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JAMA Cardiol:全新Meta分析称,当房颤遇到冠脉介入,氯吡格雷联合达比加群/利伐沙班更佳

2019-07-02 朱柳媛 中国循环杂志

近期发表在JAMA心脏病学子刊上的一项Meta分析表明,对于接受冠脉介入治疗或合并急性冠脉综合征(ACS)的房颤患者,一种新型口服抗凝药物(达比加群、利伐沙班等)联合一种P2Y12抑制剂(如氯吡格雷、替格瑞洛)可能是最好的抗栓治疗策略,而华法林+双联抗血小板治疗(阿司匹林+氯吡格雷)的抗栓策略最差。

近期发表在JAMA心脏病学子刊上的一项Meta分析表明,对于接受冠脉介入治疗或合并急性冠脉综合征(ACS)的房颤患者,一种新型口服抗凝药物(达比加群、利伐沙班等)联合一种P2Y12抑制剂(如氯吡格雷、替格瑞洛)可能是最好的抗栓治疗策略,而华法林+双联抗血小板治疗(阿司匹林+氯吡格雷)的抗栓策略最差。

分析结果显示,在上述患者中,与华法林+双联抗血小板药物的抗栓策略相比,新型口服抗凝药物+P2Y12抑制剂的抗栓策略可将TIMI大出血风险降低51%。

而华法林+P2Y12抑制剂、新型口服抗凝药物+双联抗血小板药物等抗栓策略分别可将大出血风险降低42%和30%。

这几种方案没有增加主要不良心血管事件发生风险。

研究者指出,该Meta分析说明,对于接受冠脉介入治疗的房颤患者,去掉阿司匹林的抗栓策略可减少出血,包括颅内出血,但对主要不良心血管事件发生风险没有明显影响,支持这类患者优选新型口服抗凝药物+P2Y12抑制剂的抗栓治疗策略,而华法林+双联抗血小板治疗的策略要尽量避免应用。

在该分析中,冠脉介入治疗术后所有患者均服用了阿司匹林。

研究者认为,冠脉介入术后患者住院期间可应用阿司匹林,但出院时就可以停用了。

另外,该Meta分析提示,对于大多数患者,最好用新型口服抗凝药物替代华法林。

值得注意的是,该Meta分析纳入的患者应用的P2Y12抑制剂大多数为氯吡格雷,因此替格瑞洛和普拉格雷与口服抗凝药物联用是否有同样的有效性和安全性,还需要进一步研究。

该Meta分析覆盖WOEST、PIONEERAF-PCI、RE-DUAL PCI、AUGUSTUS等四项大规模随机对照研究,共纳入10 026例患者。这四项研究中,合并急性冠脉综合征的患者占28%~61%,患者平均年龄为70~72岁,绝大部分患者是血栓栓塞和出血高危患者。

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    2019-12-11 guojianrong
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    2019-10-08 jyzxjiangqin

    冠状动脉疾病临床治疗。

    0

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    2020-03-25 一闲
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1782045, encodeId=28ef1e820459f, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Fri Dec 20 22:41:00 CST 2019, time=2019-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888030, encodeId=a946188803016, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Dec 11 10:41:00 CST 2019, time=2019-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=373665, encodeId=5c583e3665e9, content=冠状动脉疾病临床治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Tue Oct 08 19:54:56 CST 2019, time=2019-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896511, encodeId=af5a1896511b5, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Wed Mar 25 04:41:00 CST 2020, time=2020-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=368879, encodeId=bc203688e9f7, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Wed Jul 03 05:44:57 CST 2019, time=2019-07-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=368817, encodeId=e97a36881e9a, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Tue Jul 02 08:56:10 CST 2019, time=2019-07-02, status=1, ipAttribution=)]
    2019-07-02 龙胆草

    学习谢谢分享

    0

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