术前持续服用抗血小板药物对颈动脉内膜剥脱术术后出血影响的Meta分析

目的采用Meta分析比较颈动脉内膜剥脱术(carotid endarterectomy,CEA)患者术前持续服用抗血小板药物对术后出血的影响。方法检索Pubmed、Cochrane Library、Embase数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库和维普期刊网,时间从建库至2017年2月。收集所有关于术前服用抗血小板药物与CEA术后出血的随机对照试验(RCT)研究。采用Cochrane协作网系统评价法评价文献质量,采用RevMan 5.3软件对收集患者资料进行Meta分析评价。结果最终纳入4篇RCT,共514例患者,其中安慰剂组256例,干预组258例。所有结局指标各项研究结果无异质性(P0.1,I250%),采用固定效应模型分析。CEA术前持续服用抗血小板药物可明显降低CEA术后脑卒中风险(RR=0.30,95%CI 0.11~0.83,P=0.02)。两组术后30d(RR=0.23,95%CI 0.04~1.32,P=0.1)及1年全因死亡率(RR=0.49,95%CI 0.24~1.02,P=0.06)、大出血发生率(RR=1.40,95%CI 0.54~3.59,P=0.49)和出血并发症发生率(RR=1.02,95%CI0.15~6.96,P=0.98)及TIA发生率(RR=1.08,95%CI 0.47~2.49,P=0.86)差异无统计学意义。结论颈动脉内膜剥脱术前持续服用阿司匹林不增加术后出血并发症风险,但可明显降低术后脑卒中风险。

Discontinuation of antiplatelet therapy for postoperative bleeding in carotid endarterectomy patients: a meta-analysis

Objective To systematically review the effect of discontinuation of antiplatelet therapy for postoperative bleeding in carotid endarterectomy(CEA) patients by meta-analysis. Methods We searched the PubMed, Embase, Cochrane library, CNKI, China Biology Medicine (CBM), Wanfang Database and VIP, and collected all the randomized controlled trials (RCTs) about this topic. The quality of the included studies was evaluated using the method recommended by Cochrane Collaboration. Meta-analysis was conducted using RevMan 5.3 software. Results Four RCTs involving 514 patients were included, 256 in the control group and 258 in the intervention group. All outcome measures were not heterogeneous (P>0.1, I²<50%), fixed effect model was used to analyze the outcomes. The results of meta-analysis showed that discontinuation of preoperative antiplatelet therapy could significantly reduce the risk ratio of postoperative stroke (RR=0.30, 95%CI 0.11-0.83, P=0.02). There was no significant difference in the risk of 30 d (RR=0.23, 95%CI 0.04-1.32, P=0.1) and 1-year mortality (RR=0.49, 95%CI 0.24-1.02, P=0.06), postoperative major bleeding (RR=1.40, 95%CI 0.54-3.59, P=0.49), postoperative bleeding complications (RR=1.02, 95%CI 0.15-6.96, P=0.98) and TIA (RR=1.08, 95%CI 0.47-2.49,P=0.86) between the two groups. Conclusion Discontinuation of preoperative aspirin therapy could significantly reduce the rate of postoperative stroke without increasing bleeding risk.