Pannu Rajmony, Andraws Richard
Department of Medicine, New Hanover Regional Medical Center, Wilmington, North Carolina, USA.
Crit Pathw Cardiol. 2008 Mar;7(1):5-10. doi: 10.1097/HPC.0b013e318163ebc9.
Glycoprotein (Gp) IIb/IIIa inhibitors reduce morbidity and mortality in patients undergoing percutaneous coronary intervention (PCI) when added to aspirin and heparin. However, the benefits of Gp IIb/IIIa inhibition in patients pretreated with clopidogrel are less clear. We conducted a meta-analysis to determine the efficacy and safety of adding a Gp IIb/IIIa inhibitor to clopidogrel, aspirin, and heparin before PCI. Five trials were identified via electronic searches of the MEDLINE and Cochrane Central Register of Controlled Trials databases. The studies randomized a total of 5303 patients; 2654 received a Gp IIb/IIIa inhibitor. Two trials examined patients with acute coronary syndromes and 3 examined patients undergoing elective PCI. Loading doses of clopidogrel ranged from 375 to 600 mg. Follow-up ranged from 30 days to 1 year.Gp IIb/IIIa inhibition did not reduce the endpoints of death, myocardial infarction (MI), or target vessel revascularization (odds ratio [OR] = 0.84; 95% confidence interval [CI] = 0.58-1.22, P = 0.35 for death; OR = 0.86; 95% CI = 0.69-1.08, P = 0.19 for MI; and OR = 0.96; 95% CI = 0.81-1.15, P = 0.68 for target vessel revascularization). Analyses restricted to acute coronary syndromes trials yielded similar results (OR = 0.70; 95% CI = 0.33-1.48, P = 0.35 for death; OR = 0.78; 95% CI = 0.59-1.03, P = 0.08 for MI). Gp IIb/IIIa inhibition increased major and minor bleeding (OR = 1.35; 95% CI = 1.04-1.75, P = 0.02) driven by use of abciximab. There was no evidence of heterogeneity in the analyses.
糖蛋白（Gp）IIb/IIIa抑制剂在与阿司匹林和肝素联用时，可降低接受经皮冠状动脉介入治疗（PCI）患者的发病率和死亡率。然而，对于预先接受氯吡格雷治疗的患者，Gp IIb/IIIa抑制的益处尚不清楚。我们进行了一项荟萃分析，以确定在PCI前将Gp IIb/IIIa抑制剂添加到氯吡格雷、阿司匹林和肝素中的疗效和安全性。通过对MEDLINE和Cochrane对照试验中央注册库数据库进行电子检索，确定了五项试验。这些研究共随机纳入5303例患者；其中2654例接受了Gp IIb/IIIa抑制剂治疗。两项试验研究了急性冠状动脉综合征患者，三项试验研究了接受择期PCI的患者。氯吡格雷的负荷剂量为375至600毫克。随访时间为30天至1年。Gp IIb/IIIa抑制并未降低死亡、心肌梗死（MI）或靶血管血运重建等终点事件的发生率（死亡的比值比[OR]=0.84；95%置信区间[CI]=0.58 - 1.22，P = 0.35；MI的OR = 0.86；95% CI = 0.69 - 1.08，P = 0.19；靶血管血运重建的OR = 0.96；95% CI = 0.81 - 1.15，P = 0.68）。仅限于急性冠状动脉综合征试验的分析得出了类似结果（死亡的OR = 0.70；95% CI = 0.33 - 1.48，P = 0.35；MI的OR = 0.78；95% CI = 0.59 - 1.03，P = 0.08）。由于使用阿昔单抗，Gp IIb/IIIa抑制增加了严重和轻微出血的发生率（OR = 1.35；95% CI = 1.04 - 1.75，P = 0.02）。分析中没有异质性的证据。
