longer duration of anti-platelet therapy in non-elderly patients [RR 1.42, 95 CI （1.20-1.70）] implanted with paclitaxel-eluting stent （PES） [RR 1.70, 95%CI （1.26-2. 29）] or sirolimus-eluting stent （SES） [RR 1.71, 95%CI （1.07-2. 74）], but no signficant difference in primary composite endpoints between shorter and lon- ger durations of therapy between patients of different sexes, ages, with coronary diseases, whether diabetes was concurrent, or everolimus-eluting stent （EES） or zotarolimus-eluting stent （ZES） was implanted. CONCLUSION Clinician should conssider individual conditions and choose optimal duration of DAPT. It is feasible to appropriately extend the duration of DAPT based on the guidelines recommended for non-elderly patients implanted with PES or SES.

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 META分析 

分 类 号：R973[医药卫生—药品]