医学
经皮冠状动脉介入治疗
优势比
心肌梗塞
内科学
随机对照试验
科克伦图书馆
置信区间
荟萃分析
药物洗脱支架
外科
心脏病学
作者
Eliano Pio Navarese,Felicita Andreotti,Volker Schulze,Małgorzata Kołodziejczak,Antonino Buffon,Marc A. Brouwer,Francesco Costa,Mariusz Kowalewski,Gianfranco Parati,Gregory Y.H. Lip,Malte Kelm,Marco Valgimigli
出处
期刊:BMJ
[BMJ]
日期:2015-04-16
卷期号:350 (apr16 25): h1618-h1618
被引量:272
摘要
To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents.Meta-analysis of randomised controlled trials.PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major congress proceedings, searched from 1 January 2002 to 16 February 2015.Trials comparing short term (<12 months) or extended (>12 months) DAPT regimens with standard 12 month duration of therapy. Primary outcomes were cardiovascular mortality, myocardial infarction, stent thrombosis, major bleeding, and all cause mortality.10 randomised controlled trials (n=32,287) were included. Compared to 12 month DAPT, a short term course of therapy was associated with a significant reduction in major bleeding (odds ratio 0.58 (95% confidence interval 0.36 to 0.92); P=0.02) with no significant differences in ischaemic or thrombotic outcomes. Extended versus 12 month DAPT yielded a significant reduction in the odds of myocardial infarction (0.53 (0.42 to 0.66); P<0.001) and stent thrombosis (0.33 (0.21 to 0.51); P<0.001), but more major bleeding (1.62 (1.26 to 2.09); P<0.001). All cause but not cardiovascular death was also significantly increased (1.30 (1.02 to 1.66); P=0.03).Compared with a standard 12 month duration, short term DAPT (<12 months) after drug eluting stent implementation yields reduced bleeding with no apparent increase in ischaemic complications, and could be considered for most patients. In selected patients with low bleeding risk and very high ischaemic risk, extended DAPT (>12 months) could be considered. The increase in all cause but not cardiovascular death with extended DAPT requires further investigation.
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