Department of Cardiology, An Zhen Hospital, Capital Medical University, Beijing, China.
Int J Cardiol. 2011 Apr 1;148(1):96-101. doi: 10.1016/j.ijcard.2010.11.019. Epub 2010 Dec 23.
The optimal antithrombotic strategy for patients with chronic oral anticoagulation undergoing coronary stenting is unknown. Our study conducted a meta-analysis of 9 previous trials comparing the safety and efficacy of triple antithrombotic regimen (including warfarin, aspirin and clopidogrel) to non-triple antithrombotic regimens in those patients.
Two investigators independently searched Pubmed, Ovid and Elsevier databases for all reported studies, and yielded 9 (of 242 potentially relevant) articles, published before July 2009, enrolling 5181 patients, follow-up period ranging from 1 month to 18 months. Two coauthors independently recorded the data regarding interventions and the occurrence of major bleeding, stroke, myocardial infarction and death.
Patients with triple antithrombotic regimen had significant reduction in ischemic stroke (odds ratio [OR] is 0.29, 95% confidence interval [CI] is from 0.15 to 0.58; and P=0.0004) as compared with dual antiplatelet therapy. While there was a two-fold increased risk of major bleeding associated with triple antithrombotic regime (OR 2.00, 95% CI 1.41 to 2.83; and P<0.0001). The overall incidence of death (OR 1.20, 95% CI 0.63 to 2.27, and P=0.56) and myocardial infarction (OR 0.84, 95% CI 0.57 to 1.23; and P=0.38) was comparable between the two regimens.
Our study confirmed the cardiovascular benefits of triple antithrombotic regimen by reducing ischemic stroke risk, but also demonstrated its increased risk of major bleeding. It poses imperative demands for future prospective randomized studies to define the optimal antithrombotic regimen in patients requiring chronic anticoagulation undergoing coronary stenting.
对于正在接受冠状动脉支架置入术的慢性口服抗凝治疗患者，最佳的抗血栓形成策略尚不清楚。我们的研究对 9 项先前的试验进行了荟萃分析，这些试验比较了三联抗栓方案（包括华法林、阿司匹林和氯吡格雷）与非三联抗栓方案在这些患者中的安全性和疗效。
两名研究者独立检索了 Pubmed、Ovid 和 Elsevier 数据库中所有已发表的研究，共检索到 9 项（242 项可能相关研究中）研究，共纳入 5181 例患者，随访时间从 1 个月到 18 个月不等。两名合著者独立记录了关于干预措施和主要出血、卒中和心肌梗死以及死亡发生的相关数据。
与双联抗血小板治疗相比，三联抗栓方案可显著降低缺血性卒中（比值比 [OR]为 0.29，95%置信区间 [CI]为 0.15 至 0.58；P=0.0004）。然而，三联抗栓方案会使主要出血的风险增加两倍（OR 2.00，95% CI 1.41 至 2.83；P<0.0001）。两种方案的总死亡率（OR 1.20，95% CI 0.63 至 2.27，P=0.56）和心肌梗死发生率（OR 0.84，95% CI 0.57 至 1.23；P=0.38）相似。
我们的研究证实了三联抗栓方案通过降低缺血性卒中风险带来的心血管获益，但也表明其主要出血风险增加。这迫切需要未来进行前瞻性随机研究，以确定需要长期抗凝治疗的冠状动脉支架置入术后患者的最佳抗栓方案。
