Oral anticoagulant and antiplatelet therapy and peripheral arterial disease.
Oral anticoagulant and antiplatelet therapy and peripheral arterial disease.
复制标题
口服抗凝剂和抗血小板治疗和外周动脉疾病。
DOI：
10.1056/nejmoa065959
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
G. Gosselin
中科院分区：
文献类型：
--
作者：
S. Anand;S. Yusuf;C. Xie;J. Pogue;J. Eikelboom;A. Budaj;B. Sussex;Li;R. Guzman;C. Cinà;R. Crowell;M. Keltai;G. Gosselin
背景
动脉粥样硬化性外周动脉疾病与心肌梗死、中风和心血管原因死亡的风险增加有关。抗血小板药物可降低这种风险，但口服抗凝剂在预防外周动脉疾病患者心血管并发症中的作用尚不清楚。
方法
我们将外周动脉疾病患者分配到联合治疗和口服抗凝剂(靶标国际标准化比率[INR]，2.0至3.0)或单独进行抗血小板治疗。第一个主要结果是心肌梗死、中风或死于心血管原因；第二个主要结果是心肌梗死、中风、外周或冠状动脉严重缺血导致紧急干预，或死于心血管原因。
结果
共有2161名患者被随机分配到治疗中。平均随访时间35个月。在接受联合治疗的1080名患者中有132名(12.2%)发生心肌梗死、中风或死于心血管原因，而在接受单独抗血小板治疗的1081名患者中有144名发生心肌梗死、中风或死亡(13.3%)(相对风险为0.92；95%可信区间[CI]为0.73至1.16；P=0.48)。接受联合治疗的172名患者(15.9%)发生心肌梗死、中风、严重缺血或死于心血管原因，而单独接受抗血小板治疗的188名患者(17.4%)发生心肌梗死、中风、严重缺血或死亡(相对风险0.91；95%可信区间0.74-1.12；P=0.37)。接受联合治疗的43例患者发生危及生命的出血(4.0%)，而单用抗血小板治疗的患者发生危及生命的出血13例(1.2%)(相对风险为3.41；95%可信区间为1.84~6.35；P<；0.001)。
结论
在外周动脉疾病患者中，口服抗凝剂和抗血小板治疗在预防主要心血管并发症方面并不比单用抗血小板治疗更有效，并与危及生命的出血增加有关。(ClinicalTrials.gov编号，NCT00125671[ClinicalTrials.gov].)
BACKGROUND
Atherosclerotic peripheral arterial disease is associated with an increased risk of myocardial infarction, stroke, and death from cardiovascular causes. Antiplatelet drugs reduce this risk, but the role of oral anticoagulant agents in the prevention of cardiovascular complications in patients with peripheral arterial disease is unclear.
METHODS
We assigned patients with peripheral arterial disease to combination therapy with an antiplatelet agent and an oral anticoagulant agent (target international normalized ratio [INR], 2.0 to 3.0) or to antiplatelet therapy alone. The first coprimary outcome was myocardial infarction, stroke, or death from cardiovascular causes; the second coprimary outcome was myocardial infarction, stroke, severe ischemia of the peripheral or coronary arteries leading to urgent intervention, or death from cardiovascular causes.
RESULTS
A total of 2161 patients were randomly assigned to therapy. The mean follow-up time was 35 months. Myocardial infarction, stroke, or death from cardiovascular causes occurred in 132 of 1080 patients receiving combination therapy (12.2%) and in 144 of 1081 patients receiving antiplatelet therapy alone (13.3%) (relative risk, 0.92; 95% confidence interval [CI], 0.73 to 1.16; P=0.48). Myocardial infarction, stroke, severe ischemia, or death from cardiovascular causes occurred in 172 patients receiving combination therapy (15.9%) as compared with 188 patients receiving antiplatelet therapy alone (17.4%) (relative risk, 0.91; 95% CI, 0.74 to 1.12; P=0.37). Life-threatening bleeding occurred in 43 patients receiving combination therapy (4.0%) as compared with 13 patients receiving antiplatelet therapy alone (1.2%) (relative risk, 3.41; 95% CI, 1.84 to 6.35; P<0.001).
CONCLUSIONS
In patients with peripheral arterial disease, the combination of an oral anticoagulant and antiplatelet therapy was not more effective than antiplatelet therapy alone in preventing major cardiovascular complications and was associated with an increase in life-threatening bleeding. (ClinicalTrials.gov number, NCT00125671 [ClinicalTrials.gov].).
氯吡格雷疗法的个性化方法：我们在那里吗？
影响因子：
8.3
作者：
Anderson CD;Biffi A;Greenberg SM;Rosand J
通讯作者：
Rosand J
影响因子：
158.5
作者：
CRIQUI, MH;LANGER, RD;BROWNER, D
通讯作者：
BROWNER, D