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Ann Intern Med:经皮冠状动脉介入治疗后房颤双联和三联治疗效果比较

2020-03-18 MedSci原创 MedSci原创

在PCI术后成年AF患者中,双联治疗较三联治疗出血风险有所降低,但其对死亡风险和缺血终点的影响尚不清楚。

经皮冠状动脉介入治疗(PCI)后非瓣膜性房颤(AF)患者接受双联治疗(直接口服抗凝剂[DOAC]+P2Y12抑制剂)与三联治疗(维生素K拮抗剂+阿司匹林+P2Y12抑制剂)的安全性和疗效尚不清楚。近日,内科学权威杂志Annals of Internal Medicine上发表了一篇研究文章,该研究旨在探讨双联和三联治疗对PCI术后成年AF患者出血和缺血性结局的影响。

研究人员对PubMed、EMBASE和Cochrane图书馆(数据库成立到2019年12月31日)和ClinicalTrials.gov(截止至2020年1月7日)、杂志网站和引文列表进行了检索。研究人员选择了旨在比较双联和三联治疗对成年PCI术后AF患者出血、死亡率和缺血性事件的影响的随机对照试验。由两位独立调查人员提取数据,评估证据质量,并对证据的确定性进行评级。

该分析共选择了4个试验,涉及7953名患者。在中位随访1年后,高确定性的证据表明,与三联治疗相比,双联治疗可降低大出血的风险(风险差[RD]为-0.013[95%CI为-0.025至-0.002])。低确定性的证据表明双联与三联治疗对全因死亡(RD为0.004[CI为0.010−0.017])、心血管死亡率(RD为0.001[CI为0.011−0.013])、心肌梗死(RD为0.003[CI为0.010−0.017])、支架血栓形成(RD为0.003[CI为0.005−0.010])和卒中(RD为−0.003[CI为0.010−0.005])的风险具有不确定的效应。这些效应的CIs上界与双联治疗可能增加的风险是一致的。

由此可见,在PCI术后成年AF患者中,双联治疗较三联治疗出血风险有所降低,但其对死亡风险和缺血终点的影响尚不清楚。

原始出处:

Safi U. Khan,et al.Dual Versus Triple Therapy for Atrial Fibrillation After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.AIM.2020.https://annals.org/aim/article-abstract/2763089/dual-versus-triple-therapy-atrial-fibrillation-after-percutaneous-coronary-intervention

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    2020-03-18 心介

    房颤,临床上碰到很多哦

    0

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    2020-03-18 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1738240, encodeId=d97a1e38240e0, content=<a href='/topic/show?id=cbea19e8944' target=_blank style='color:#2F92EE;'>#三联治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19789, encryptionId=cbea19e8944, topicName=三联治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6bb734392571, createdName=12498768m24(暂无昵称), createdTime=Tue May 26 07:18:12 CST 2020, time=2020-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1894148, encodeId=706a1894148b9, content=<a href='/topic/show?id=5e456463eee' target=_blank style='color:#2F92EE;'>#治疗效果#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64637, encryptionId=5e456463eee, topicName=治疗效果)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373a131, createdName=jxrzshh, createdTime=Sat Oct 31 20:18:12 CST 2020, time=2020-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1648958, encodeId=da5b1648958c0, content=<a href='/topic/show?id=6e0630843d0' target=_blank style='color:#2F92EE;'>#冠状动脉介入治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30843, encryptionId=6e0630843d0, topicName=冠状动脉介入治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a9ec23698107, createdName=3631181, createdTime=Wed Jun 17 17:18:12 CST 2020, time=2020-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1320768, encodeId=b0851320e688f, content=<a href='/topic/show?id=cd29e838938' target=_blank style='color:#2F92EE;'>#经皮冠状动脉介入治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78389, encryptionId=cd29e838938, topicName=经皮冠状动脉介入治疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Fri Mar 20 11:18:12 CST 2020, time=2020-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610359, encodeId=a59516103598d, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=133, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Mar 20 11:18:12 CST 2020, time=2020-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031236, encodeId=0e6510312364e, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Wed Mar 18 23:18:12 CST 2020, time=2020-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032449, encodeId=26c71032449fc, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=176, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Mar 18 23:18:12 CST 2020, time=2020-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047016, encodeId=fa58104e0167f, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Wed Mar 18 23:18:12 CST 2020, time=2020-03-18, status=1, ipAttribution=)]
    2020-03-18 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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