Objective To assess the effectiveness and safety of different dual antiplatelet therapies in patients undergoing percutaneous coronary intervention. Methods Such databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched to collect the randomized controlled trials (RCTs) and observational studies on the effectiveness and safety of dual antiplatelet therapies both short-duration (≤6 months) and long-duration (gt;6 months) after percutaneous coronary intervention. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, the quality was evaluated, the data were extracted, and meta-analyses were performed by using RevMan 5.1 software. Results Eight trials were included, of which 3 were RCTs involving 7 475 patients, and 5 were observational studies involving 12 744 patients. Meta-analyses on RCTs showed that the incidence of death or myocardial infarction in the long-duration treatment group was lower than that of the short-duration treatment group (OR=0.74, 95%CI 0.56 to 0.98, Plt;0.000 1), while meta-analyses on observation studies showed the similar result (OR=0.7, 95%CI 0.45 to 1.08, P=0.11). With the variables of published year and follow-up time, the heterogeneity of cohort studies was discussed through meta-regression (Z=3.61, P=0.000) which indicated that both published year and follow-up time might be the source of heterogeneity due to their contribution. For RCTs, the incidence of severe bleeding events in the short-duration treatment group was lower than that in the long-duration treatment group (OR=1.29, 95%CI 0.99 to 1.69, P=0.06). For observational studies, the incidence of late stent thrombosis in the long-duration treatment group was lower than that in the short-duration treatment group (OR=0.40, 95%CI 0.15 to 1.07, P=0.07). Conclusion The long duration (gt;6months) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction and decrease the tendency of late stent thrombosis, but cannot obviously increase the incidence rate of severe bleeding events. The current evidence shows no marked superiority in longer duration (gt;12months) of dual antiplatelet therapy.
Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
Objective To compare the therapeutic effect of one-stage direct revascularization and medicine therapy for the treatment of ischemic moyamoya disease. Methods From March 2002 to March 2008, 18 patients with ischemic moyamoyadisease (12 males and 6 females) were treated, aged 9 to 33 years old. Eighteen patients presented with ischemic stroke, including 11 cases of cerebral infarction and 7 cases of transient ischemic attack. According to Chinese ischemic cardiovascular diseases evaluation tools, 17 patients were classified as low risk ischemic stroke and 1 as modernte risk ischemic stroke. Different levels of occlusion branch of the intracranial carotid arteries and pathosis collaterals were identified by DSA. Fourteen patients and 4 patients were showed unilateral and bilateral hypoperfusion of cerebral blood flow by single photon emission computed tomography, respectively. Eleven patients received superficial temporal artery-middle cerebral artery anastomosis and 7 patients received medicine (anti-PLT agglutinin and calcium channel blocker). Results All incisions healed at stage I. There was no stroke events during perioperation. Anastomosis vessel vasospasm occurred in 2 patients 5 days after operation; and hyperperfusion syndrome in 1 patient 2 weeks afteroperation. All patients were followed up 13-32 months (mean 18 months). In 11 anastomosis patients, 6 underwent 6 stroke events within 12 months; in 7 medicine patients, 6 underwent 11 stroke events within 12 months; and showing a significant difference (P lt; 0.05). The stroke recurrence rate was 85.7% in medicine patients and 54.5% in anastomosis patients 12 months after therapy. DSA showed pathosis collaterals in 7 anastomosis patients and 6 medicine patients 6 months after therapy. After 12 months according to modified Rankin scale, the scores of anastomosis patients were 3 points in 1 case, 2 points in 6 cases and 0-1 point in 4 cases, and the scores of medicine patients were 2 points in 2 cases and 0-1 point in 5 cases; showing no significant difference (P gt; 0.05). Conclusion As long as onset of stroke occurred and ischemic moyamoya disease is diagnosed, one-stage direct revascularization should be performed, which can reduce the rate of stroke recurrence risk and slow down the progression of disease.
