氯吡格雷对行非心脏手术的老年患者术后不良事件的评价-meta分析

A meta-analysis of benefits and risks associated with use of Clopidogrel in non-cardiac surgery of elderly people

目的评价老年患者(年龄> 65岁)接受非心脏手术前使用氯吡格雷的益处和风险,为临床患者制定出个体化治疗方案,以提高围手术期安全性。方法计算机检索Pubmed,Cochrane图书馆,万方,CBM,CNKI等数据库检索相关资源,检索时间为2000年1月-2014年12月,手工检索并辅以追溯文献的方法寻找相关参考文献。收集老年患者(年龄> 65岁)接受非心脏手术前使用氯吡格雷的术后影响的病例对照和队列研究,由两位研究员独立地完成文献质量评价后,将有效数据提取后采用RevMan5.3软件进行评价。结果纳入12篇文献,共计3197名患者。Meta分析结果显示:老年患者(年龄> 65岁)行非心脏手术前使用氯吡格雷组与对照组相比,增加了3.23倍的二次手术止血相对风险[RR:3.23;95%CI:1.51-6.87]。与对照组相比,围术期死亡率[RR:1.66;95%CI:0.45-6.10]、心脏不良事件[RR:1.10;95%CI:0.79-1.53]、伤口并发症[RR:2.33;95%CI:0.87-6.25]的发生率均无统计学差异。结论老年患者接受非心脏手术前使用氯吡格雷会增加术后出血的风险。

Objective To perform a meta-analysis of benefits and risks about Clopidogrel in non-cardiac surgery of elderly people,and to make an individual treatment regimen in order to increase the safety in perioperative period. Methods The relevant resources were searched by computer in the Pubmed, Cochrane Library, Wanfang, and the CBMN, CNKI database. The retrieval time was from January 2000 to December 2014. The relevant references were searched by hand and assisted by the method of tracing back to the literature. A case-control and cohort study of post-operative effects of Clopidogrel on elderly patients（over 65 years of age）undergoing non-cardiac surgery was performed independently by two researchers. The valid data were extracted and evaluated by Revman 5.3 software. Results There were twelve studies which met the selection criteria and 3197 patients were included. Elderly patients（age 65）who received clopidogrel before non-cardiac surgery increased the relative risk of reoperation by 3.23 times as compared with the control group. Compared with the control group, the perioperative mortality（RR： 1.6695 CI： 0.45-6.10）, adverse cardiac events（RR：1.1095 CI： 0.79-1.53）and wound complications（RR： 2.3395 CI： 0.87-6.25）were not significantly different. Conclusion Clopidogrel may increase the risk of postoperative bleeding in elderly patients before non-cardiac surgery.