[1]吴小燕,刘 杰,刘文锋,等.稳定性冠心病合并心房颤动患者抗栓策略的Meta分析[J].医学信息,2020,33(03):82-86.[doi:10.3969/j.issn.1006-1959.2020.03.024]
　WU Xiao-yan,LIU Jie,LIU Wen-feng,et al.Meta-analysis of Antithrombotic Strategies for Stable Coronary Heart Disease with Atrial Fibrillation[J].Medical Information,2020,33(03):82-86.[doi:10.3969/j.issn.1006-1959.2020.03.024]
点击复制

稳定性冠心病合并心房颤动患者抗栓策略的Meta分析()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年03期
页码:
82-86
栏目:
论著
出版日期:
2020-02-01

文章信息/Info

Title:
Meta-analysis of Antithrombotic Strategies for Stable Coronary Heart Disease with Atrial Fibrillation
文章编号:
1006-1959（2020）03-0082-05
作者:
吴小燕; 刘 杰; 刘文锋; 等
（暨南大学第二临床医学院深圳市人民医院老年病科，广东 深圳 518020）
Author(s):
WU Xiao-yan; LIU Jie; LIU Wen-feng; JIANG Xin
(Department of Geriatrics,Shenzhen People’s Hospital,Second Clinical Medical College,Jinan University,Shenzhen 518020,Guangdong,China)
关键词:
稳定性冠心病; 房颤; 抗栓; 抗凝
Keywords:
Stable coronary heart disease; Atrial fibrillation; Antithrombotic; Anticoagulation
分类号:
R541
DOI:
10.3969/j.issn.1006-1959.2020.03.024
文献标志码:
A
摘要:
目的 比较稳定性冠心病合并心房颤动患者单用口服抗凝药与使用抗凝联合抗血小板药物治疗对预后的影响。方法 计算机检索Embase、CochraneLibrary、Pubmed、Web of Science、CNKI、万方数据库，收集关于稳定性冠心病合并房颤患者抗栓治疗的文献，检索截止时间为建库至2019年9月，应用RevMan 5.3软件统计稳定性冠心病合并房颤患者单用口服抗凝药物与抗凝联合抗血小板治疗的主要心血管不良事件（MACE）、缺血性卒中、全因死亡率和出血事件的发生率。结果 共纳入6项临床试验，8842例患者，其中单用口服抗凝治疗组（OAC组）3993例，抗凝联合抗血小板药治疗组（OAC+SAPT组）4477例。两组MACE（OR=1.0466，95%CI：0.8466~1.2939）、缺血性卒中发生率（OR=0.8360，95%CI：0.6893~1.0138）及全因死亡率比较（OR=1.0420，95%CI：0.7723~1.4059），差异无统计学意义（P＞0.05）；OAC+SAPT组主要出血事件发生率高于OAC组（RR=1.5986，95%CI：1.1772~2.1708），差异有统计学意义（P＜0.05）。结论 稳定性冠心病合并房颤患者联合口服抗凝加抗血小板与单用抗凝药物治疗在预防主要心血管不良事件及缺血性卒中事件的中疗效相当，但出血风险较高。
Abstract:
Objective To compare the effects of anticoagulant alone and anticoagulant combined with antiplatelet therapy on the prognosis of patients with stable coronary heart disease and atrial fibrillation. Methods The computer searched the databases of Embase, CochraneLibrary, Pubmed, Web of Science, CNKI, and Wanfang, and collected the literature on antithrombotic therapy for patients with stable coronary heart disease and atrial fibrillation.The cut-off time was from the establishment of the database to September 2019. The major cardiovascular adverse events (MACE) and ischemic symptoms of patients with coronary heart disease and atrial fibrillation who were treated with oral anticoagulation and anticoagulation alone were evaluated using RevMan 5.3 software. The incidence of stroke, all-cause mortality, and bleeding events.Results A total of 8842 patients were included in 6 clinical trials, including 3993 patients in the oral anticoagulation therapy group (OAC group) alone and 4477 patients in the anticoagulation combined antiplatelet therapy group (OAC + SAPT group). Comparison of MACE(OR=1.0466, 95%CI: 0.8466~1.2939), incidence of ischemic stroke(OR=0.8360, 95%CI: 0.6893~1.0138) and all-cause mortality between the two groups(OR=1.0420, 95%CI: 0.7723~1.4059), the difference was not statistically significant(P>0.05); the incidence of major bleeding events was higher in the OAC+SAPT group than in the OAC group (RR=1.5986, 95%CI:1.1772~2.1708),the difference was statistically significant(P<0.05).Conclusion Patients with stable coronary heart disease and atrial fibrillation combined with oral anticoagulation plus antiplatelet therapy and anticoagulant therapy alone have comparable efficacy in preventing major cardiovascular adverse events and ischemic stroke events, but with a higher risk of bleeding.

