Roule Vincent, Agueznai Moaad, Sabatier Rémi, Blanchart Katrien, Lemaître Adrien, Ardouin Pierre, Collet Jean-Philippe, Milliez Paul, Montalescot Gilles, Beygui Farzin
a Department of Cardiology , Caen University Hospital , Caen , France.
b ACTION Academic Group , Institut de Cardiologie, Pitié-Salpétrière University Hospital , Paris , France.
Platelets. 2017 Mar;28(2):174-181. doi: 10.1080/09537104.2016.1218453. Epub 2016 Sep 22.
The risk and benefit of GP-IIb/IIIa Inhibition (GPI) in combination with recent antiplatelet regimens in acute coronary syndromes (ACS) remain unassessed. The advent of fast-acting highly active oral P2Y inhibitors questions the additional value and risk of their association with GPI. We studied the effect of GPI in combination with prasugrel and ticagrelor, compared to clopidogrel on major bleeding in pivotal randomized controlled trials in the setting of ACS, using a meta-analytic approach. A similar analysis, further including the comparison of a double versus standard dose clopidogrel regimen, was performed for the risk of the primary efficacy endpoint. The combination of GPI and recent P2Y inhibitors was associated with a similar risk of bleeding as compared with GPI and the standard clopidogrel regimen (RR 0.92 [0.74; 1.13]). The benefit of recent regimens, including double dose clopidogrel, in reducing the primary ischemic endpoint (RR 0.86 [0.78; 0.94]) persisted in those treated with GPI. Although GPI use was associated with a consistent increase in the risk of bleeding in both recent (RR 1.27 [1.05-1.55]) and standard regimens (RR 2.01 [1.64-2.47]), the relative magnitude of such an increase was lower in association with prasugrel or ticagrelor as compared with clopidogrel. The risk of bleeding using a combination of GPI and oral antiplatelet regimens is mainly related to the use of GPI and not the oral antiplatelet regimen. Considering the absence of increased risk of bleeding and the persistence of the benefit of recent P2Y regimens in combination with GPI as compared with the standard clopidogrel regimen, the use of such a combination within the guidelines is supported by our findings.
糖蛋白IIb/IIIa抑制剂（GPI）与近期抗血小板治疗方案联合用于急性冠状动脉综合征（ACS）的风险和获益尚未得到评估。速效高活性口服P2Y抑制剂的出现使人们对其与GPI联合使用的附加价值和风险产生质疑。我们采用荟萃分析方法，在ACS的关键随机对照试验中，研究了GPI与普拉格雷和替格瑞洛联合使用相较于氯吡格雷对大出血的影响。针对主要疗效终点的风险，进行了类似分析，进一步纳入了双倍剂量与标准剂量氯吡格雷治疗方案的比较。与GPI和标准氯吡格雷治疗方案相比，GPI与近期P2Y抑制剂联合使用的出血风险相似（相对危险度[RR]为0.92[0.74；1.13]）。近期治疗方案，包括双倍剂量氯吡格雷，在降低主要缺血终点方面的获益（RR为0.86[0.78；0.94]）在接受GPI治疗的患者中依然存在。尽管使用GPI在近期治疗方案（RR为1.27[1.05 - 1.55]）和标准治疗方案（RR为2.01[1.64 - 2.47]）中均与出血风险持续增加相关，但与氯吡格雷相比，与普拉格雷或替格瑞洛联合使用时这种增加的相对幅度更低。GPI与口服抗血小板治疗方案联合使用时的出血风险主要与GPI的使用有关，而非口服抗血小板治疗方案。鉴于与标准氯吡格雷治疗方案相比，联合使用GPI时出血风险未增加且近期P2Y治疗方案的获益依然存在，我们的研究结果支持在指南范围内使用这种联合治疗方案。
