Chua Su-Kiat, Chen Lung-Ching, Shyu Kou-Gi, Cheng Jun-Jack, Hung Huei-Fong, Chiu Chiung-Zuan, Lin Chiu-Mei
School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan.
Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.
J Clin Med. 2020 Apr 8;9(4):1062. doi: 10.3390/jcm9041062.
Up to 10% of patients with atrial fibrillation (AF) undergo percutaneous coronary intervention (PCI). A systematic review and network meta-analysis were conducted by searching PubMed, Embase, and the Cochrane database of systematic reviews for randomized control trials that studied the safety and efficacy of different antithrombotic strategies in these patients. Six studies, including 12,158 patients were included. Compared to that in the triple antithrombotic therapy group (vitamin K antagonist (VKA) plus P2Y inhibitor and aspirin), thrombolysis in myocardial infarction (TIMI) major bleeding was significantly reduced in the dual antithrombotic therapy (non-vitamin K oral anticoagulants (NOACs) plus P2Y inhibitor) group by 47% (Odds ratio (OR), 0.53; 95% credible interval [CrI], 0.35-0.78; I = 0%). Besides, NOAC plus a P2Y inhibitor was associated with less intracranial hemorrhage compared to VKA plus single antiplatelet therapy (OR: 0.20, 95% CrI: 0.05-0.77). There was no significant difference in the trial-defined major adverse cardiac events or the individual outcomes of all-cause mortality, cardiovascular death, myocardial infarction, stroke or stent thrombosis among all antithrombotic strategies. In conclusion, antithrombotic strategy of NOACs plus P2Y inhibitor is safer than, and as effective as, the strategies including aspirin when used in AF patients undergoing PCI.
高达10%的心房颤动（AF）患者接受经皮冠状动脉介入治疗（PCI）。通过检索PubMed、Embase和Cochrane系统评价数据库，对研究这些患者不同抗栓策略安全性和有效性的随机对照试验进行了系统评价和网络荟萃分析。纳入了6项研究，共12158例患者。与三联抗栓治疗组（维生素K拮抗剂（VKA）加P2Y抑制剂和阿司匹林）相比，双联抗栓治疗组（非维生素K口服抗凝剂（NOACs）加P2Y抑制剂）的心肌梗死溶栓（TIMI）大出血显著减少47%（比值比（OR），0.53；95%可信区间[CrI]，0.35 - 0.78；I² = 0%）。此外，与VKA加单一抗血小板治疗相比，NOAC加P2Y抑制剂的颅内出血较少（OR：0.20，95% CrI：0.05 - 0.77）。在所有抗栓策略中，试验定义的主要不良心脏事件或全因死亡、心血管死亡、心肌梗死、中风或支架血栓形成的个体结局均无显著差异。总之，在接受PCI的AF患者中，NOAC加P2Y抑制剂的抗栓策略比包括阿司匹林的策略更安全，且效果相当。
