比瓦利鲁丁与肝素在计划进行穿皮冠状动脉干预的患者中:随机对照试验的元分析
Matthew A Cavender1, Marc S Sabatine1
1TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Lancet (London, England)
|August 19, 2014
概括
与PCI期间的肝素相比,比瓦利鲁丁增加了心肌梗塞和支架血栓的风险,但减少了出血事件. 减少出血因使用糖蛋白IIb/IIIa抑制剂而异,需要仔细考虑权衡.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 干预心脏病学 干预心脏病学
背景情况:
- 比瓦利鲁丁是氨酸的替代抗凝剂,用于穿皮冠状动脉干预 (PCI).
- 这项研究旨在比较基于比瓦利鲁丁的与基于氨酸的抗凝血疗法对PCI患者缺血和出血结果的影响.
研究的目的:
- 确定比瓦利鲁丁与肝素对接受PCI的患者主要心脏不良事件 (MACE) 和出血的比较作用.
- 评估二次疗效终点,包括死亡,心肌梗塞,缺血病驱动的血管再循环和支架血栓.
- 评估PCI后30天大出血的主要安全终点.
主要方法:
- 随机对照试验的系统审查和元分析,比较PCI患者的比瓦利鲁丁与肝素.
- 数据来源于Medline,Cochrane图书馆和会议摘要,搜索时间为2014年4月9日.
- 组合风险比率和95%置信区间是使用初级和二级终点的随机效应模型来计算的.
主要成果:
- 比瓦利鲁丁治疗方案与MACE的风险增加有关 (RR 1.09,95% CI 1.01-1.17) 主要是由心肌梗塞 (RR 1.12,1.03-1.23) 和缺血驱动的复血管化驱动的.
- 使用比瓦利鲁丁 (RR 1.38,1.09-1.74) 观察到支架血栓形成风险显著增加,特别是在ST升高心肌梗塞中.
- 比瓦利鲁丁显著降低了重大出血风险 (RR 0.62,0.49-0.78),其大小取决于同时使用糖蛋白IIb/IIIa抑制剂.
结论:
- 基于比瓦利鲁丁的抗凝剂增加了缺血风险 (心肌梗塞,支架血栓形成),但与PCI中的氨酸相比,降低了出血风险.
- 净临床益处取决于缺血和出血事件之间的平衡,受糖蛋白IIb/IIIa抑制剂使用的影响.
- 临床医生必须在选择PCI抗凝策略时仔细权衡这些竞争风险.
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