双抗血小板治疗与冠状动脉旁路移植手术后静脉移植失败的关联:系统性审查和分析
Sigrid Sandner1,2, Björn Redfors3, Dominick J Angiolillo4
1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
JAMA
|August 9, 2022
概括
与单独使用阿司匹林相比,双重抗血小板治疗 (DAPT) 显著降低了冠状动脉旁路移植手术后的静脉移植衰竭,但增加了出血风险. 单一治疗没有显著的差异.
科学领域:
- 心血管医学
- 药理学
- 临床试验
背景情况:
- 在冠状动脉旁路移植 (CABG) 手术后,最佳的抗血小板策略尚不清楚.
- 目前正在考虑用阿司匹林或不用阿司匹林的提卡格勒尔,但其在这种情况下的疗效和安全性需要澄清.
研究的目的:
- 为了比较软静脉移植失败和出血事件的发生率.
- 在接受CABG手术的患者中,对阿司匹林进行双重抗血小板治疗 (DAPT) 或单一治疗.
主要方法:
- 这是一项对4项随机临床试验 (RCT) 的元分析,涉及1316名患者和1668名静脉移植.
- 通过多层次逻辑回归合成了个别患者的数据.
- 主要结局:每种移植的软静脉移植失败;次要结局:每位患者的移植失败和Bleeding Academic Research Consortium (BARC) 的2,3或5种出血事件.
主要成果:
- 与阿司匹林相比,Ticagrelor DAPT显著降低了每种移植 (11. 2%与20%相比; OR,0. 51) 和每位患者 (13. 2%与23. 0%相比; OR,0. 51).
- 提卡格雷勒DAPT与2型,3型或5型BARC出血事件的发生率显著增加 (22. 1%与8. 7%相比; OR,2. 98).
- 与阿司匹林相比,单独使用蒂卡格勒对移植失败或出血事件没有显著差异.
结论:
- 在接受CABG手术的患者中,提卡格雷勒DAPT显著降低了静脉移植衰竭,但增加了临床重要出血的风险.
- 这些发现表明,在CABG后使用蒂卡格勒勒DAPT时,移植通透性和出血风险之间存在权衡.
- 在这种患者群体中,单独使用蒂卡格洛尔似乎没有比阿司匹林在移植失败或出血方面提供显著的益处.
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