冠状动脉疾病患者的口服抗凝剂治疗:一个元分析
1Program of Preventive Cardiology and Therapeutics, Hamilton Civic Hospitals Research Centre, McMaster University, Ontario, Canada. anands@fhs.mcmaster.ca
JAMA
|December 11, 1999
概括
高强度口服抗凝剂 (OA) 在冠状动脉疾病 (CAD) 患者中有效降低死亡率和心肌梗塞 (MI),但增加出血风险. 中等强度的OA还可以减少心脏病发作和中风,从而增加出血风险.
科学领域:
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 口服抗凝剂 (OA) 在治疗冠状动脉疾病 (CAD) 中的作用仍然是争论的主题,尽管进行了广泛的研究.
- 现有的研究已经探讨了OA的有效性,但对其长期使用缺乏明确的共识,特别是在强度上分层.
研究的目的:
- 评估口服抗凝剂 (OA) 治疗在冠状动脉疾病 (CAD) 患者的长期影响.
- 根据抗凝血强度和同时使用阿司匹林对关键临床结果的OA治疗的影响进行分层.
主要方法:
- 1960年至1999年7月间发表的随机对照试验的系统审查,通过全面的数据库搜索 (MEDLINE,EMBASE,CURRENT CONTENTS) 和专家咨询确定.
- 纳入标准要求患有CAD的患者,至少3个月的OA治疗持续时间,以及随机研究设计.
- 两个独立观察员的数据抽象包括OA类型,持续时间,监测和死亡率,心肌梗塞 (MI),中风,血栓栓塞事件和出血.
主要成果:
- 高强度OA (INR 2.8-4.8) 显著降低了死亡率 (22%),心脏病发作 (42%) 和中风 (63%),但与对照组相比,大出血增加了6倍.
- 中等强度的OA (INR 2-3) 也减少了MI (52%) 和中风 (53%),但增加了7.7倍的出血.
- 与中度至高强度OA和阿司匹林的联合治疗显示出对不良事件的有希望的减少,随着出血风险的适度增加 (1.9倍).
结论:
- 高强度和中等强度的口服抗凝剂在降低心脏病发作和中风患者中有效,但会增加出血风险.
- 低强度OA与阿司匹林并不优于单独的阿司匹林;中度至高强度OA与阿司匹林显示出潜力,但需要进一步验证.
- 这些发现强调了在选择OA强度用于CAD管理时,平衡抗血栓疗效与出血风险的重要性.
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