Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Thromb Haemost. 2010 Apr;103(4):841-8. doi: 10.1160/TH09-06-0418. Epub 2010 Feb 2.
We performed this meta-analysis to update the clinical evidences on the relation between clopidogrel non-responsiveness and clinical outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention. An electronic literature search through MEDLINE, EMBASE, Web of Science, and the Cochrane Library and bibliographies of retrieved articles up to January, 2009 was conducted. Studies were included if they had a cohort prospective design, if they analysed clopidogrel responsiveness in CAD patients in relation to death and/or occurrence of adverse coronary events during follow-up, and if they reported an adequate statistical analysis. Fourteen studies, totalling 4,564 CAD patients followed for a time ranging from 14 days to one year, were included. The cumulative analysis reported that residual platelet reactivity despite clopidogrel treatment was significantly associated with an increased risk of death and/or thrombotic recurrences (odds ratio [OR] 5.67, 95% confidence interval [CI] 2.97 to 10.84; p<0.00001). However, four studies contributed to a consistent heterogeneity of the model and evidenced a significant risk of publication bias, so were excluded from the analysis. This exclusion, however, did not influence the overall result, by confirming the increased risk of cardiovascular recurrences for patients with a poor response to clopidogrel treatment (OR 3.58, 95%CI 2.54 to 5.05; p<0.00001). The present updated meta-analysis documents a significant association between residual platelet reactivity under clopidogrel treatment and recurrent cardiovascular events, so suggesting the relevance of ongoing interventional studies aimed at tailoring the antithrombotic therapy in CAD patients.
我们进行了这项荟萃分析，以更新关于经皮冠状动脉介入治疗的冠心病患者氯吡格雷反应性与临床结局之间关系的临床证据。通过 MEDLINE、EMBASE、Web of Science 和 Cochrane 图书馆进行了电子文献检索，并检索了截至 2009 年 1 月的文章的参考文献。如果研究具有前瞻性队列设计，如果他们分析了 CAD 患者氯吡格雷反应性与随访期间死亡和/或不良冠状动脉事件的发生有关，并且如果他们报告了充分的统计分析，则纳入研究。共纳入了 14 项研究，总计 4564 例 CAD 患者，随访时间从 14 天到 1 年不等。累积分析报告，尽管使用氯吡格雷治疗，但血小板反应性残留与死亡和/或血栓复发的风险增加显著相关（比值比 [OR] 5.67，95%置信区间 [CI] 2.97 至 10.84；p<0.00001）。然而，四项研究对模型的一致性存在显著异质性，并表明存在发表偏倚的显著风险，因此从分析中排除。然而，这种排除并没有影响总体结果，因为它证实了氯吡格雷治疗反应不佳的患者发生心血管再发事件的风险增加（OR 3.58，95%CI 2.54 至 5.05；p<0.00001）。本更新的荟萃分析记录了氯吡格雷治疗下残留血小板反应性与复发性心血管事件之间的显著相关性，因此提示正在进行的旨在调整 CAD 患者抗血栓治疗的干预研究具有相关性。
