本文關(guān)鍵詞：長期口服抗凝藥患者冠脈介入治療后抗栓治療方案的Meta分析　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 長期口服抗凝治療 冠脈介入治療 三聯(lián)抗栓治療 雙聯(lián)抗血小板治療 華法林聯(lián)合氯吡格雷

【摘要】：心房顫動(Atrial Fibrillation, AF)(以下簡稱房顫)作為最常見的心律失常,其發(fā)病率隨著人群年齡增長而逐漸升高,對于房顫患者來說,適當(dāng)?shù)目鼓委?華法林,Wafarin)可以有效預(yù)防卒中(Stroke)等血栓栓塞事件的發(fā)生。此外,接受外科手術(shù)、心臟瓣膜手術(shù)治療以及長期臥床的患者也常需要長期的口服抗凝藥物(Oral Anticoagulant, OAC)治療以預(yù)防深靜脈血栓、肺栓塞等血栓栓塞事件的發(fā)生。冠心病作為最常見的心血管疾病,其發(fā)病率也在逐年上升,因此,臨床上正有越來越多的患者在接受長期口服抗凝藥物治療的同時(shí)因冠心病而接受冠脈介入治療(Percutaneous Coronary Intervention, PCI)對于此類患者,在接受冠脈介入治療后,為預(yù)防冠脈血栓及支架內(nèi)血栓(Stent Thrombosis)等事件的發(fā)生,應(yīng)接受雙聯(lián)抗血小板(Dual Antiplatelet Therapy, DAPT)(阿司匹林聯(lián)合氯吡格雷)治療,同時(shí),為了預(yù)防卒中、深靜脈血栓、肺栓塞等事件的發(fā)生,患者仍有接受抗凝藥物治療的指征,此時(shí),聯(lián)合華法林及雙聯(lián)抗血小板治療治療——三聯(lián)抗栓治療(Triple Antithrombotic Therapy, TT)——似乎是合理的選擇。但是,隨著抗栓藥物種類的增加患者發(fā)生出血事件的幾率也可能增加。因此,針對此類患者,臨床工作者對于如何平衡栓塞及出血風(fēng)險(xiǎn)以及選擇何種抗栓藥物治療方案仍存在較大分歧。研究目的：本研究檢索現(xiàn)有的關(guān)于長期口服抗凝藥患者冠狀動脈介入治療后抗栓治療方案的臨床試驗(yàn),對其進(jìn)行整合并進(jìn)行meta分析,比較三聯(lián)抗栓治療(阿司匹林+氯吡格雷+華法林)與另外兩種抗栓方案(1.雙聯(lián)抗血小板治療(阿司匹林+氯吡格雷)；2.華法林聯(lián)合氯吡格雷(Double Therapy))的安全性和有效性,以期尋找最佳的抗栓治療方案,并為臨床決策的制定提供相應(yīng)的循證醫(yī)學(xué)證據(jù)。研究方法：1.計(jì)算機(jī)系統(tǒng)檢索PubMed和Cochrane Library數(shù)據(jù)庫,檢索時(shí)間截至2014年11月；2.根據(jù)預(yù)先設(shè)定的納入標(biāo)準(zhǔn)對文獻(xiàn)進(jìn)行篩選,獲得符合納入標(biāo)準(zhǔn)的臨床試驗(yàn)；3采用RevMan 5.2軟件進(jìn)行Meta分析。采用隨機(jī)效應(yīng)模型對數(shù)據(jù)進(jìn)行合并,抗栓治療方案的安全性及有效性的效應(yīng)值用比值比(Odds Ratio, OR)及其95%置信區(qū)間(Confidence Interval, CI)表示。試驗(yàn)結(jié)果：1.共納入18個(gè)符合標(biāo)準(zhǔn)的臨床試驗(yàn),其中16個(gè)實(shí)驗(yàn)比較了TT與DAPT的治療效果,6個(gè)實(shí)驗(yàn)比較了TT與Double Therapy治療的效果。2.TT與DAPT相比可以更有效的預(yù)防血栓事件的發(fā)生。TT有降低患者卒中事件發(fā)生率的趨勢(OR,0.66; 95% CI,0.41-1.09; p=0.10),亞組分析提示,當(dāng)將研究局限于非亞洲人群后,TT可以顯著降低患者卒中的風(fēng)險(xiǎn)(OR,0.49; 95% CI, 0.35-0.67; p0.00001) 。TT與DAPT治療組支架內(nèi)血栓發(fā)生率相當(dāng)(OR,1.07; 95% CI,0.42-2.77; p=0.88).3.TT與DAPT相比導(dǎo)致更多的出血事件。TT與DAPT相比導(dǎo)致的大出血事件(Major Bleeding) (OR,1.54; 95% CI,1.09-2.19; p=0.02)和小出血事件(Minor Bleeding) (OR,1.46; 95% CI,1.07-1.99; p=0.02)更多,但是,當(dāng)將研究局限于口服抗凝治療指征僅為房顫的臨床試驗(yàn)時(shí),接受TT與DAPT治療的患者發(fā)生大出血的幾率相當(dāng)(OR,1.26; 95% CI,0.89-1.79; p=0.20)。4. TT與Double Therpy的死亡(Death)、卒中、支架內(nèi)血栓、大出血等事件的發(fā)生率相似。結(jié)論及意義：1.長期口服抗凝藥患者接受冠脈介入治療后,三聯(lián)抗栓治療與雙聯(lián)抗血小板治療相比可以更有效地預(yù)防血栓栓塞事件的發(fā)生但是會增加患者出血的風(fēng)險(xiǎn)。2.長期口服抗凝治療患者接受冠脈介入治療后,華法林聯(lián)合氯吡格雷治療可能成為三聯(lián)抗栓治療的替代治療。
[Abstract]:Atrial fibrillation (Atrial Fibrillation AF) (hereinafter referred to as AF) is the most common arrhythmia, the incidence with age gradually increased, for patients with atrial fibrillation, appropriate anticoagulation (Hua Falin, Wafarin) (Stroke) can be effective for the prevention of stroke and thromboembolic events occurred. In addition, accept surgery, heart valve surgery and long-term bedridden patients often need long-term oral anticoagulation (Oral Anticoagulant, OAC) for prevention of deep vein thrombosis, pulmonary embolism and other thromboembolic events. Coronary heart disease is the most common cardiovascular disease, and its incidence is increasing, therefore, it is clinically more and more patients receiving long-term oral anticoagulant therapy at the same time due to coronary heart disease and undergoing coronary intervention (Percutaneous Coronary, Intervention, PCI) in these patients, in Percutaneous coronary intervention after treatment for prevention of coronary thrombosis and in stent thrombosis (Stent Thrombosis) and other events, should receive dual antiplatelet (Dual Antiplatelet, Therapy, DAPT) (aspirin and clopidogrel) treatment, at the same time, in order to