PCI 术后三联与双联抗凝策略疗效比较的 Meta 分析

目的 比较双联 （阿司匹林、 氯吡格雷） 与三联 （阿司匹林、 氯吡格雷、 华法林） 抗血小板聚集方案治疗同时 有应用口服抗凝药物（OAC）及双联抗血小板聚集药物（DAPT）指征患者的疗效与安全性。方法 检索 PubMed、 Cochrane、 Embase 数据库， 收集 1966 年 1 月—2016 年 4 月发表的有 OAC 及 DAPT 应用指征的患者抗凝药物使用的 疗效和安全性比较的研究， 同时辅以手检纳入文献的参考文献。对文献进行筛选、 质量评价与资料提取， 采用 RevMan 5.1 软件进行 Meta 分析， 主要终点事件为全因死亡率， 次要终点事件包括缺血性卒中、 主要出血事件、 心肌 梗死以及支架内血栓形成。结果 共纳入 16 项研究， 共 7 083 例患者（三联 3 330 例， 双联 3 753 例）， 中位随访期 1.6 年， 平均年龄 73.2 岁。Meta 分析显示： 三联抗凝与双联抗凝策略相比， 全因死亡率OR（95%CI） =0.94（0.79～ 1.13）， P=0.54]、 心肌梗死发生率OR（95%CI） =1.21（0.92～1.59）， P=0.16]、 支架内血栓事件发生率OR（95%CI） =1.02 （0.55～1.90）， P=0.94]差异均无统计学意义， 相对于采取双联抗凝策略的患者， 应用三联抗凝策略能降低缺血性卒中 风险OR（95%CI） =0.44（0.30～0.63）， P＜0.001]， 增加主要出血事件风险OR（95%CI） =1.31（1.07～1.61）， P=0.008]。 结论 针对同时具有应用 OAC 及 DAPT 指征的患者， 使用三联抗凝策略在降低卒中风险的同时会增加出血的风险。

Meta analysis of the efficacy and safety of triple and double antithrombosis strategies in patients with PCI

Objective To compare the efficacy and safety of double antiplatelet treatment strategy (DAPT, aspirin, clopidogrel) and triple antiplatelet strategy (aspirin, clopidogrel and warfarin) in patients with oral anticoagulants (OAC). Methods PubMed, Cochrane and Embase database were searched, and the information from January 1966 to April 2016 was collected. The efficacy and safety of antithrombotic drugs in patients with OAC were compared. At the same time, supplemented data searched by hand were collected and included into references. RevMan 5.1 software was used in this Meta analysis. The primary endpoint events were all cause mortality, and the secondary endpoints included ischemic stroke, major bleeding events, myocardial infarction and in- stent thrombus formation. Results A total of 16 studies including 7 083 patients (triple antiplatelet treatment 3 330, double antiplatelet treatment 3 753) in this analysis. The median followup period was 1.6 years, and the average age was 73.2 years. Meta analysis showed that there was no significant difference in all cause mortality rate between dual antiplatelet strategy and triple antithrombotic strategy OR（95%CI) =0.94（0.79-1.13)， P=0.54] , no significant difference in myocardial infarction incidence rate OR（95%CI） =1.21（0.92-1.59)， P=0.16], and no significant difference in in-stent thrombosis events between dual antiplatelet strategy and triple antithrombotic strategy OR （95%CI） =1.02（0.55-1.90)， P=0.94]. Compared with dual antiplatelet strategy for patients, the triple antithrombotic strategy can significantly reduce the risk of ischemic stroke OR（95%CI)=0.44（0.30-0.63)， P＜0.001], and increase major bleeding events OR（95%CI） =1.31（1.07-1.61)， P=0.008]. Conclusion In review of the application of OAC and DAPT in patients with indications of the anti thrombosis strategy, triple antithrombotic strategy can reduce the risk of stroke, and increase the risk of bleeding.