Duration of dual antiplatelet therapy and stability of coronary heart disease: a 60 000-patient meta-analysis of randomised controlled trials.
Duration of dual antiplatelet therapy and stability of coronary heart disease: a 60 000-patient meta-analysis of randomised controlled trials.
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DOI：
10.1136/openhrt-2021-001707
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发表时间：
2021-07
期刊：
影响因子：
2.7
通讯作者：
Lee KK
中科院分区：
文献类型：
--
作者：
Bularga A;Meah MN;Doudesis D;Shah ASV;Mills NL;Newby DE;Lee KK
双重抗血小板治疗（DAPT）对冠状动脉疾病的临床结局具有重要意义。然而，最佳DAPT持续时间仍然不确定。我们检索了四个主要数据库，以比较冠状动脉综合征患者长期（≥12个月）与短期（≤6个月）或更短（≤3个月）DAPT的随机对照试验。主要结局是全因死亡率。次要结局为任何出血和大出血（安全性）、心源性死亡、心肌梗死、支架内血栓形成、血运重建和卒中（疗效）。19项随机对照试验（n=60 111）符合入选标准，8项评估为≤3个月DAPT。与长期相比（≥12个月），短期DAPT（≤6个月）与全因死亡率降低的趋势相关（RR：0.90，95% CI：0.80 - 1.01）和出血显著减少（严重出血和任何出血的RR：0.68，95%CI：0.55至0.83和RR：0.66，95%CI：0.56至0.77）。疗效结局无显著差异。在比较较短持续时间DAPT（≤3个月）与长期DAPT（≥12个月）的全因死亡率的敏感性分析中，这些相关性持续存在（RR：0.91，95% CI：0.79 - 1.05）。在亚组分析中，短期DAPT与急性或慢性冠状动脉综合征患者出血风险降低相关（RR：0.66，95% CI：0.54 - 0.81和RR：0.53，95% CI：0.33 - 0.65），但急性冠脉综合征支架内血栓形成风险较高（RR：1.49，95% CI：1.02至2.17 vs RR：1.25，95% CI 0.44至3.58）。我们的荟萃分析表明，短（≤6个月）和短（≤3个月）DAPT持续时间与出血风险较低、疗效相当以及全因死亡率降低的趋势相关，与冠状动脉疾病稳定性无关。
Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain. We searched four major databases for randomised controlled trials comparing long-term (≥12 months) with short-term (≤6 months) or shorter (≤3 months) DAPT in patients with coronary syndromes. The primary outcome was all-cause mortality. Secondary outcomes were any bleeding and major bleeding (safety), cardiac death, myocardial infarction, stent thrombosis, revascularisation and stroke (efficacy). Nineteen randomised controlled trials (n=60 111) satisfied inclusion criteria, 8 assessed ≤3 months DAPT. Compared with long-term (≥12 months), short-term DAPT (≤6 months) was associated with a trend towards reduced all-cause mortality (RR: 0.90, 95% CI: 0.80 to 1.01) and significant bleeding reduction (RR: 0.68, 95% CI: 0.55 to 0.83 and RR: 0.66, 95% CI: 0.56 to 0.77 for major and any bleeding, respectively). There were no significant differences in efficacy outcomes. These associations persisted in sensitivity analysis comparing shorter duration DAPT (≤3 months) to long-term DAPT (≥12 months) for all-cause mortality (RR: 0.91, 95% CI: 0.79 to 1.05). In subgroup analysis, short-term DAPT was associated with lower risk of bleeding in patients with acute or chronic coronary syndromes (RR: 0.66, 95% CI: 0.54 to 0.81 and RR: 0.53, 95% CI: 0.33 to 0.65, respectively), but higher risk of stent thrombosis in acute coronary syndrome (RR: 1.49, 95% CI: 1.02 to 2.17 vs RR: 1.25, 95% CI 0.44 to 3.58). Our meta-analysis suggests that short (≤6 months) and shorter (≤3 months) durations DAPT are associated with lower risk of bleeding, equivalent efficacy and a trend towards lower all-cause mortality irrespective of coronary artery disease stability.
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DOI：
10.1038/ncpcardio1302
发表时间：
2008-09-01
期刊：
NATURE CLINICAL PRACTICE CARDIOVASCULAR MEDICINE
影响因子：
--
作者：
Fox, Keith A. A.;Anderson, Frederick A., Jr.;Gore, Joel M.
通讯作者：
Gore, Joel M.
影响因子：
39.3
作者：
Helft, Gerard;Steg, Philippe Gabriel;Vicaut, Eric
通讯作者：
Vicaut, Eric
影响因子：
2
作者：
Harbord, Roger M.;Egger, Matthias;Sterne, Jonathan A. C.
通讯作者：
Sterne, Jonathan A. C.
DOI：
10.1136/bmj.k3793
发表时间：
2018-10-02
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Kedhi E;Fabris E;van der Ent M;Buszman P;von Birgelen C;Roolvink V;Zurakowski A;Schotborgh CE;Hoorntje JCA;Eek CH;Cook S;Togni M;Meuwissen M;van Royen N;van Vliet R;Wedel H;Delewi R;Zijlstra F
通讯作者：
Zijlstra F
影响因子：
37.8
作者：
Cutlip, Donald E.;Windecker, Stephan;Serruys, Patrick W.
通讯作者：
Serruys, Patrick W.