Galli Mattia, Andreotti Felicita, D'Amario Domenico, Vergallo Rocco, Montone Rocco A, Niccoli Giampaolo, Crea Filippo
Department of Cardiovascular Sciences, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Int J Cardiol Heart Vasc. 2020 May 14;28:100524. doi: 10.1016/j.ijcha.2020.100524. eCollection 2020 Jun.
•The optimal antithrombotic regimen to be used in patients with AF and PCI or ACS is still debated.•Each of the six randomised controlled trials comparing double to triple therapy has limitations.•None was powered to assess differences between treatment arms in ischaemic event rates.•The contrasting results regarding ischaemic events within published meta-analyses can be explained by heterogeneity, incompleteness and varying definitions of stent thrombosis.•The overall reduced bleeding rates, but increased early definite and probable stent thrombosis rates with double versus triple antithrombotic therapy encourage consideration of triple therapy during the first weeks from PCI followed by double therapy.
•房颤合并经皮冠状动脉介入治疗（PCI）或急性冠状动脉综合征（ACS）患者的最佳抗栓治疗方案仍存在争议。
•六项比较双联治疗与三联治疗的随机对照试验均有局限性。
•没有一项试验有足够的效力来评估各治疗组在缺血事件发生率上的差异。
•已发表的荟萃分析中关于缺血事件的对比结果可由异质性、不完整性以及支架血栓形成的不同定义来解释。
•与三联抗栓治疗相比，双联抗栓治疗总体出血率降低，但早期明确和可能的支架血栓形成率增加，这促使人们考虑在PCI后的最初几周采用三联治疗，随后采用双联治疗。
