Roule Vincent, Ardouin Pierre, Briet Clément, Lemaitre Adrien, Bignon Mathieu, Sabatier Rémi, Champ-Rigot Laure, Milliez Paul, Blanchart Katrien, Beygui Farzin
CHU de Caen Normandie, Service de Cardiologie, Caen, France.
Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France.
Clin Cardiol. 2019 Sep;42(9):839-846. doi: 10.1002/clc.23224. Epub 2019 Jul 9.
The combination of vitamin K antagonists (VKA) for atrial fibrillation (AF) and antiplatelet agents following percutaneous coronary intervention (PCI) is associated with an increased bleeding risk.
Direct oral anticoagulants (DOAC) are associated with a greater safety profile but the optimal antithrombotic treatment strategy, especially when considering ischemic events, is unclear.
We performed a meta-analysis of randomized controlled trials comparing outcomes in AF patients following PCI and/or acute coronary syndrome (ACS) when treated with DOAC vs VKA, both in combination with one (dual) or two (triple) antiplatelet regimens. A systematic review was performed by searches of electronic databases MEDLINE (source PubMed) and the Cochrane Controlled Clinical Trials Register Database as well as Cardiology annual meetings. Three studies were finally included.
Compared to VKA triple therapy, the use of DOAC was associated with a decreased risk of any bleeding (relative risk [RR] 0.68 [0.62; 0.74]), major bleeding (RR 0.61 [0.51; 0.75]) and intracranial bleeding (RR 0.33 [0.17; 0.66]) and similar rates of the composite efficacy endpoint (RR 1.0 [0.87; 1.14]) and its components. Similar and consistent results were observed with both dual and triple therapy including a DOAC compared to VKA.
Our meta-analysis supports the use of dual therapy combining a DOAC and clopidogrel as the default regimen in most AF patients after PCI and/or ACS.
心房颤动（AF）患者使用维生素K拮抗剂（VKA）与经皮冠状动脉介入治疗（PCI）后使用抗血小板药物联合应用会增加出血风险。
直接口服抗凝剂（DOAC）具有更高的安全性，但最佳的抗栓治疗策略，尤其是考虑到缺血事件时，尚不清楚。
我们对随机对照试验进行了荟萃分析，比较PCI和/或急性冠状动脉综合征（ACS）后接受DOAC与VKA治疗的AF患者的结局，两种治疗均与一种（双联）或两种（三联）抗血小板方案联合使用。通过检索电子数据库MEDLINE（来源PubMed）、Cochrane对照临床试验注册数据库以及心脏病学年会进行系统评价。最终纳入三项研究。
与VKA三联疗法相比，使用DOAC与任何出血风险降低（相对风险[RR] 0.68 [0.62；0.74]）、大出血（RR 0.61 [0.51；0.75]）和颅内出血（RR 0.33 [0.17；0.66]）相关，且复合疗效终点（RR 1.0 [0.87；1.14]）及其组成部分的发生率相似。与VKA相比，在包括DOAC的双联和三联疗法中均观察到相似且一致的结果。
我们的荟萃分析支持在大多数PCI和/或ACS后的AF患者中，将DOAC与氯吡格雷联合的双联疗法作为默认方案。
