延长时间的双重抗血小板治疗和死亡率:系统性审查和元分析
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
概括
延长双重抗血小板治疗 (DAPT) 不会增加心血管病患者的全因死亡率. 这次元分析发现,心血管或非心血管死亡率与较长的DAPT持续时间没有显著差异.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 使用阿司匹林和P2Y12抑制剂的双抗血小板治疗 (DAPT) 是心血管疾病的标准.
- 延长DAPT持续时间对整体死亡率的影响仍然不清楚.
- 对DAPT研究产生了担忧,该研究表明,在支架后长时间治疗时,非心血管疾病死亡率增加.
研究的目的:
- 评估延长DAPT持续时间对所有原因,心血管和非心血管死亡率的影响.
- 对随机对照试验进行元分析,调查心血管患者的DAPT治疗持续时间.
主要方法:
- 在2014年10月1日之前对Medline,Embase和Cochrane CENTRAL的系统文献搜索.
- 使用层次的贝叶斯随机效应模型进行元分析.
- 主要结局包括所有原因,心血管和非心血管死亡的危险比率.
主要成果:
- 其中包括了14项试验,共有69644名参与者.
- 与单独使用阿司匹林或短期DAPT (≤6个月) 相比,扩展的DAPT在所有原因的死亡率 (HR1.05,95%CRI 0.96-1.19) 中没有显著差异.
- 对于心血管 (HR 1.01,0.93-1.12) 或非心血管死亡率 (HR 1.04,0.90-1.26) 没有发现显著差异.
结论:
- 长时间的双重抗血小板治疗与任何原因,心血管或非心血管死亡风险的增加无关.
- 研究结果表明,目前的DAPT持续时间对于死亡结果是安全的.
- 进一步的研究可能会探索特定的患者亚组或出血风险.
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