参考文献/References:

[1]中华医学会心血管病学分会介入心脏病学组,中华医学会心血管病学分会动脉粥样硬化与冠心病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,等.稳定性冠心病诊断与治疗指南[J].中华心血管病杂志,2018,46(9):680-694. [2]黄从新,张澍,黄德嘉,等.心房颤动：目前的认识和治疗建议（2018）[J].中华心律失常学杂志,2018,22(4):279-346. [3]Kralev S,Schneider K,Lang S,et al.Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography[J].PloS One,2011,6(9):e24964. [4]Valgimigli M,Bueno H,Byrne RA,et al.2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS:The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology(ESC)and of the European Association for Cardio-Thoracic Surgery(EACTS)[J].Eur Heart J,2018,39(3):213-260. [5]Kimura T,Morimoto T,Nakagawa Y,et al.Antiplatelet Therapy and Stent Thrombosis After Sirolimus-Eluting Stent Implantation[J].Circulation,2009,119(7):987-995. [6]Hart RG,Pearce LA,Aguilar MI,et al.Meta-analysis:Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation[J].Annals of Internal Medicine,2007,146(12):857. [7]ACTIVE Writing Group of the ACTIVE Investigators,Connolly S,Pogue J,et al.Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events(ACTIVE W):a randomised controlled trial[J].The Lancet,2006,367(9526):1903-1912. [8]Lamberts M,Gislason GH,Lip GYH,et al.Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients Taking an Oral Anticoagulant A Nationwide Cohort Study[J].Circulation,2014,129(15):1577-1585. [9]Lemesle G,Ducrocq G,Elbez Y,et al.Vitamin K antagonists with or without long-term antiplatelet therapy in outpatients with stable coronary artery disease and atrial fibrillation:association with ischemic and bleeding events[J].Clin Cardiol,2017,40(10):932-939. [10]Fischer Q,Georges JL,Le Feuvre C,et al.Optimal long-term antithrombotic treatment of patients with stable coronary artery disease and atrial fibrillation:"OLTAT registry"[J].International Journal of Cardiology,2018(264):64-69. [11]Patti G,Pecen L,Lucerna M,et al.Outcomes of anticoagulated patients with atrial fibrillation treated with or without antiplatelet therapy-A pooled analysis from the PREFER in AF and PREFER in AF PROLONGATON registries[J].International Journal of Cardiology,2018(270):160-166. [12]Matsumura-Nakano Y,Shizuta S,Komasa A,et al.Open-Label Randomized Trial Comparing Oral Anticoagulation With and Without Single Antiplatelet Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease Beyond 1 Year After Coronary Stent Implantation[J].Circulation,2019,139(5):604-616. [13]Yasuda S,Kaikita K,Akao M,et al.Antithrombotic therapy for atrial fibrillation with stable coronary disease[J].New England Journal of Medicine,2019,381(12):1103-1113. [14]Bai Y,Zhu J,Yang YM,et al.Clinical characteristics and one year outcomes in Chinese atrial fibrillation patients with stable coronary artery disease：a population-based study[J].Journal of Geriatric Cardiology Jgc,2016(8):665-671. [15]Golwala HB,Cannon CP,Steg PG,et al.Safety and efficacy of dual vs.triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention:a systematic review and meta-analysis of randomized clinical trials[J].European Heart Journal,2018,39(19):1726-1735a. [16]Valgimigli M,Bueno H,Byrne RA,et al.2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS[J].European Heart Journal,2018,39(3):213-260. [17]中国老年学学会心脑血管病专业委员会,中国康复医学会心脑血管病专业委员会.稳定性冠心病口服抗血小板药物治疗中国专家共识[J].中华心血管病杂志,2016,44(2):104-111. [18]Connolly SJ,Eikelboom JW,Bosch J,et al.Rivaroxaban with or without aspirin in patients with stable coronary artery disease:an international,randomised,double-blind,placebo-controlled trial[J].Lancet(London,England),2018,391(10117):205. [19]Han Y,Xu B,Xu K,et al.Six Versus 12 Months of Dual Antiplatelet Therapy After Implantation of Biodegradable Polymer Sirolimus-Eluting Stent[J].Circulation Cardiovascular Interventions,2016,9(2):e003145. [20]Watanabe H,Domei T,Morimoto T,et al.Effect of 1-Month Dual Antiplatelet Therapy Followed by Clopidogrel vs 12-Month Dual Antiplatelet Therapy on Cardiovascular and Bleeding Events in Patients Receiving PCI:The STOPDAPT-2 Randomized Clinical Trial[J].JAMA,2019,321(24):2414-2427. [21]Hurlen M,Abdelnoor M,Smith P,et al.Warfarin,aspirin,or both after myocardial infarction[J].New England Journal of Medicine,2003,12(1):11-12. [22]Patel MR,Mahaffey KW,Garg J,et al.Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J].New England Journal of Medicine,2011,365(10):883-891. [23]Dans AL,Connolly SJ,Wallentin L,et al.Concomitant Use of Antiplatelet Therapy with Dabigatran or Warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy(RE-LY) Trial[J].Circulation,2013,127(5):634-640. [24]Artang R,Rome E,Nielsen JD,et al.Meta-Analysis of Randomized Controlled Trials on Risk of Myocardial Infarction from the Use of Oral Direct Thrombin Inhibitors[J].The American Journal of Cardiology,2013,112(12):1973-1979.

