Clopidogrel 150 vs. 75 mg day−1 in patients undergoing percutaneous coronary intervention: a meta‐analysis
Clopidogrel 150 vs. 75 mg day−1 in patients undergoing percutaneous coronary intervention: a meta‐analysis
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DOI：
10.1111/j.1538-7836.2011.04216.x
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发表时间：
2011-04
影响因子：
10.4
通讯作者：
P. Hao;M. X. Zhang;R. Li;J. Yang;J. Wang;Y. G. Chen;Y. Zhang
中科院分区：
文献类型：
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作者：
P. Hao;M. X. Zhang;R. Li;J. Yang;J. Wang;Y. G. Chen;Y. Zhang
总结。背景：增加每日口服维持剂量氯吡格雷是否可以改善经皮冠状动脉介入治疗（PCI）患者的临床结果仍有争议。目的：本荟萃分析旨在评估每日150毫克与75毫克氯吡格雷维持剂量对PCI患者临床和实验室终点的相对影响。方法：我们检索了符合预定纳入标准的随机对照试验和观察性研究的电子和印刷资料（截至2010年12月14日）。结果：我们检索到12篇研究报告，共包括23814例患者。氯吡格雷150mg day - 1与主要心脏和/或脑血管不良事件（优势比[or]， 0.67； 95%可信区间[CI]， 0.48-0.94）、心肌梗死（or, 0.72; 95% CI, 0.60-0.86）、靶血管重建术（or, 0.27; 95% CI, 0.12-0.62）和支架血栓形成（or, 0.64; 95% CI, 0.53-0.77）以及二磷酸腺苷诱导的最大血小板聚集降低相关。然而，与75 mg每日维持剂量相比，150 mg每日维持剂量显著增加了轻度出血的风险（OR, 1.21; 95% CI, 1.08-1.36）。结论：与目前推荐的75毫克/天的氯吡格雷维持剂量相比，150毫克/天的剂量可以减少主要的心脏和/或脑血管不良事件，但可能增加轻微出血的风险。
Summary. Background: Whether an increase in the daily oral maintenance dose of clopidogrel may improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated. Objectives: This meta‐analysis aimed to estimate the relative effect of a 150‐ vs. 75‐mg daily maintenance dosage of clopidogrel on clinical and laboratory end‐points in patients undergoing PCI. Methods: We searched electronic and printed sources (up to 14 December 2010) for both randomized control trials and observational studies satisfying the predefined inclusion criteria. Results: We retrieved 12 reports of studies including a total of 23 814 patients. Clopidogrel, 150 mg day−1, was associated with significant reductions in major adverse cardiac and/or cerebrovascular events (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.48–0.94), myocardial infarction (OR, 0.72; 95% CI, 0.60–0.86), target vessel revascularization (OR, 0.27; 95% CI, 0.12–0.62) and stent thrombosis (OR, 0.64; 95% CI, 0.53–0.77) and decreased adenosine diphosphate‐induced maximal platelet aggregation. However, as compared with 75 mg day−1, the 150‐mg daily maintenance dosage significantly increased the risk of minor bleeding (OR, 1.21; 95% CI, 1.08–1.36). Conclusion: As compared with the currently recommended 75‐mg day−1 maintenance dosage of clopidogrel, the 150‐mg day−1 dosage can reduce major adverse cardiac and/or cerebrovascular events but may increase the risk of minor bleeding.