Ling Hua, Andrews Ebony, Ombengi David, Li Fang
Department of Pharmacy Practice, School of Pharmacy, Georgia Campus-Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA.
Department of Pharmacy Practice, School of Pharmacy, Hampton University, Hampton, VA, USA.
Cardiol Res. 2018 Jun;9(3):137-143. doi: 10.14740/cr719w. Epub 2018 Jun 6.
Patients with peripheral arterial disease (PAD) undergoing percutaneous coronary intervention (PCI) are at elevated risk of ischemic and bleeding events. However, the optimal duration of dual antiplatelet therapy (DAPT) after PCI in patients with PAD remains unclear.
A systematic literature search was performed through June 2017 using PubMed, EMBASE and Cochrane databases with the following key terms: "dual antiplatelet therapy", "P2Y12 inhibitor", "myocardial infarction", "percutaneous coronary intervention", "stent", "peripheral arterial disease", and "ankle-brachial index". The analysis was restricted to randomized trials published in English in patients with PAD receiving extended DAPT (> 12-month) after PCI. Overall analysis was performed using Review Manager 5.3 with the Mantel-Haenszel method.
Two randomized controlled trials involving 895 patients were included in this review. Compared to the placebo group, there was no statistical significance in the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients receiving extended DAPT (odds ratio (OR) 0.76, 95% confidence interval (CI) 0.37 - 1.57; P = 0.46). The results were associated with substantial heterogeneity (I = 71%, P = 0.07). Extended DAPT was not significantly associated with increased moderate/severe bleeding events (OR 1.63, 95% CI 0.84 - 3.18; P = 0.15; I = 0%, P = 0.59). The extended DAPT was associated with 82% relative risk reduction in the events of definite/probably stent thrombosis.
Among patients with PAD, extended DAPT after PCI resulted in a non-significant difference in ischemic and bleeding events compared to placebo, respectively. The routine use of extended DAPT in this cohort should be carefully evaluated.
接受经皮冠状动脉介入治疗（PCI）的外周动脉疾病（PAD）患者发生缺血和出血事件的风险较高。然而，PAD患者PCI术后双联抗血小板治疗（DAPT）的最佳持续时间仍不明确。
截至2017年6月，通过PubMed、EMBASE和Cochrane数据库进行系统文献检索，检索关键词如下：“双联抗血小板治疗”、“P2Y12抑制剂”、“心肌梗死”、“经皮冠状动脉介入治疗”、“支架”、“外周动脉疾病”和“踝臂指数”。分析仅限于以英文发表的随机试验，这些试验的受试者为接受PCI术后延长DAPT（>12个月）的PAD患者。使用Review Manager 5.3软件，采用Mantel-Haenszel方法进行总体分析。
本综述纳入了两项涉及895例患者的随机对照试验。与安慰剂组相比，接受延长DAPT的患者发生主要不良心血管和脑血管事件（MACCE）的差异无统计学意义（比值比（OR）0.76，95%置信区间（CI）0.37 - 1.57；P = 0.46）。结果存在显著异质性（I² = 71%，P = 0.07）。延长DAPT与中度/重度出血事件增加无显著相关性（OR 1.63，95% CI 0.84 - 3.18；P = 0.15；I² = 0%，P = 0.59）。延长DAPT可使明确/可能的支架血栓形成事件的相对风险降低82%。
在PAD患者中，PCI术后延长DAPT与安慰剂相比，缺血和出血事件差异均无统计学意义。对此类患者常规使用延长DAPT应谨慎评估。
