OPTIMAL ANTITHROMBOTIC THERAPY FOLLOWING AORTOCORONARY BYPASS - A METAANALYSIS
OPTIMAL ANTITHROMBOTIC THERAPY FOLLOWING AORTOCORONARY BYPASS - A METAANALYSIS
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DOI：
10.1016/1010-7940(93)90155-5
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发表时间：
1993-04-01
影响因子：
3.4
通讯作者：
GOLDMAN, BS
中科院分区：
文献类型：
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作者：
FREMES, SE;LEVINTON, C;GOLDMAN, BS
为了评估抗血栓治疗在保持移植物通畅方面的作用，我们对涉及阿司匹林（ASA）、双嘧达莫(D)、抗凝剂（AC）和安慰剂或非治疗对照(P)的随机临床试验进行了荟萃分析。手工文献检索由计算机化MEDLINE清单补充，完成于1991年7月。通过血管造影（大于或等于1远端吻合口闭塞的患者）确定移植物隐静脉阻塞。试验数据采用Mantel和Haenszel方法汇总。结果以比值比(OR) +/- 95%置信区间（CI）报告。17个试验被评估。阿司匹林强烈影响移植物闭塞[ASA +/- D vs . P: OR 0.60, 95% CI 0.51, 0.71, P < 0.0001]，但双吡啶莫没有提供额外的益处[ASA + D vs . ASA: OR 0.94, 95% CI 0.72, 1.24, P = 0.71]。抗凝剂减少移植物闭塞[AC vs P: OR 0.56, 95% CI 0.33, 0.93, P = 0.025]，结果与阿司匹林相似[ASA vs AC: OR 0.95, 95% CI 0.62, 1.44, P = 0.87]。在两项有限的试验中，阿司匹林联合抗凝药物优于单独使用抗凝药物[ASA + AC vs AC: OR 0.55, 95% CI 0.33, 0.88, P = 0.01]。每日低剂量（100毫克）至中等剂量（325毫克）阿司匹林比高剂量（975毫克）更有效。术后早期治疗（少于或等于6小时）强烈影响移植物闭塞，而术前给药没有提供额外的益处。没有发现任何抗血栓治疗的死亡率优势。阿司匹林或抗凝剂可增强冠状动脉搭桥手术后隐静脉移植物的通畅性，两者的联合用药值得进一步研究，需要足够大的试验来检测这些治疗对临床事件的影响。
To evaluate the role of antithrombotic therapy, on preserving graft patency, we performed a meta-analysis of randomized clinical trials involving aspirin (ASA), dipyridamole (D), anticoagulants (AC) and placebo or nontreatment controls (P). Manual literature searches were performed supplemented by computerized MEDLINE listings complete to July 1991. Saphenous vein graft occlusion was determined by angiography (patients with greater-than-or-equal-to 1 distal anastomotic occlusion). The trial data were aggregated with the methods of Mantel and Haenszel. The results are reported as odds ratios (OR) +/- 95% confidence intervals (CI). Seventeen trials were evaluated. Aspirin strongly influenced graft occlusion [ASA +/- D vs P: OR 0.60, 95% CI 0.51, 0.71, P < 0.0001], but dipyridamole provided no additional benefit [ASA + D vs ASA: OR 0.94, 95% CI 0.72, 1.24, P = 0.71]. Anticoagulants reduced graft occlusion [AC vs P: OR 0.56, 95% CI 0.33, 0.93, P = 0.025] and the results were similar to that achieved with aspirin [ASA vs AC: OR 0.95, 95% CI 0.62, 1.44, P = 0.87]. The combination of aspirin and anticoagulants was superior to anticoagulants alone in two limited trials [ASA + AC vs AC: OR 0.55, 95% CI 0.33, 0.88, P = 0.01]. A low (100 mg) to medium (325 mg) daily aspirin dosage was more effective than a high dose (975 mg). Early postoperative treatment (less-than-or-equal-to 6 h) strongly influenced graft occlusion while preoperative administration provided no additional benefit. No mortality advantage was identified for any antithrombotic therapy. Aspirin or anticoagulants enhance saphenous vein graft patency following aortocoronary bypass surgery, and a combination thereof deserves further investigation in a trial large enough to detect the effects of these treatments with respect to clinical events.