Huang He, Li Ya, Chen Yu, Fu Guo-Sheng
Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
Chin Med J (Engl). 2016 Dec 5;129(23):2861-2867. doi: 10.4103/0366-6999.194663.
Patients with diabetes mellitus (DM) have a higher risk of thromboembolic events; however, the optimal duration of dual antiplatelet therapy (DAPT) remains unclear. The goal of this study was to assess the efficacy and safety of various DAPT durations in patients with DM undergoing drug-eluting stent implantation.
We conducted a literature search for randomized controlled trials (RCTs). We searched databases including EMBASE, PubMed, Cochrane Library, and Scopus up to June 2016. Investigators extracted data independently, including outcomes, characteristics, and study quality. A random-effect model was used to pool odds ratios (OR s) with 95% confidence intervals (CI s) of the clinical outcomes.
Six RCTs totaling 6040 patients with DM were included in the study. Shorter-duration DAPT resulted in an increased rate of stent thrombosis (ST) (OR, 1.83, 95% CI: 1.03-3.26, P = 0.04), but did not increase the risk of myocardial infarction (OR, 1.33, 95% CI: 0.71-2.47, P = 0.37), stroke (OR, 0.96, 95% CI: 0.52-1.77, P = 0.90), target vessel revascularization (OR, 1.19, 95% CI: 0.46-3.07, P = 0.71), all-cause death (OR: 0.72, 95% CI: 0.48-1.09, P = 0.12), or cardiac death (OR, 0.82, 95% CI: 0.49-1.36, P = 0.44) significantly. Shorter-duration DAPT was associated with a decreased risk of major bleeding (OR, 0.60, 95% CI: 0.38-0.94, P = 0.02).
In patients with DM, longer-duration DAPT had a lower risk of ST, but was associated with an increased bleeding risk.
糖尿病（DM）患者发生血栓栓塞事件的风险较高；然而，双联抗血小板治疗（DAPT）的最佳持续时间仍不明确。本研究的目的是评估不同DAPT持续时间在接受药物洗脱支架植入的DM患者中的疗效和安全性。
我们对随机对照试验（RCT）进行了文献检索。检索了截至2016年6月的EMBASE、PubMed、Cochrane图书馆和Scopus等数据库。研究人员独立提取数据，包括结局、特征和研究质量。采用随机效应模型汇总临床结局的比值比（OR）及其95%置信区间（CI）。
该研究纳入了6项RCT，共6040例DM患者。较短疗程的DAPT导致支架血栓形成（ST）发生率增加（OR，1.83；95%CI：1.03 - 3.26；P = 0.04），但未增加心肌梗死风险（OR，1.33；95%CI：0.71 - 2.47；P = 0.37）、中风风险（OR，0.96；95%CI：0.52 - 1.77；P = 0.90）、靶血管血运重建风险（OR，1.19；95%CI：0.46 - 3.07；P = 0.71）、全因死亡风险（OR：0.72；95%CI：0.48 - 1.09；P = 0.12）或心源性死亡风险（OR，0.82；95%CI：0.49 - 1.36；P = 0.44）。较短疗程的DAPT与大出血风险降低相关（OR，0.60；95%CI：0.38 - 0.94；P = 0.02）。
在DM患者中，较长疗程的DAPT发生ST的风险较低，但与出血风险增加相关。
