Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Avenue #2, Chaoyang District, Beijing, 100029, China.
BMC Cardiovasc Disord. 2021 Dec 1;21(1):574. doi: 10.1186/s12872-021-02384-w.
We performed a meta-analysis sought to investigate the risk of stroke with antiplatelet and anticoagulant therapies among patients with coronary artery disease (CAD).
We searched PubMed, EMBASE, and Cochrane Library for randomized controlled trials from January 1995 to March 2020. Studies were retrieved if they reported data of stroke for patients with CAD and were randomized to receive intensive versus conservative antithrombotic therapies, including antiplatelet and oral anticoagulant (OAC). Analyses were pooled by random-effects modeling. A total of 42 studies with 301,547subjects were enrolled in this analysis.
Intensive antithrombotic therapy significantly reduced risk of all stroke (RR 0.86, 95% CI 0.80-0.94) and ischemic stroke (RR 0.80, 95% CI 0.71-0.91), but increased risk of hemorrhagic stroke (RR 1.36, 95% CI 1.00-1.86) and intracranial hemorrhage (RR 1.46, 95% CI 1.17-1.81). Subgroup analyses indicated that OAC yields more benefit to all stroke than antiplatelet therapy (OAC: RR 0.73, 95% CI 0.58-0.92; Antiplatelet: RR 0.90, 95% CI 0.83-0.97; Between-group heterogeneity P value = 0.030). The benefit of antiplatelet therapy on all stroke and ischemic stroke were mainly driven by the studies comparing longer versus shorter duration of dual antiplatelet therapy (All stroke: RR 0.86, 95% CI 0.78-0.95; ischemic stroke: RR 0.84, 95% CI 0.75-0.94).
Among CAD patients who have already received antiplatelet therapy, either strengthening antiplatelet or anticoagulant treatments significantly reduced all stroke, mainly due to the reduction of ischemic stroke, although it increased the risk of hemorrhagic stroke and intracranial hemorrhage. OAC yields more benefit to all stroke than antiplatelet therapy.
我们进行了一项荟萃分析，旨在研究冠心病患者抗血小板和抗凝治疗的卒中风险。
我们检索了 1995 年 1 月至 2020 年 3 月期间的 PubMed、EMBASE 和 Cochrane 图书馆中的随机对照试验。如果研究报告了冠心病患者的卒中数据，并被随机分配接受强化与保守抗血栓治疗，包括抗血小板和口服抗凝剂（OAC），则纳入分析。采用随机效应模型进行分析。共纳入 42 项研究，共 301547 例患者。
强化抗血栓治疗显著降低了所有卒中（RR 0.86，95%CI 0.80-0.94）和缺血性卒中（RR 0.80，95%CI 0.71-0.91）的风险，但增加了出血性卒中（RR 1.36，95%CI 1.00-1.86）和颅内出血（RR 1.46，95%CI 1.17-1.81）的风险。亚组分析表明，OAC 对所有卒中的获益优于抗血小板治疗（OAC：RR 0.73，95%CI 0.58-0.92；抗血小板：RR 0.90，95%CI 0.83-0.97；组间异质性 P 值=0.030）。抗血小板治疗对所有卒中和缺血性卒中的获益主要来自于比较更长时间与更短时间双重抗血小板治疗的研究（所有卒中：RR 0.86，95%CI 0.78-0.95；缺血性卒中：RR 0.84，95%CI 0.75-0.94）。
在已经接受抗血小板治疗的冠心病患者中，强化抗血小板或抗凝治疗显著降低了所有卒中，主要是由于缺血性卒中的减少，尽管增加了出血性卒中及颅内出血的风险。OAC 对所有卒中的获益优于抗血小板治疗。
