Chen Jun, Meng Haoyu, Xu Lei, Liu Jie, Kong Deyu, Chen Pengsheng, Gong Xiaoxuan, Bai Jianling, Zou Fengwei, Yang Zhijian, Li Chunjian, Eikelboom John W
Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, 300, Guangzhou Road, Nanjing, 210029, China.
J Thromb Thrombolysis. 2015 Jan;39(1):23-34. doi: 10.1007/s11239-014-1090-5.
The aim of this study was to obtain best estimates of the efficacy and safety of cilostazol-based triple antiplatelet therapy (TAPT: aspirin, clopidogrel and cilostazol) compared with dual antiplatelet therapy (DAPT: aspirin and clopidogrel) in patients undergoing coronary stent implantation. We searched the literature to identify all randomized clinical trials examining efficacy and safety of TAPT versus DAPT in patients undergoing coronary stent implantation. Major efficacy outcomes were death, non-fatal myocardial infarction (MI), ischemic stroke and stent thrombosis (ST) and the safety outcome was bleeding. Data were analyzed using the Review Manager 5.0.0 software. A total of 19 trials involving 7,464 patients were included. TAPT and DAPT were associated with similar rates of death, non-fatal MI, ischemic stroke and ST, but compared with DAPT, TAPT had lower rates of target lesion revascularization (TLR) (RR 0.67, 95 % CI 0.56-0.82, P < 0.0001) and target vessel revascularization (TVR) (RR 0.65, 95 % CI 0.55-0.77, P < 0.00001), as well as less late loss of minimal lumen diameter (mean difference -0.14, 95 % CI -0.17--0.11, P < 0.00001), and less binary angiographic restenosis (RR 0.54, 95 % CI 0.45-0.65, P < 0.00001). TAPT and DAPT had similar rates of bleeding, but TAPT had significantly higher rates of headache, palpitation, rash and gastrointestinal side-effects. Cilostazol-based TAPT compared with DAPT is associated with improved angiographic outcomes and decreased risk of TLR and TVR but does not reduce major cardiovascular events and is associated with an increase in minor adverse events.
本研究的目的是获得与双联抗血小板治疗（DAPT：阿司匹林和氯吡格雷）相比，西洛他唑三联抗血小板治疗（TAPT：阿司匹林、氯吡格雷和西洛他唑）在接受冠状动脉支架植入术患者中的疗效和安全性的最佳估计值。我们检索文献以确定所有研究TAPT与DAPT在冠状动脉支架植入术患者中疗效和安全性的随机临床试验。主要疗效结局为死亡、非致命性心肌梗死（MI）、缺血性卒中以及支架血栓形成（ST），安全性结局为出血。使用Review Manager 5.0.0软件进行数据分析。共纳入19项试验，涉及7464例患者。TAPT和DAPT的死亡、非致命性MI、缺血性卒中和ST发生率相似，但与DAPT相比，TAPT的靶病变血运重建（TLR）率较低（RR 0.67，95%CI 0.56 - 0.82，P < 0.0001）和靶血管血运重建（TVR）率较低（RR 0.65，95%CI 0.55 - 0.77，P < 0.00001），以及最小管腔直径的晚期丢失较少（平均差值 -0.14，95%CI -0.17 - -0.11，P < 0.00001），且二元血管造影再狭窄较少（RR 0.54，95%CI 0.45 - 0.65，P < 0.00001）。TAPT和DAPT的出血发生率相似，但TAPT的头痛、心悸、皮疹和胃肠道副作用发生率显著更高。与DAPT相比，基于西洛他唑的TAPT与血管造影结局改善以及TLR和TVR风险降低相关，但不能降低主要心血管事件发生率，且与轻微不良事件增加相关。
