【摘要】：目的:對比房顫患者PCI術后三聯(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)治療的臨床相關終點事件發(fā)生率。方法:分別檢索Pubmed、EMBASE、Cochrane Library、中國知網(wǎng)、萬方數(shù)據(jù)、維普數(shù)據(jù)庫自建庫以來至2016年12月31日的所有相關文獻,嚴格依據(jù)納入排除標準完成篩選,并使用NOS量表進行質(zhì)量評價,運用review manager 5.3軟件進行數(shù)據(jù)處理與分析。結果:共納入13項觀察性臨床研究,合計樣本量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評分均為6-9分的高質(zhì)量文獻。合并結果顯示:1)TT相較于DAPT可顯著增加患者術后大出血發(fā)生風險(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)生風險無顯著性差異(OR=0.57,95%CI(0.19,1.77),P=0.33);2)TT及DAPT所致術后心梗發(fā)生幾率相當(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)生風險(OR=2.16,95%CI(1.32,3.53),P=0.002);3)對隨訪時間較長(12個月)患者,TT及DAPT治療對患者術后卒中發(fā)生風險相當(OR=1.02,95%CI(0.81,1.27),P=0.88);對隨訪時間較短(≤12個月)患者,TT對比DAPT治療可顯著降低患者術后卒中發(fā)生率(OR=2.42,95%CI(1.76,3.32),P0.00001),且該組內(nèi)隨訪時間長短為異質(zhì)性來源;4)TT及DAPT所致術后全因死亡率發(fā)生風險相當(OR=1.36,95%CI(0.98,1.90),P=0.07);5)TT較DAPT治療可降低患者術后發(fā)生支架內(nèi)血栓風險,但差異無統(tǒng)計學意義(OR=1.92;95%CI(0.98,3.75),P=0.06)。結論:TT相較于DAPT可降低患者術后發(fā)生支架內(nèi)血栓風險(差異無統(tǒng)計學意義),卻可顯著增加大出血發(fā)生風險,而兩者在心梗、卒中及全因死亡率方面風險相當,顯示DAPT較TT治療對PCI術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，

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