摘要
目的采用循证医学方法系统评价体外循环冠状动脉旁路移植术后联用阿司匹林氯吡格雷与单用阿司匹林抗血小板治疗效果和安全性。方法检索Cochrane图书馆、Pubmed、EMBASE、MEDLINE、中国知网、万方数据库、维普数据库中从建库到2015年6月发表的有关文献。提取资料并对纳入研究的质量进行严格评价,对数据进行Meta分析。统计学分析应用Rev Man 5.3软件。结果纳入9个研究共计16 032例患者;阿司匹林+氯吡格雷组(C组)围术期死亡率、术后出血的发生率均显著低于单用阿司匹林组(A组)[OR(95%CI)分别为0.51(0.36,0.73)、0.84(0.71,0.99)];且C组ADP和ASPI诱导的血小板聚集率均显著低于A组[MD(95%CI)分别为-10.74(-19.73,-1.75)、-27.98(-35.84,-20.12)],而两组术后桥静脉闭塞率、心梗发生率、休克发生率及住院时间差异无统计学意义。结论现有临床证据表明,体外循环冠状动脉旁路移植术后联用阿司匹林和氯吡格雷抗血小板治疗效果比单用阿司匹林好,但系统评价纳入的研究多为观察性研究,仍需大样本、多中心、高质量的临床随机对照实验进一步论证。
Objective To evaluate the anti-platelet effect of aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting and possible side effects. Methods A search was performed within the Cochrane library, Pubmed,MEDLINE, EMBASE, CINK, Wanfang Data and VIP up to June of 2015. The quality of the papers included in this study was rigorously evaluated. The extracted data were analyzed by Rev Man 5.3. Results Total 9 pieces of references paper were selected, with a total of 16 032 cases. The results of meta-analyses showed that the mortality in the perioperative period and the incidence of bleeding could be reduced by aspirin plus clopidogrel when compared with using aspirin alone [OR（95% CI） were 0.51（0.36,0.73）, 0.84（0.71,0.99）, respectively ]; Platelet aggregation in response to adenosine diphosphate（PLADP） and arachidonic acid（PLAA） was significantly lower in C group than those in the A group [MD（95% CI） were-10.74（-19.73,-1.75）,-27.98（-35.84,-20.12）, respectively ],but there was no significant difference with the incidence of bridge vein occlusion, shock, recurrent myocardial infarction and the length of stay（LOS） of inpatients. Conclusion Compared with aspirin alone, using aspirin plus clopidogrel as anti-platelet therapy is safe and effective. However, more samples, high-quality randomized controlled trials（RCTs） are required for further verification.
出处
《热带医学杂志》
CAS
2016年第8期1063-1067,1078,共6页
Journal of Tropical Medicine
