Statins significantly reduce mortality in patients receiving clopidogrel without affecting platelet activation and aggregation: a systematic review and meta-analysis
Statins significantly reduce mortality in patients receiving clopidogrel without affecting platelet activation and aggregation: a systematic review and meta-analysis
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他汀类药物可显着降低接受氯吡格雷治疗的患者的死亡率，而不影响血小板活化和聚集：系统评价和荟萃分析
DOI：
10.1186/s12944-019-1053-0
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发表时间：
2019-05-24
影响因子：
4.5
通讯作者：
Wang, Shaohua
中科院分区：
文献类型：
--
作者：
An, Ke;Huang, Rong;Wang, Shaohua
背景他汀类药物和氯吡格雷联合应用是冠心病患者常用的治疗方法。它们主要在肝脏中被细胞色素P450同工酶3A 4（CYP 3A 4）激活和消除。目的是澄清是否共同管理的氯吡格雷和他汀类药物减弱各自的efficacy.MethodsPubMed，Embase，科克伦图书馆，网络科学和临床试验。gov被搜索到2018年8月。随机对照试验和队列研究纳入质量评价。数据采用随机效应模型进行汇总，以估计标准均数差（SMD）或风险比（RR）与95%置信区间（CI）。ResultsIn总数，28项研究，代表25,267名参与者。他汀类药物降低氯吡格雷治疗患者的死亡率（RR 0.54; 95%CI 0.40，0.74;p= 0.000），血小板聚集（PA）无差异（SMD 0.02; 95%CI-0.38，0.42;p= 0.920）和P-选择素表达（SMD -0.04; 95% CI-0.14，0.05;p= 0.346），CD40 L（SMD 0.09; 95% CI-0.29，0.48;p= 0.633）、CD63（SMD 0.09; 95% CI-0.01，0.19;p= 0.079）和PAC-1（SMD 0.03; 95% CI-0.08，0.13;p= 0.633）。此外，CYP 3A 4代谢或非CYP 3A 4代谢的他汀类药物在PA中无差异（SMD 0.13; 95% CI-0.31，0.58;p= 0.556），P-选择素（SMD 0.17; 95% CI-0.16，0.51;p= 0.310），死亡（RR 0.89; 95% CI 0.38，2.07;p= 0.791），甘油三酯（TG）除外（SMD-0.19; 95% CI-0.33，-0.06;结论：本荟萃分析证实他汀类药物可降低接受氯吡格雷治疗患者的死亡率，而不影响血小板活化和聚集。
BackgroundCombination of statins and clopidogrel is frequently administered in patients with coronary artery disease (CAD). They are mainly activated and eliminated in the liver by cytochrome P450 isoenzyme 3A4 (CYP3A4). The aim was to clarify whether the coadministration of clopidogrel and statins attenuate respective efficacy.MethodsPubMed, Embase, the Cochrane Library, Web of Science and Clinical Trials. gov were searched for until August 2018. Randomized controlled trials (RCTs) and cohort studies were taken into quality evaluation. Data were pooled using random effect models to estimate standard mean difference (SMD) or risk ratio (RR) with 95% confidence interval (CI).ResultsIn total, 28 studies representing 25,267 participants were included. Statins reduce the mortality of patients administered clopidogrel (RR 0.54; 95% CI 0.40,0.74;p= 0.000), no differences were found in platelet aggregation (PA) (SMD 0.02; 95% CI -0.38,0.42;p= 0.920) and the expressions of P-selectin (SMD -0.04; 95% CI -0.14,0.05;p= 0.346), CD40L (SMD 0.09; 95% CI -0.29,0.48;p= 0.633), CD63 (SMD 0.09; 95% CI -0.01,0.19;p= 0.079) and PAC-1 (SMD 0.03; 95% CI -0.08,0.13;p= 0.633). Furthermore, CYP3A4 metabolized or non-CYP3A4 metabolized statins have no discrepancies in PA (SMD 0.13; 95% CI -0.31,0.58;p= 0.556), P-selectin (SMD 0.17; 95% CI -0.16,0.51;p= 0310), death (RR 0.89; 95% CI 0.38,2.07;p= 0.791), except for triglyceride (TG) (SMD -0.19; 95% CI –0.33,-0.06;p= 0.005).ConclusionsThis meta-analysis confirmed that statins reduce mortality in patients undergoing clopidogrel treatment without affecting platelet activation and aggregation.