心房颤动采用三联疗法和双重抗血小板疗法抗血栓治疗策略对卒中、主要不良心脑血管事件、出血事件、全因病死率影响的Meta分析  

A meta-analysis of antithrombotic strategies on stroke,major adverse cardiovascular and cerebrovascular events,bleeding events,and all-cause mortality for triple therapy and dual antiplatelet therapy for atrial fibrillation

作　　者：林海 许青青 林孔万 顾勇 LIN Hai;XU Qingqing;LIN Kongwan;GU Yong(Department of Emergency,Hainan Hospital of Traditional Chi-nese Medicine,Haikou,Hainan 570203,China;Department of Clinical Laboratory,Hainan Hospital of Traditional Chi-nese Medicine,Haikou,Hainan 570203,China)

机构地区：[1]海南省中医院急诊科,海南海口570203 [2]海南省中医院临床实验室,海南海口570203

出　　处：《安徽医药》2022年第5期849-854,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的综合评价三联疗法(TT)和双重抗血小板治疗(DAPT)的策略在心房颤动(AF)病人接受经皮冠状动脉介入治疗(PCI)后对卒中、主要不良心脑血管事件(MCAE)、出血事件、全因病死率的影响。方法检索PubMed,Embase,WebofScience数据库中2000―2018年的文章。根据纳入和排除标准进行筛选。提取AF病人TT组和DAPT组卒中、MCAE、出血事件、全因病死率等临床结果数据,采用ReVman 5.3进行合并效应分析。结果TT组总出血事件发生率(RR=1.0,95%CI:0.82~1.22,P=0.99,I^(2)=38%)和次要出血事件发生率(RR=1.12,95%CI:0.71~1.75,P=0.63,I^(2)=27%)与DAPT组之间差异无统计学意义,而TT组主要出血事件发生率(RR=3.55,95%CI:2.17~5.81,P<0.05,I^(2)=0%)则高于DAPT组,差异有统计学意义;DAPT组病人相比TT组具有较高卒中发生率(RR=0.71,95%CI:0.56~0.91,P<0.05,I^(2)=0%),差异有统计学意义;而DAPT组与TT组主要心脑血管事件发生率(RR=0.98,95%CI:0.91~1.06,P=0.68,I^(2)=0%)以及全因病死率(RR=0.98,95%CI:0.91~1.06,P=0.68,I^(2)=0%)差异无统计学意义。结论与DAPT相比,TT增加了出血发生率,且对于降低MACE以及全因病死率并无影响。与此同时,DAPT具有较高的卒中风险。临床医生应仔细评估病人的栓塞、缺血和出血风险,选择用药策略。Objective To comprehensively evaluate the impact of triple therapy(TT)and dual antiplatelet therapy(DAPT)strategies in atrial fibrillation(AF)patients after percutaneous coronary intervention(PCI)is controversial on stroke,major adverse cardiovascular and cerebrovascular events(MACCEs),bleeding events,and all-cause mortality.Methods We searched the PubMed,Embase,and Web of Science databases for articles published from 2000 to 2018.Screening according to inclusion and exclusion criteria.The clini⁃cal outcome data such as stroke,MACCEs,bleeding events,and all-cause mortality in the TT group and DAPT group of AF patients were extracted,and ReVman 5.3 was used for combined effect analysis.Results There was no significant difference in the incidence of total bleeding events(RR=1.0,95%CI:0.82-1.22,P=0.99,I^(2)=38%)or secondary bleeding events(RR=1.12,95%CI:0.71-1.75,P=0.63,I^(2)=27%)between the two groups,while the incidence of major bleeding events in TT group(RR=3.55,95%CI:2.17-5.81,P<0.05,I^(2)=0%)was higher than that in the DAPT group.Compared with the TT group,the DAPT group had a significantly higher incidence of stroke(RR=0.71,95%CI:0.56-0.91,P<0.05,I^(2)=0%).There was no significant difference in the incidence of MACCEs(RR=0.98,95%CI:0.91-1.06,P=0.68,I^(2)=0%)or all-cause mortality(RR=0.98,95%CI:0.91-1.06,P=0.68,I^(2)=0%)between the two groups.Conclusions Compared with DAPT,TT increased the incidence of bleeding and had no effect on reducing MACCEs or all-cause mortality.Meanwhile,DAPT has a higher risk of stroke.Clinicians should carefully assess the patient's risk of thromboembolism,ischemia,and bleeding and choose a medication strategy.

关 键 词：心房颤动 抗栓治疗 经皮冠状动脉介入治疗 双重抗血小板治疗 三联疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]