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双抗和单抗血小板治疗对经导管主动脉瓣置换术预后影响的比较

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摘要:

目的 比较单抗血小板治疗(SAPT)和双抗血小板治疗(DAPT)对经导管主动脉瓣置换
术(TAVR)后患者预后的影响。方法 系统检索EMbase、MedLine和Cochrane数据库,检索时间范围为
建库至2020年12月,收集比较SAPT和DAPT对TAVR术后患者预后影响的队列研究和随机对照研究,由两
位研究者独立筛选符合纳入标准的所有文献,提取相关资料,主要预后指标包括术后1月、3月、6月、
1年及以上的全因死亡率、卒中发生率、大出血或危及生命的出血(LT/MB)发生率。利用STATA 12.0
软件进行Meta分析,并使用漏斗图评价偏倚风险。结果 最终纳入符合标准的文献有9篇,其中有5项队
列研究共2118例患者,4项随机对照研究共1086例患者,总计3204例患者。结果显示,对于接受TAVR
手术的患者,3个月全因死亡率SAPT组低于DAPT组(RR=0.50,95%CI:0.31~0.82);6月以上全因死
亡率,SAPT组和DAPT组无明显差异(RR=0.97,95%CI:0.81~1.17)。3个月卒中发生率(RR=0.65,
95%CI:0.32~1.31)和6个月以上卒中发生率(RR=0.42,95%CI:0.17~1.04)SAPT组和DAPT组无明显差
异。3个月LT/MB发生率(RR=0.55,95%CI:0.44~0.69)和6个月以上LT/MB发生率(RR=0.36,95%CI:
0.22~0.59)SAPT组均低于DAPT组。结论 对于接受TAVR手术的患者,相对于SAPT方案,DAPT方案不
能降低近期及远期全因死亡率及卒中发生率,反而会增加LT/MB风险。

Abstract:

Objective To compare the influence of single antiplatelet therapy (SAPT) and dual antiplatelet
therapy (DAPT) on prognosis of patients after transcatheter aortic valve replacement (TAVR). Methods The
databases of EMbase, MedLine and Cochrane were retrieved systematically from database establishment time
to Dec. 2020. The cohort studies and randomized controlled studies on the influence of DAPT and SAPT on
patients’ prognosis after TAVR were collected and compared. All eligible literature was independently screened
by 2 researchers to extract relative materials. The main prognosis indexes included all-cause mortality, stroke
incidence rate and incidence rate of life-threatening or major bleeding (LT/MB) after the operation for 1 month,
3 months, 6 months, 1 year and longer time. A Meta-analysis was conducted by using STATA 12.0 software, and
bias risk was reviewed by using funnel plot. Results There were finally 9 eligible documents included, among
them there were 5 cohort studies involved 2118 patients and 4 randomized controlled studies involved 1086
patients (totally 3204 patients). The results of Meta-analysis showed that 3-month all-cause mortality was lower
in SAPT group than that in DAPT group (RR=0.50, 95%CI: 0.31~0.82) in patients undergone TAVR. All-cause
mortality for more than 6 months had no significant difference between SAPT group and DAPT group (RR=0.97,
95%CI: 0.81~1.17). The incidence rate of stroke for 3 months (RR=0.65, 95%CI: 0.32~1.31) and for more than
6 months (RR=0.42, 95%CI: 0.17~1.04) had no significant difference between SAPT group and DAPT group.
The incidence rate of LT/MB for 3 months (RR=0.55, 95%CI: 0.44~0.69) and for more than 6 months (RR=0.36,
95%CI: 0.22~0.59) were lower in SAPT group than those in DAPT group. Conclusion For the patients
undergone TAVR, DAPT cannot reduce short-term and long-term all-cause mortality and stroke incidence rate
and may increase LT/MB risk compared with SAPT.

基金项目:

北京市临床重点专科项目;首都医科大学附属北京
友谊医院科研启动基金资助项目(yyqdkt2017-35)

参考文献:

  • 2008

  • 1

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