Chaudhary Nabin, Bundhun Pravesh Kumar, Yan He
Department of Geriatric Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China.
Medicine (Baltimore). 2016 Dec;95(50):e5581. doi: 10.1097/MD.0000000000005581.
Data regarding the clinical outcomes in patients with atrial fibrillation (AF) receiving dual antiplatelet therapy (DAPT) and an anticoagulant in addition to DAPT (DAPT + vitamin K antagonist [VKA]) after coronary stent implantation are still controversial. Therefore, in order to solve this issue, we aim to compare the adverse clinical outcomes in AF patients receiving DAPT and DAPT + VKA after percutaneous coronary intervention and stenting (PCI-S).
Observational studies comparing the adverse clinical outcomes such as major bleeding, major adverse cardiovascular events, stroke, myocardial infarction, all-cause mortality, and stent thrombosis (ST) in AF patients receiving DAPT + VKA therapy, and DAPT after PCI-S have been searched from Medline, EMBASE, and PubMed databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to express the pooled effect on discontinuous variables, and the pooled analyses were performed with RevMan 5.3.
Eighteen studies consisting of a total of 20,456 patients with AF (7203 patients received DAPT + VKA and 13,253 patients received DAPT after PCI-S) were included in this meta-analysis. At a mean follow-up period of 15 months, the risk of major bleeding was significantly higher in DAPT + VKA group, with OR 0.62 (95% CI 0.50-0.77, P < 0.0001). There was no significant differences in myocardial infarction and major adverse cardiovascular event between DAPT + VKA and DAPT, with OR 1.27 (95% CI 0.92-1.77, P = 0.15) and OR 1.17 (95% CI 0.99-1.39, P = 0.07), respectively. However, the ST, stroke, and all-cause mortality were significantly lower in the DAPT + VKA group, with OR 1.98 (95% CI 1.03-3.81, P = 0.04), 1.59 (95% CI 1.08-2.34, P = 0.02), and 1.41 (95% CI 1.03-1.94, P = 0.03), respectively.
At a mean follow-up period of 15 months, DAPT + VKA was associated with significantly lower risk of stroke, ST, and all-cause mortality in AF patients after PCI-S compared with DAPT group. However, the risk of major bleeding was significantly higher in the DAPT + VKA group.
关于心房颤动（AF）患者在冠状动脉支架植入术后接受双联抗血小板治疗（DAPT）以及除DAPT外还接受抗凝治疗（DAPT + 维生素K拮抗剂[VKA]）的临床结局数据仍存在争议。因此，为解决这一问题，我们旨在比较接受经皮冠状动脉介入治疗及支架置入术（PCI-S）后的AF患者接受DAPT和DAPT + VKA治疗后的不良临床结局。
从Medline、EMBASE和PubMed数据库中检索比较接受PCI-S后接受DAPT + VKA治疗和DAPT治疗的AF患者的主要出血、主要不良心血管事件、中风、心肌梗死、全因死亡率和支架血栓形成（ST）等不良临床结局的观察性研究。采用比值比（OR）及95%置信区间（CI）来表示对间断性变量的合并效应，并使用RevMan 5.3进行汇总分析。
本荟萃分析纳入了18项研究，共20456例AF患者（7203例接受DAPT + VKA治疗，13253例在PCI-S后接受DAPT治疗）。在平均随访15个月时，DAPT + VKA组主要出血风险显著更高，OR为0.62（95%CI 0.50 - 0.77，P < 0.0001）。DAPT + VKA组与DAPT组在心肌梗死和主要不良心血管事件方面无显著差异，OR分别为1.27（95%CI 0.92 - 1.77，P = 0.15）和OR 1.17（95%CI 0.99 - 1.39，P = 0.07）。然而，DAPT + VKA组的ST、中风和全因死亡率显著更低，OR分别为1.98（95%CI 1.03 - 3.81，P = 0.04）、1.59（95%CI 1.08 - 2.34，P = 0.02）和1.41（95%CI 1.03 -
