Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Heart. 2011 Jan;97(2):98-105. doi: 10.1136/hrt.2010.195438. Epub 2010 Aug 23.
Enhanced platelet inhibition by clopidogrel decreases the risk of ischemic events but carries a risk for a concomitant increase in bleeding.
To compare the efficacy and safety of two clopidogrel loading regimens (300mg vs. 600mg) in patients undergoing percutaneous coronary intervention (PCI) at one month after start of therapy.
A systematic literature search of MEDLINE, EMBASE, CENTRAL, and Web of Science databases using predefined search terms for relevant articles in any language.
Randomised controlled trials and non-randomised studies reporting adjusted effect estimates were included. Summary estimates of the risks ratios (RRs) with therapy were calculated using a random-effect model. Outcomes evaluated were combined major adverse cardiovascular events (MACE) and major bleedings. Results Seven studies met the inclusion criteria and included 25,383 patients. A 600mg clopidogrel loading was associated with a 34% relative risk reduction of MACE (RR=0.66; 95% confidence intervals CI=0.52-0.84; p<0.001). Sub-analysis revealed a 47% risk reduction of MACE in randomised trials (RR=0.53; 95%CI=0.32-0.88; p=0.01) and a 31% relative risk reduction in non-randomised trials (RR=0.69; 95%CI=0.54-0.90; p=0.005) in patients receiving 600mg loading with clopidogrel. In patients suffering from acute coronary syndrome, 600mg clopidogrel loading was associated with a 24% relative risk reduction in MACE (RR=0.76; 95%CI=0.60-0.95; p=0.02). Importantly, the 600mg clopidogrel loading dose was not associated with an increased risk of major bleedings (RR=0.91; 95%CI=0.73-1.15; p=0.44).
This meta-analysis demonstrates that intensified clopidogrel loading with 600mg reduces the rate of major cardiovascular events without increase in major bleeding compared to 300mg in patients undergoing PCI during one month follow-up.
氯吡格雷增强血小板抑制作用降低了缺血事件的风险，但同时增加了出血的风险。
比较两种氯吡格雷负荷剂量（300mg 与 600mg）在治疗开始后一个月行经皮冠状动脉介入治疗（PCI）的患者中的疗效和安全性。
使用预定义的搜索词，对 MEDLINE、EMBASE、CENTRAL 和 Web of Science 数据库进行系统文献检索，以获取任何语言的相关文章。
纳入了随机对照试验和非随机研究，报告了调整后的效应估计值。使用随机效应模型计算治疗风险比（RR）的汇总估计值。评估的结果是联合主要不良心血管事件（MACE）和大出血。结果：符合纳入标准的研究有 7 项，共纳入 25383 例患者。氯吡格雷 600mg 负荷剂量与 MACE 的相对风险降低 34%相关（RR=0.66；95%置信区间 CI=0.52-0.84；p<0.001）。亚分析显示，随机试验中 MACE 风险降低 47%（RR=0.53；95%CI=0.32-0.88；p=0.01），非随机试验中 MACE 的相对风险降低 31%（RR=0.69；95%CI=0.54-0.90；p=0.005），接受氯吡格雷 600mg 负荷剂量的患者。在急性冠状动脉综合征患者中，氯吡格雷 600mg 负荷剂量与 MACE 的相对风险降低 24%相关（RR=0.76；95%CI=0.60-0.95；p=0.02）。重要的是，氯吡格雷 600mg 负荷剂量与大出血风险增加无关（RR=0.91；95%CI=0.73-1.15；p=0.44）。
本荟萃分析表明，与 300mg 相比，在接受 PCI 治疗的患者中，在一个月随访期间，强化氯吡格雷负荷剂量 600mg 可降低主要心血管事件的发生率，而不增加大出血的风险。
