Background The combination of cilostazol, aspirin and clopidogrel （triple antiplatelet therapy, TAT） after a percutaneous coronary intervention has been used as an alternative therapy. We performed a meta-analysis t...Background The combination of cilostazol, aspirin and clopidogrel （triple antiplatelet therapy, TAT） after a percutaneous coronary intervention has been used as an alternative therapy. We performed a meta-analysis to evaluate the efficacy and safety of TAT for patients after percutaneous coronary intervention （PCI）. Methods We systematically searched Pubmed, Embase and Web of Science databases to identify all randomized controlled trials （RCTs） that compared dual antiplatelet therapy （DAT） with and without cilostazol after PCI. All analyses were conducted using Review Manager 5.0. Results The final analysis consisted of 4474 patients from ten studies. The combined results suggested that there was a lower risk of cardiac death （relative risk （RR）=0.55, 95% confidence interval （Cl）： 0.31-0.98, P 〈0.05） and major adverse cardiac events （MACEs） （RR=0.63, 95% Cl： 0.54-0.74, P 〈0.05） in patients treated with TAT as compared to those with DAT follow-ups after six months to one year; no significant difference was observed in bleeding and non-fatal myocardial infarction （MI） （RR=1.14, 95% Cl： 0.80-1.64, P 〉0.055 RR=0.87, 95% Cl： 0.42-1.83, P 〉0.05）. However, the rate of adverse drug reaction was higher in patients receiving TAT than in patients receiving DAT （RR=2.21, 95% Cl： 1.84-2.66, P 〈0.05）. Moreover, there was a lower risk of stent thrombosis in patients treated with TAT as compared to those treated with DAT （RR=0.44, 95% Cl： 0.21-0.94, P 〈0.05）. The TAT group had a reduced risk of target lesion revascularization （TLR） （RR=0.60, 95% Cl： 0.43-0.82, P=-0.001） and target vessel revascularization （TVR） than the DAT group （RR=0.56, 95% Cl： 0.45-0.71, P 〈0.05）. The number of MACEs was lower for patients in the TAT group than in the DAT group with diabetes mellitus sub-analysis （RR=0.41, 95% Cl： 0.28-0.61, P 〈0.05）. But no significant difference was observed between the two groups regarding MACEs in patients with drug-eluting stent implantations （RR=0.82, 95% Cl： 0.65-1.03, P 〉0.05）. Conclusion TAT could significantly reduce the rates of MACEs and cardiac death in comparison to DAT, but more attention should be paid to adverse side effects of the drugs.展开更多
Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated. This meta-analysis ...Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated. This meta-analysis aimed to update and re-compare the benefits and risks of triple antithrombotic therapy （TT） with double anti-platelet therapy （DAPT） after in patients who requiring oral anticoagulation after percutaneous coronary interventions with stenting （PCI-s）. Methods Ten reports of observational retrospective or prospective studies were retrieved, including a total of 6296 patients, follow-up period ranging from 1 year to 2 years. Results Baseline characteristics were similar in both groups. The main finding of this study is the overall incidence of major adverse cardiovascular events （MACE）, myocardial infarction （MI） and stent thrombosis was comparable between two groups. Patients with TT was associated with significant reduction in ischemic stroke （OR： 0.27; 95% CI： 0.13-0.57; P=0.0006） as compared to DAPT. We reaffirmed triple therapy significantly increased the risk of major bleeding （OR： 1.47; 95% CI： 1.22-1.78; P 〈0.0001） and minor bleeding （OR： 1.55; 95% CI： 1.07-2.24; P=-0.02）. Conclusions Triple therapy is more efficacious in reducing the occurrence of ischemic stroke in PCI-s patients with an indication of chronic oral anticoagulation （OAC）, compared with DAPT. However, it significantly increased major and minor risk of bleeding. It is imperative that further prospective randomized controlled trials are required to define the best therapeutic strateav for patients with an indication of chronic OAC underaoina PCI-s.展开更多
文摘Background The combination of cilostazol, aspirin and clopidogrel （triple antiplatelet therapy, TAT） after a percutaneous coronary intervention has been used as an alternative therapy. We performed a meta-analysis to evaluate the efficacy and safety of TAT for patients after percutaneous coronary intervention （PCI）. Methods We systematically searched Pubmed, Embase and Web of Science databases to identify all randomized controlled trials （RCTs） that compared dual antiplatelet therapy （DAT） with and without cilostazol after PCI. All analyses were conducted using Review Manager 5.0. Results The final analysis consisted of 4474 patients from ten studies. The combined results suggested that there was a lower risk of cardiac death （relative risk （RR）=0.55, 95% confidence interval （Cl）： 0.31-0.98, P 〈0.05） and major adverse cardiac events （MACEs） （RR=0.63, 95% Cl： 0.54-0.74, P 〈0.05） in patients treated with TAT as compared to those with DAT follow-ups after six months to one year; no significant difference was observed in bleeding and non-fatal myocardial infarction （MI） （RR=1.14, 95% Cl： 0.80-1.64, P 〉0.055 RR=0.87, 95% Cl： 0.42-1.83, P 〉0.05）. However, the rate of adverse drug reaction was higher in patients receiving TAT than in patients receiving DAT （RR=2.21, 95% Cl： 1.84-2.66, P 〈0.05）. Moreover, there was a lower risk of stent thrombosis in patients treated with TAT as compared to those treated with DAT （RR=0.44, 95% Cl： 0.21-0.94, P 〈0.05）. The TAT group had a reduced risk of target lesion revascularization （TLR） （RR=0.60, 95% Cl： 0.43-0.82, P=-0.001） and target vessel revascularization （TVR） than the DAT group （RR=0.56, 95% Cl： 0.45-0.71, P 〈0.05）. The number of MACEs was lower for patients in the TAT group than in the DAT group with diabetes mellitus sub-analysis （RR=0.41, 95% Cl： 0.28-0.61, P 〈0.05）. But no significant difference was observed between the two groups regarding MACEs in patients with drug-eluting stent implantations （RR=0.82, 95% Cl： 0.65-1.03, P 〉0.05）. Conclusion TAT could significantly reduce the rates of MACEs and cardiac death in comparison to DAT, but more attention should be paid to adverse side effects of the drugs.
文摘Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated. This meta-analysis aimed to update and re-compare the benefits and risks of triple antithrombotic therapy （TT） with double anti-platelet therapy （DAPT） after in patients who requiring oral anticoagulation after percutaneous coronary interventions with stenting （PCI-s）. Methods Ten reports of observational retrospective or prospective studies were retrieved, including a total of 6296 patients, follow-up period ranging from 1 year to 2 years. Results Baseline characteristics were similar in both groups. The main finding of this study is the overall incidence of major adverse cardiovascular events （MACE）, myocardial infarction （MI） and stent thrombosis was comparable between two groups. Patients with TT was associated with significant reduction in ischemic stroke （OR： 0.27; 95% CI： 0.13-0.57; P=0.0006） as compared to DAPT. We reaffirmed triple therapy significantly increased the risk of major bleeding （OR： 1.47; 95% CI： 1.22-1.78; P 〈0.0001） and minor bleeding （OR： 1.55; 95% CI： 1.07-2.24; P=-0.02）. Conclusions Triple therapy is more efficacious in reducing the occurrence of ischemic stroke in PCI-s patients with an indication of chronic oral anticoagulation （OAC）, compared with DAPT. However, it significantly increased major and minor risk of bleeding. It is imperative that further prospective randomized controlled trials are required to define the best therapeutic strateav for patients with an indication of chronic OAC underaoina PCI-s.