ObjectiveTo summarize the effectiveness and safety of antiplatelet combined with anticoagulant therapy for peripheral arterial disease (PAD). MethodUsing the search strategy developed by Cochrane Collaborative Network, the relevant literature from domestic and foreign databases as of November 1, 2023 was searched and a meta-analysis of outcome indicators was conducted using Stata 14.0 software and Review Manager 5.4.1 software provided by Cochrane Collaboration Network. ResultsA total of 15 eligible literature and 15 383 patients were included, including 7 692 in the antiplatelet combined with anticoagulant therapy group (study group) and 7 691 in the control group (only antiplatelet drug therapy). The meta-analysis results showed that: ① Symptoms: The ankle brachial index [mean difference (MD) and 95% confidence interval (95%CI)=0.04(0.02, 0.06)] and the minimum lumen diameter [MD (95%CI)=0.48(0.40, 0.55)] of the study group were greater than those of the control group; The plasma D-2 dimer level of the study group was lower than that of the control group [MD (95%CI)=–0.55(–0.57, –0.52)], and the probability of the limb ischemia risk of the study group was lower than that of the control group [risk ratio (RR) and 95%CI=0.67(0.56, 0.80)]. ② Vascular patency: The probability of the vascular patency of the study group was higher than that of the control group [RR (95%CI)=1.13(1.08, 1.17)]; The subgroup analysis results: the vascular patency rate of the two antiplatelet drugs combined with anticoagulation therapy was highest among the different treatment regimens [effect size (ES) and 95%CI=0.90(0.86, 0.94)], which of the other measures in descending order was only one antiplatelet drug combined with anticoagulation therapy [ES(95%CI)=0.82(0.76, 0.89)], two antiplatelet drugs therapy [ES(95%CI)=0.79(0.72, 0.85)], and only one antiplatelet drug therapy [ES(95%CI)=0.71(0.54, 0.87)]; The probability of the vascular patency using vitamin K antagonists in the study group was higher than that in the control group [RR(95%CI)=1.15(1.10, 1.20)], which had no statistical difference using Ⅹa inhibitor between the study group and the control group [RR(95%CI)=1.04 (0.95, 1.15)]. ③ Bleeding risk: The risk of bleeding of the study group was higher than that of the control group [RR(95%CI)=1.55(1.27, 1.89)]; The subgroup analysis results: The bleeding rate of the only one antiplatelet drug therapy among the different intervention measures was the lowest [ES(95%CI)=0.02(0.01, 0.02)], which of the other measures in ascending order was only one antiplatelet drug combined with anticoagulant therapy [ES(95%CI)=0.04(0.03, 0.06)], two antiplatelet drugs therapy [ES(95%CI)= 0.08(0.06, 0.10)], and two antiplatelet drugs combined with anticoagulant [ES(95%CI)=0.12(0.06, 0.18)]; The probabilities of the bleeding occurring using the vitamin K antagonists and Ⅹa inhibitor in the study group were higher than those in the control group [RR(95%CI)=1.76(1.28, 2.42); RR(95%CI)=1.44(1.12, 1.84)]. ConclusionsFrom the results of this meta-analysis, it can be seen that the combination of antiplatelet and anticoagulant therapy can effectively improve symptoms of patients with PAD, increase vascular patency rate, but it has a certain risk of bleeding. The combination of only one antiplatelet drug combined with anticoagulant therapy might achieve an optimum clinical effect and lower bleeding risk.
ObjectivesTo evaluate the efficacy and safety of four antiplatelet regimens after coronary drug-eluting stents by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) of the comparison of different antiplatelet regimens after coronary drug-eluting stenting from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Network meta-analysis was then performed by using Gemtc14.3 software, Stata16.0 software and RevMan5.3 software.ResultsA total of 23 RCTs involving 45 837 patients were included. The results of network meta-analysis showed that: in terms of prevention of myocardial infarction (MI) recurrence, the aspirin monotherapy after short-term dual antiplatelet therapy was inferior to the triple antiplatelet therapy (OR=2.13, 95%CI 1.08 to 4.03). In terms of reducing the incidence of ischemic compound events, the triple antiplatelet therapy was superior to the standard dual antiplatelet therapy (OR=0.53, 95%CI 0.39 to 0.72), the aspirin monotherapy after short-term dual antiplatelet therapy (OR=0.49, 95%CI 0.35 to 0.69) and the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (OR=0.51, 95%CI 0.35 to 0.73). There was no statistically significant difference among the four interventions in reducing the rate of in-stent thrombosis and all-cause mortality (P>0.05). In terms of safety, the bleeding rate of aspirin monotherapy after short-term dual antiplatelet therapy was lower than that of standard dual antiplatelet therapy (OR=0.70, 95%CI 0.55 to 0.86) and triple antiplatelet therapy (OR=0.58, 95%CI 0.36 to 0.90), and the bleeding rate of P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was also lower than that of standard dual antiplatelet therapy (OR=0.51, 95%CI 0.39 to 0.65) and triple antiplatelet therapy (OR=0.43, 95%CI 0.26 to 0.67). The probability ranking diagram showed that: in terms of the recurrence rate of MI, the rate of in-stent thrombosis and the incidence of ischemic compound events, triple antiplatelet therapy was the lowest and aspirin monotherapy after short-term dual antiplatelet therapy was the highest. However, in terms of all-cause mortality and bleeding rate, aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was the lowest and triple antiplatelet therapy was the highest.ConclusionsThe available evidence suggests that when the risk of ischemia is low, we should choose aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy, and P2Y12 inhibitor monotherapy may have a lower risk of ischemia and bleeding. When the risk of ischemia is high and bleeding is low, the triple or standard dual antiplatelet therapy should be selected, and the efficacy of triple antiplatelet therapy is superior, while the safety may be inferior.
