Meta-analysis of Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
Meta-analysis of Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention
复制标题
DOI：
10.1016/j.amjcard.2019.11.022
复制
发表时间：
2020-02-15
影响因子：
2.8
通讯作者：
Bangalore, Sripal
中科院分区：
文献类型：
--
作者：
Kuno, Toshiki;Ueyama, Hiroki;Bangalore, Sripal
对于接受经皮冠状动脉介入治疗（PCI）的房颤（AF）患者，适用抗血栓治疗，包括口服抗凝剂和抗血小板药物。最佳组合尚不清楚。我们研究了接受PCI的AF患者中不同抗血栓策略的有效性和安全性。检索了截至2019年9月的PUBMED和EMBASE随机试验，研究了不同抗血栓策略在接受PCI和/或急性冠脉综合征的AF患者中的疗效和安全性。比较了9种抗血栓形成策略，包括维生素K拮抗剂（VKA）联合双联抗血小板治疗（DAPT）或P2 Y（12）抑制剂，直接口服抗凝剂（DOAC）（阿哌沙班、达比加群、利伐沙班和依度沙班）联合DAPT或P2 Y（12）抑制剂（氯吡格雷、普拉格雷和替格瑞洛）。主要安全性结局为试验定义的原发性出血结局。主要疗效结局为试验定义的主要不良心血管事件。我们的检索确定了5项合格试验，共招募了11，532例患者，并比较了9种治疗策略。与大多数联合用药相比，VKA + DAPT显著增加出血（例如，与VKA + P2 Y（12）抑制剂相比：比值比2.11; 95%置信区间[1.76 - 2.52]，p
For patients with atrial fibrillation (AF) who undergo percutaneous coronary intervention (PCI), antithrombotic therapy including oral anticoagulants and antiplatelets are indicated. The optimal combination is not known. We investigated the efficacy and safety of different antithrombotic strategies in patients with AF undergoing PCI. PUBMED and EMBASE were searched through September 2019 for randomized trials investigating the efficacy and safety of different antithrombotic strategies in patients with AF who underwent PCI and/or acute coronary syndrome. Nine antithrombotic strategies were compared including combinations of vitamin K antagonist (VKA) with dual antiplatelet therapy (DAPT) or P2Y(12) inhibitor, combinations of direct oral anticoagulants (DOAC) (apixaban, dabigatran, rivaroxaban, and edoxaban) with DAPT or P2Y(12) inhibitor (clopidogrel, prasugrel, and ticagrelor). The primary safety outcome was trial defined primary bleeding outcome. The primary efficacy outcome was trial defined major adverse cardiovascular events. Our search identified 5 eligible trials that enrolled a total of 11,532 patients and compared 9 treatment strategies. VKA + DAPT significantly increased bleeding when compared with most combinations (for example, vs VKA + P2Y(12) inhibitor: odds ratio 2.11; 95% confidence interval [1.76 to 2.52], p