Verheugt F W
Department of Cardiology, University Hospital Nijmegen, The Netherlands.
J Cardiovasc Risk. 1996 Apr;3(2):229-32.
In controlled clinical trials with patients with cardiovascular disease, both antiplatelet and oral anticoagulant therapy have proved effective in reducing thrombotic and thromboembolic complications. The combination of both therapeutic strategies has been evaluated in several cardiovascular conditions.
A meta-analysis was performed on the bleeding risk in six published trials of combined oral anticoagulant and antiplatelet therapy.
The results of clinical trials (in patients with artificial heart valves and in patients with unstable angina or non-Q myocardial infarction) suggest that combined oral anticoagulant and antiplatelet therapy may be as safe as oral anticoagulation alone. Also, in a large study of healthy subjects the safety of combined oral anticoagulant and low-dose antiplatelet therapy was acceptable at one to two major bleedings per 100 person-years more than with oral anticoagulation alone.
The safety of combined oral anticoagulant and antiplatelet therapy is probably acceptable, provided the antiplatelet therapy is given in a low dose. These results warrant an efficacy and safety evaluation of combined oral anticoagulant and low-dose antiplatelet therapy in large clinical trials.
在针对心血管疾病患者的对照临床试验中，抗血小板治疗和口服抗凝治疗均已证明在减少血栓形成和血栓栓塞并发症方面有效。这两种治疗策略的联合应用已在多种心血管疾病中得到评估。
对已发表的六项口服抗凝药与抗血小板联合治疗试验中的出血风险进行了荟萃分析。
临床试验结果（在人工心脏瓣膜患者以及不稳定型心绞痛或非Q波心肌梗死患者中）表明，口服抗凝药与抗血小板联合治疗可能与单独口服抗凝治疗一样安全。此外，在一项针对健康受试者的大型研究中，口服抗凝药与低剂量抗血小板联合治疗的安全性在每100人年发生1至2次严重出血的情况下是可以接受的，且比单独口服抗凝治疗略高。
只要抗血小板治疗采用低剂量给药，口服抗凝药与抗血小板联合治疗的安全性可能是可以接受的。这些结果值得在大型临床试验中对口服抗凝药与低剂量抗血小板联合治疗的疗效和安全性进行评估。
