【摘要】：目的:對(duì)比房顫患者PCI術(shù)后三聯(lián)抗栓(阿司匹林、氯吡格雷及華法林)及雙聯(lián)抗血小板(阿司匹林及氯吡格雷)治療的臨床相關(guān)終點(diǎn)事件發(fā)生率。方法:分別檢索Pubmed、EMBASE、Cochrane Library、中國(guó)知網(wǎng)、萬(wàn)方數(shù)據(jù)、維普數(shù)據(jù)庫(kù)自建庫(kù)以來(lái)至2016年12月31日的所有相關(guān)文獻(xiàn),嚴(yán)格依據(jù)納入排除標(biāo)準(zhǔn)完成篩選,并使用NOS量表進(jìn)行質(zhì)量評(píng)價(jià),運(yùn)用review manager 5.3軟件進(jìn)行數(shù)據(jù)處理與分析。結(jié)果:共納入13項(xiàng)觀察性臨床研究,合計(jì)樣本量19807人,其中11662人予以雙聯(lián)抗血小板治療(dual antiplatelet therapy,DAPT),另6251人予三聯(lián)抗栓治療(triple therapy,TT)。納入研究NOS評(píng)分均為6-9分的高質(zhì)量文獻(xiàn)。合并結(jié)果顯示:1)TT相較于DAPT可顯著增加患者術(shù)后大出血發(fā)生風(fēng)險(xiǎn)(OR=0.66,95%CI(0.53,0.83),P=0.0003),而在亞洲人群中,兩者所致大出血發(fā)生風(fēng)險(xiǎn)無(wú)顯著性差異(OR=0.57,95%CI(0.19,1.77),P=0.33);2)TT及DAPT所致術(shù)后心梗發(fā)生幾率相當(dāng)(OR=1.23,95%CI(0.85,1.77),P=0.27),在亞洲人群中,TT相較于DAPT可顯著降低心梗發(fā)生風(fēng)險(xiǎn)(OR=2.16,95%CI(1.32,3.53),P=0.002);3)對(duì)隨訪時(shí)間較長(zhǎng)(12個(gè)月)患者,TT及DAPT治療對(duì)患者術(shù)后卒中發(fā)生風(fēng)險(xiǎn)相當(dāng)(OR=1.02,95%CI(0.81,1.27),P=0.88);對(duì)隨訪時(shí)間較短(≤12個(gè)月)患者,TT對(duì)比DAPT治療可顯著降低患者術(shù)后卒中發(fā)生率(OR=2.42,95%CI(1.76,3.32),P0.00001),且該組內(nèi)隨訪時(shí)間長(zhǎng)短為異質(zhì)性來(lái)源;4)TT及DAPT所致術(shù)后全因死亡率發(fā)生風(fēng)險(xiǎn)相當(dāng)(OR=1.36,95%CI(0.98,1.90),P=0.07);5)TT較DAPT治療可降低患者術(shù)后發(fā)生支架內(nèi)血栓風(fēng)險(xiǎn),但差異無(wú)統(tǒng)計(jì)學(xué)意義(OR=1.92;95%CI(0.98,3.75),P=0.06)。結(jié)論:TT相較于DAPT可降低患者術(shù)后發(fā)生支架內(nèi)血栓風(fēng)險(xiǎn)(差異無(wú)統(tǒng)計(jì)學(xué)意義),卻可顯著增加大出血發(fā)生風(fēng)險(xiǎn),而兩者在心梗、卒中及全因死亡率方面風(fēng)險(xiǎn)相當(dāng),顯示DAPT較TT治療對(duì)PCI術(shù)后的房顫患者更為安全。
[Abstract]:Objective: to compare the incidence of related end point events between triple antithrombotic therapy (aspirin, clopidogrel and warfarin) and dual antiplatelet therapy (aspirin and clopidogrel) after PCI in patients with atrial fibrillation. Methods: the data of Pubmed,EMBASE,Cochrane Library, China knowledge Network, Wanfang data, and all the relevant documents from Weip database to December 31, 2016 were searched separately. The screening was completed strictly according to the inclusive exclusion criteria, and the quality was evaluated by NOS scale. Data processing and analysis are carried out with review manager 5.3 software. Results: a total of 13 observational clinical studies were conducted. A total of 19807 patients were enrolled, 11662 of whom were treated with dual antiplatelet therapy (dual antiplatelet therapy,DAPT) and 6251 received triple antithrombotic therapy (triple therapy,TT). High quality literature with NOS score of 6-9 was included in the study. The combined results showed that: 1) compared with DAPT, TT significantly increased the risk of postoperative massive hemorrhage in patients (OR=0.66,95%CI (0.530.83), Pu 0.0003), while in Asian population, the risk of massive hemorrhage was significantly higher than that of DAPT (P < 0.05). There was no significant difference in the risk of haemorrhage between the two groups (OR=0.57,95%CI (0.191.77), P < 0.33). 2) the incidence of myocardial infarction induced by TT and DAPT was the same (OR=1.23,95%CI (0.851.77), P = 0.27). TT significantly decreased the risk of myocardial infarction compared with DAPT (OR=2.16,95%CI (1.32m3.53) in Asian population. P0. 002); 3) for the patients with longer follow-up time (12 months), TT and DAPT treatment had the same risk of postoperative stroke (OR=1.02,95%CI (0.81 鹵1.27), P = 0.88). For the patients with shorter follow-up time (鈮，

本文編號(hào)：2332802