相似文献/References:

[1]李 燕,王 英.冷冻球囊介入术中并发急性心包填塞的1例抢救护理[J].医学信息,2018,31(08):174.[doi:10.3969/j.issn.1006-1959.2018.08.063]
　LI Yan,WANG Ying.Emergency Nursing Care of One Case of Acute Pericardial Tamponade during Cryopreservation Balloon Intervention[J].Medical Information,2018,31(03):174.[doi:10.3969/j.issn.1006-1959.2018.08.063]
[2]肖智谦.阵发性室上性心动过速、房颤、胸痛1例[J].医学信息,2018,31(12):190.[doi:10.3969/j.issn.1006-1959.2018.12.063]
　XIAO Zhi-qian.Paroxysmal Supraventricular Tachycardia,Atrial Fibrillation and Chest Pain in 1 Case[J].Medical Information,2018,31(03):190.[doi:10.3969/j.issn.1006-1959.2018.12.063]
[3]刘东庭.心电散点图鉴别诊断房颤伴宽QRS波心动过速的临床应用价值[J].医学信息,2022,35(11):157.[doi:10.3969/j.issn.1006-1959.2022.11.042]
　LIU Dong-ting.Clinical Value of ECG Scatter Plot in Differential Diagnosis of Atrial Fibrillation with Wide QRS Tachycardia[J].Medical Information,2022,35(03):157.[doi:10.3969/j.issn.1006-1959.2022.11.042]
[4]周井铎,田康爱,孟 震,等.急性脾肾梗死伴房颤1例并文献复习[J].医学信息,2018,31(15):191.[doi:10.3969/j.issn.1006-1959.2018.15.066]
[5]张文波,杨玉雯.希氏束起搏在慢性心力衰竭患者中的应用[J].医学信息,2019,32(10):41.[doi:10.3969/j.issn.1006-1959.2019.10.015]
　ZHANG Wen-bo,YANG Yu-wen.Application of His Bundle Pacing in Patients with Chronic Heart Failure[J].Medical Information,2019,32(03):41.[doi:10.3969/j.issn.1006-1959.2019.10.015]
[6]甄秀丽,冯国鹏.房颤合并冠心病患者冠脉支架植入术后二联和三联抗凝治疗的效果比较[J].医学信息,2021,34(03):162.[doi:10.3969/j.issn.1006-1959.2021.03.046]
　ZHEN Xiu-li,FENG Guo-peng.Comparison of the Effects of Dual and Triple Anticoagulation Therapy in Patients with Atrial Fibrillation and Coronary Heart Disease After Coronary Stent Implantation[J].Medical Information,2021,34(03):162.[doi:10.3969/j.issn.1006-1959.2021.03.046]
[7]张 凯,魏 昕,丁 盟,等.老年房颤患者非心脏手术围术期心脑血管事件的危险因素分析[J].医学信息,2021,34(06):122.[doi:10.3969/j.issn.1006-1959.2021.06.031]
　ZHANG Kai,WEI Xin,DING Meng,et al.Analysis of Risk Factors for Perioperative Cardiovascular and Cerebrovascular Events in Elderly Patients with Atrial Fibrillation[J].Medical Information,2021,34(03):122.[doi:10.3969/j.issn.1006-1959.2021.06.031]
[8]章 胜,王昌会,方 浩,等.非瓣膜病房颤患者左心耳血栓形成的预测因素[J].医学信息,2021,34(18):84.[doi:10.3969/j.issn.1006-1959.2021.18.022]
　ZHANG Sheng,WANG Chang-hui,FANG Hao,et al.Predictive Factors of Left Atrial Appendage Thrombosis in Patients with Non-valvular Atrial Fibrillation[J].Medical Information,2021,34(03):84.[doi:10.3969/j.issn.1006-1959.2021.18.022]

更新日期/Last Update: 2020-02-01