多种抗血小板疗法治疗缺血性卒中和短暂性脑缺血发作二级预防的疗效和安全性比较：网状荟萃分析。

Comparative efficacy and safety of multiple antiplatelet therapies for secondary prevention of ischemic stroke or transient ischemic attack: A network meta-analysis.

机构信息

Department of Clinical Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenhe District, Shenyang, Liaoning, China.

出版信息

J Neurol Sci. 2019 Apr 15;399:199-206. doi: 10.1016/j.jns.2019.02.037. Epub 2019 Feb 27.

DOI:10.1016/j.jns.2019.02.037

PMID:30849580

Abstract

BACKGROUND

Antiplatelet therapies for secondary prevention of ischemic stroke or transient ischemic attack (TIA) is a highly active research topic with five critical drugs obtained by visual analysis. We aimed to compare and rank multiple antiplatelet therapies using a network meta-analysis.

METHODS

Relevant medical databases were searched. Eligible randomized controlled trials (RCTs) which examined any comparisons involving mono- or dual antiplatelet therapies, based on aspirin, clopidogrel, dipyridamole, ticlopidine, cilostazol and placebo for patients with noncardioembolic ischemic stroke or TIA, were included. 14 outcomes were assessed. Primary outcomes were stroke recurrence, composite events (stroke recurrence, myocardial infarction and vascular death), and intracranial hemorrhage. PROSPERO registered number CRD42017069728.

RESULTS

45 RCTs with 173,131 patients were included in network meta-analysis, involving eight antiplatelet therapies. Cilostazol and clopidogrel were statistically more efficacious than aspirin (odds ratio (OR) = 0.64, 95% confidence interval (CI) = 0.47-0.88; OR = 0.77, 95%CI = 0.62-0.95) and dipyridamole (OR = 0.64, 95%CI = 0.44-0.93; OR = 0.76, 95%CI = 0.58-0.99) in reducing stroke recurrence, and showed significant benefits in reducing composite events compared with aspirin (OR = 0.63, 95%CI = 0.45-0.89; OR = 0.90, 95%CI = 0.83-0.97). No significant difference was found between cilostazol and clopidogrel in intracranial hemorrhage. Weighted regression suggested cilostazol was hierarchically the optimum treatment in consideration of both efficacy and safety, followed by clopidogrel.

CONCLUSION

Cilostazol and clopidogrel are probably promising options for secondary prevention of ischemic stroke or TIA. Both of them reduce stroke recurrence similarly compared with aspirin or dipyridamole, and reduce composite events compared with aspirin. Further studies are needed to confirm this finding.

摘要

背景

抗血小板治疗用于缺血性卒中和短暂性脑缺血发作（TIA）的二级预防是一个非常活跃的研究课题，通过视觉分析得到了五种关键药物。我们旨在使用网络荟萃分析比较和排名多种抗血小板治疗。

方法

检索相关医学数据库。纳入了比较任何基于阿司匹林、氯吡格雷、双嘧达莫、噻氯匹定、西洛他唑和安慰剂的单药或双联抗血小板治疗的随机对照试验（RCT），适用于非心源性缺血性卒中和 TIA 患者。评估了 14 项结局。主要结局是卒中复发、复合事件（卒中复发、心肌梗死和血管性死亡）和颅内出血。PROSPERO 注册号 CRD42017069728。

结果

网络荟萃分析纳入了 45 项 RCT，共 173131 例患者，涉及 8 种抗血小板治疗。西洛他唑和氯吡格雷在降低卒中复发方面比阿司匹林（比值比（OR）=0.64，95%置信区间（CI）=0.47-0.88；OR=0.77，95%CI=0.62-0.95）和双嘧达莫（OR=0.64，95%CI=0.44-0.93；OR=0.76，95%CI=0.58-0.99）更有效，与阿司匹林相比，在降低复合事件方面也显示出显著益处（OR=0.63，95%CI=0.45-0.89；OR=0.90，95%CI=0.83-0.97）。西洛他唑和氯吡格雷在颅内出血方面无显著差异。加权回归表明，考虑到疗效和安全性，西洛他唑是层次上的最佳治疗选择，其次是氯吡格雷。