延長された二重抗血小板治療と死亡率: 系統的レビューとメタ解析
Sammy Elmariah1, Laura Mauri2, Gheorghe Doros3
1Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Harvard Clinical Research Institute, Boston, MA, USA.
Lancet (London, England)
|December 4, 2014
まとめ
延長された二重抗血小板療法 (DAPT) は,心血管疾患患者の全因死亡率を増加させない. このメタアナリシスでは,より長いDAPT期間で心血管疾患または心血管疾患以外の疾患による死亡率に有意な差は認められませんでした.
科学分野:
- 心臓病学 心臓病学
- クリニック・トライアル 臨床試験
- 薬理学 薬理学とは
背景:
- アスピリンとP2Y12阻害剤による二重抗血小板療法 (DAPT) は,心血管疾患の標準治療である.
- DAPTの延長期間が全体的な死亡率に与える影響は不明のままである.
- DAPT研究から懸念が生じ,ステント設置後の長期治療で非心血管疾患による死亡の増加が示唆された.
研究 の 目的:
- すべての原因,心血管,心血管以外の死亡率に対する延長されたDAPTの効果を評価する.
- 心血管疾患患者のDAPT治療期間を調査するランダム化対照試験のメタ分析を実施する.
主な方法:
- 2014年10月1日までのMedline,Embase,Cochrane CENTRALの体系的な文献検索を行いました.
- 階層的なベイジアンランダム効果モデルを用いたメタ分析.
- 主なアウトカムには,全原因,心血管,心血管以外の死に対する危険比が含まれていました.
主要な成果:
- 69,644人の参加者を含む14件の試験が含まれた.
- 拡張されたDAPTは,アスピリン単独または短期DAPT (≤6ヶ月) と比較して,全因死亡率 (HR1.05,95%CRI 0.96-1.19) で有意な差異を示さなかった.
- 心血管 (HR 1.01,0.93-1.12) または心血管以外の死亡率 (HR 1.04,0.90-1.26) の有意な差異は認められなかった.
結論:
- 長期にわたる二重抗血小板治療は,全因,心血管,または心血管以外の死亡のリスクの増加と関連していません.
- 発見は,現在のDAPTの持続期間は,死亡率の結果に関して安全であることを示唆しています.
- 追加の研究は,特定の患者のサブグループまたは出血リスクを探索することができます.
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