冠心病合并心房颤动冠状动脉介入术后双联与三联抗栓治疗对比的网状Meta分析

Network Meta-analysis of the comparison of double and triple antithrombotic therapy for coronary heart disease with atrial fibrillation after percutaneous coronary intervention

目的:通过网状Meta分析评估伴有冠心病和/或接受经皮冠状动脉介入治疗(PCI)治疗的心房颤动患者应用双联与三联抗栓治疗的有效性与安全性。方法:计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library等数据库,筛选出符合标准的文献提取数据后进行Meta分析,研究终点包括不良心血管事件,全因死亡,心血管死亡,MI,ST,卒中等有效性及主要出血事件,颅内出血等安全性指标。结果:共纳入6篇文献,包括12044例伴有冠心病和/或接受PCI治疗的心房颤动患者。网状Meta分析结果表明,与VKA+DAPT相比,VKA+P2Y12抑制剂(OR=0.52,95%CI:0.31~0.86)及NOAC+P2Y12抑制剂(OR=0.52,95%CI:0.35~0.76)主要出血事件发生率较低,差异均有统计学意义;NOAC+DAPT(OR=0.71,95%CI:0.42~1.19),VKA+阿司匹林(OR=0.93,95%CI:0.34~2.52)与VKA+DAPT相比差异均无统计学意义。与VKA+DAPT相比,各种干预措施在不良心血管事件,全因死亡,心血管死亡,MI,ST,卒中等事件发生率上差异均无统计学意义(P>0.05)。结论:在伴有冠心病和/或接受PCI的AF患者中,NOAC+P2Y12抑制剂与VKA+DAPT相比,出血并发症较少(包括颅内出血),在缺血事件上差异无统计学意义。另外其他DAT方案相比于VKA+DAPT出血风险较低或有降低趋势,因此应避免在此类患者中应用VKA+DAPT抗栓疗法。

Objective:To evaluate the efficacy and safety of dual and triple antithrombotic therapy in patients with atrial fibrillation associated with coronary heart disease and/or PCI.Methods:A literature search was conducted using the databases CNKI,WanFang,VIP,CBM,PubMed,Embase,Web of Science,Co-chrane Library,and the literatures meeting the standards were selected for data extraction and Meta analysis.The endpoints of the study included all-cause death,cardiovascular death,major adverse cardiovascular event,MI,ST,stroke and major bleeding events.Results:A total of 6 articles were included,including 12044 patients with atrial fibrillation associated with CHD and/or PCI.Meta analysis showed that compared with VKA+DAPT,VKA+P2Y12 inhibitors(OR=0.52,95%CI:0.31-0.86)and NOAC+P2Y12 inhibitors(OR=0.52,95%CI:0.35-0.76)had lower incidence of major bleeding events,and the differences were statistically significant.There were no statistically significant differences between NOAC+DAPT(OR=0.71,95%CI:0.42-1.19),VKA+aspirin(OR=0.93,95%CI:0.34-2.52)and VKA+DAPT.Compared with VKA+DAPT,there were no statistically significant differences in the incidence of major adverse cardiovascular events,all-cause death,cardiovascular death,MI,ST and stroke.Conclusions:Compared with VKA+DAPT,NOAC+P2Y12 inhibi-tor has fewer bleeding complications(including intracranial hemorrhage)and no significant difference in ische-mic events in AF patients with cad and/or PCI.In addition,compared with VKA+DAPT,the bleeding risk of other DAT schemes is lower or tends to decrease,so anti-thrombotic therapy of VKA+DAPT should be avoided in such patients.