prevent stroke, deep vein thrombosis, pulmonary embolism and other events, there were still receiving anticoagulant drug treatment indications, at this time, with Hua Falin and dual antiplatelet therapy for triple antithrombotic therapy (Triple Antithrombotic, Therapy, TT) - seems to be a reasonable choice. However, with the increase in the types of antithrombotic drugs in patients with probability of bleeding may also increase. Therefore, for these patients, the clinical workers still exist large differences on how to balance the risk of thromboembolism and bleeding as well as the choice of antithrombotic drug treatment. Objective: the purpose of this research on the long-term existing retrieval Clinical trials of antithrombotic therapy for coronary artery in patients with oral anticoagulation after interventional therapy, the integration and meta analysis, comparison of triple antithrombotic therapy (aspirin + clopidogrel + warfarin) and other two kinds of antithrombotic schemes (1. dual antiplatelet therapy (aspirin + clopidogrel A Si); 2. Double (warfarin and clopidogrel Therapy)) the efficacy and safety of antithrombotic therapy, in order to find the optimal solution, and to provide evidence for the clinical decision-making. Methods: 1. computer retrieval system of PubMed and Cochrane Library database, retrieval time as of November 2014 2.; according to the preset inclusion criteria for literature screening. For clinical trials in accordance with the inclusion criteria; 3 RevMan 5.2 software was used for Meta analysis. By using a random effects model is used to merge data, scheme of antithrombotic therapy The effect of the safety and effectiveness of the value of odds ratio (Odds Ratio OR) and its 95% confidence interval (Confidence, Interval, CI). Results: 1. a total of 18 to meet the standards of clinical trials, 16 of which were compared with TT DAPT treatment, 6 experiments have decreased in patients with stroke the incidence trend effects than the.2.TT and DAPT is TT and Double Therapy treatment compared to.TT can more effectively prevent thromboembolic events (OR, 0.66; 95% CI, 0.41-1.09; p=0.10), subgroup analysis suggests that when the research was limited to non Asian group, TT can significantly reduce the risk of stroke patients (OR, 0.49; 95% CI, 0.35-0.67; p0.00001).TT DAPT and the incidence of stent thrombosis in treatment group (OR, 1.07; 95% CI, 0.42-2.77; p=0.88.3.TT) compared with DAPT resulted in more.TT and DAPT than the bleeding bleeding incident (Major Bleeding) (OR, 1.54; 95% CI, 1.09-2.19; p=0.02) and minor bleeding events (Minor Bleeding) (OR, 1.46; 95% CI, 1.07-1.99; p=0.02) more, but when the study is confined to oral anticoagulation therapy indications only clinical trials for atrial fibrillation, TT patients treated with DAPT major a risk of bleeding (OR, 1.26; 95% CI, 0.89-1.79; p=0.20).4. TT and Double Therpy death (Death), stroke, stent thrombosis, bleeding and other events were similar. Conclusion and significance: 1. long-term oral anticoagulants in patients undergoing coronary intervention after treatment with triple antithrombotic therapy dual antiplatelet therapy can be more effective than to prevent occurrence of thromboembolic events but will increase the risk of bleeding in patients with long-term oral anticoagulant therapy in.2. patients undergoing coronary intervention after warfarin combined with clopidogrel in the treatment of replacement therapy may become triple antithrombotic therapy.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4

【共引文獻(xiàn)】

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