抗血小板治疗预防冠脉支架术后再狭窄的Meta分析

目的:就冠状动脉(冠脉)支架术后有关西洛他唑、氯吡格雷、阿司匹林三联抗血小板治疗对血小板活化和聚集功能及支架内再狭窄的影响相关文献进行系统评价。方法:计算机检索国内外公开发表的有关西洛他唑,氯吡格雷,阿司匹林对血小板聚集率、冠脉支架术后再狭窄率影响的临床随机对照试验文献,按一定标准筛选文献后进行质量评价,共纳入5篇随机对照研究文献。以Cochrane协作网的软件RevMan v5.0进行处理,主要以血小板聚集抑制率,最小管腔直径(MLD),晚期管腔丢失,再狭窄率为评价指标,进行Meta分析。结果:在以二磷酸腺苷(ADP)为诱导剂的血小板聚集抑制率方面,实验组与对照组之间差异无显著意义,在最小血管直径,晚期血管丢失,再狭窄率方面,试验组与对照组之间的差异存在显著意义。结论:三联(西洛他唑+氯吡格雷+阿司匹林)抗血小板药物治疗与常规两联(氯吡格雷+阿司匹林)治疗组相比能更有效地抑制冠脉支架术后的再狭窄,但其疗效和安全性还需要大规模临床试验的证实。

Meta-analysis on effect of anti-platelet medication on coronary stent restenosis

AIM: To provide clinical drug reference by systematically evaluating relevant literature of cilostazol, clopidogrel and aspirin triple anti-platelet medication in patients who underwent coronary stenting. METHODS: Five randomized controlled trials concerning the effect of cilostazol, clopidogrel and aspirin on platelet aggregation and coronary stent restenosis rate were retrieved and RevMan v.5.0 was used for the meta-analysis of platelet aggregation inhibition rate, minimal luminal diameter (MLD), late lumen loss, and restenosis rate for the evaluation of indicators. RESULTS: Except for the inhibition rate of ADP-induced platelet aggregation, significant differences were found between the experimental and control groups in MLD, late lumen loss, and restenosis rate for the evaluation of indicators. CONCLUSION: Compared with dual anti-platelet regime with aspirin plus clopidogrel, triple anti-platelet therapy with aspirin and clopidogrel combined with cilostazol is more efficient in suppressing restenosis after coronary stent implantation. Large-scale clinical trials are needed to confirm the efficacy and safety of the triple anti-platelet regimen.