Cilostazol, clopidogrel or ticlopidine to prevent sub-acute stent thrombosis: a meta-analysis of randomized trials.
Cilostazol, clopidogrel or ticlopidine to prevent sub-acute stent thrombosis: a meta-analysis of randomized trials.
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西洛他唑、氯吡格雷或噻氯匹定预防亚急性支架内血栓形成：随机试验的荟萃分析。
DOI：
10.1016/j.ahj.2004.03.066
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Heidenreich,PaulA
中科院分区：
文献类型：
--
作者：
Schleinitz,MarkD;Olkin,Ingram;Heidenreich,PaulA
亚急性血栓形成是冠状动脉支架置入术的严重并发症。氯吡格雷加阿司匹林是公认的预防方案，但尚未被证明上级噻氯匹定加阿司匹林，和一个新的方案结合西洛他唑和阿司匹林已经introduced. METHODS我们进行了荟萃分析的所有试验，比较≥2口服抗血栓形成的策略，在接受冠状动脉支架置入术的患者，以确定哪种治疗最佳预防不良心脏事件在30天后支架插入。我们使用荟萃回归比较所有策略与共享控制策略：噻氯匹定加阿司匹林。我们还将随机试验与历史对照和其他非随机试验进行了比较。我们进行了敏感性分析和亚组分析，以评估可能的异质性。与噻氯匹定加阿司匹林相比，心脏事件的比值比（95%置信区间）为：阿司匹林，4.29（3.09-5.97），香豆素加阿司匹林，2.65（2.18-3.21），氯吡格雷加阿司匹林，1.06（0.86-1.31），西洛他唑加阿司匹林，0.73（0.47-1.14）。在比较氯吡格雷联合阿司匹林与噻氯匹定联合阿司匹林的试验中，历史对照试验与随机试验在统计学上有差异。西洛他唑的分析是敏感的小尺寸的included studies. CONCLUSIONSN无论是氯吡格雷加阿司匹林，也不是西洛他唑加阿司匹林可以从统计学上区分噻氯匹定加阿司匹林预防不良心脏事件在支架植入后30天。包括西洛他唑的随机试验是必要的。
BACKGROUNDSub-acute thrombosis is a serious complication of coronary artery stenting. Clopidogrel plus aspirin is the accepted prophylactic regimen, but has yet to be proven superior to ticlopidine plus aspirin, and a new regimen combining cilostazol and aspirin has been introduced.METHODSWe conducted a meta-analysis of all trials that compared ≥2 oral anti-thrombotic strategies in patients undergoing coronary stent placement to determine which treatment optimally prevents adverse cardiac events in the 30 days following stent insertion. We used meta-regression to compare all strategies to a shared control strategy: ticlopidine plus aspirin. We also compared randomized trials to historically controlled and other non-randomized trials. We conducted sensitivity analysis and subgroup analysis to assess for possible heterogeneity.RESULTSIn comparison to ticlopidine plus aspirin the odds-ratios for cardiac events, with 95% confidence intervals were: aspirin alone, 4.29 (3.09–5.97), coumadin plus aspirin, 2.65 (2.18–3.21), clopidogrel plus aspirin, 1.06 (0.86–1.31), cilostazol plus aspirin, 0.73 (0.47–1.14). Among trials that compared clopidogrel plus aspirin to ticlopidine plus aspirin, historically controlled trials were statistically distinct from randomized trials. The analysis of cilostazol was sensitive to the small size of the included studies.CONCLUSIONSNeither clopidogrel plus aspirin nor cilostazol plus aspirin can be statistically distinguished from ticlopidine plus aspirin for the prevention of adverse cardiac events in the 30 days after stenting. A randomized trial including cilostazol is warranted.