Traditional surgical aortic valve replacement is associated with a high risk of serious complications, especially in elderly patients with other preoperative diseases and unable to undergo thoracotomy. Therefore, transcatheter aortic valve implantation (TAVI) is now the accepted standard treatment for patients with symptomatic severe aortic stenosis at elevated risk for conventional surgical valve replacement. Currently, guidelines propose the use of dual antiplatelet therapy for the prevention of thromboembolic events after TAVI in the patients without an indication for oral anticoagulation. While, this strategy is empiric and largely based on expert consensus extrapolated from the arena of percutaneous coronary intervention. Antithrombotic therapy is associated with a significant occurrence of both thrombotic and bleeding complications, thus, the balance between thrombotic and bleeding risk is critical. This review summarizes current guidelines and the evidence underpinning them and explores the rational for using antiplatelet and/or anticoagulant strategies after TAVI.
Objective To systematically review the efficacy and safety of different duration of dual antiplatelet therapies in patients undergoing new-generation drug-eluting stents implantation. Methods Such databases as MEDLINE, The Cochrane Library (Issue 2, 2015), EMbase, CBM, CNKI and WanFang Data were searched to collect studies on the different duration of dual antiplatelet therapies in patients undergoing new-generation drug-eluting stents implantation from inception to April 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Six trials were included. The results of meta-analysis showed: compared with 12 months dual antiplatelet therapy group, the incidence of bleeding in the 6 months dual antiplatelet therapy group was lower (OR=0.48, 95%CI 0.26 to 0.89, P=0.02). There were no significant differences in incidence of myocardial infarction, all cause mortality, stroke and stent thrombosis between two groups. Compared with 24 months dual antiplatelet therapy group, the incidence of stent thrombosis in the 12 months dual antiplatelet therapy group was higher (OR=2.50, 95%CI 1.13 to 5.61, P=0.02), but the incidence of bleeding in 12 months dual antiplatelet therapy group was lower (OR=0.25, 95%CI 0.07 to 0.89, P=0.03). No significant differences were found in the incidence of myocardial infarction, all cause mortality and stroke between 12 months dual antiplatelet therapy group and 24 months dual antiplatelet therapy group. Conclusions 6 months dual antiplatelet therapy following new-generation drug-eluting stent implantation is relatively more safe and efficacy. There is significant increase of incidence of bleeding in 12 or 24 months dual antiplatelet therapy. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more high quality studies.
ObjectiveTo compare the effect of aspirin+ticagrelor and aspirin+clopidogrel on graft patency one year after coronary artery bypass grafting (CABG).MethodsA total of 67 patients who received CABG in our department from January 2014 to September 2017 were included in this study (52 males and 15 females). They were randomly divided into a group A (aspirin+clopidogrel) and a group B (aspirin+ticagrelor). There were 34 participants in the group A (28 males and 6 females) and 33 patients in the group B (24 males and 9 females). All patients were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis in 1 year postoperatively. Cardiovascular events, bleeding events and other adverse events were followed up.ResultsFour patients were lost to follow-up. Two patients died. A total of 61 patients (48 males and 13 females) completed coronary CTA, and 31 in the group A (25 males and 6 females) and 30 in the group B (23 males and 7 females). The total number of bridged vessels was 156 (59 internal thoracic artery bridges and 97 great saphenous vein bridges), including 79 in the group A (31 internal thoracic artery bridges and 48 great saphenous vein bridges) and 77 in the group B (28 internal thoracic artery bridges and 49 great saphenous vein bridges). Graft patency rate 1 year post CABG was 82.3% (65/79) in the group A and 92.2% (71/77) in the group B (P>0.05). Artery graft patency rate 1 year post CABG was 96.8% (30/31) in the group A and 96.4% (27/28) in the group B (P>0.05). Saphenous vein graft patency rate 1 year post CABG was 72.9% (35/48) in the group A and 89.8% (44/49) in the group B (P<0.05). Multivariable analysis with binary logistic regression showed ticagrelor use reduced graft occlusion (OR=0.282, 95%CI 0.093 to 0.862, P<0.05). There was no significant difference in adverse events between the two groups.ConclusionCompared with clopidogrel plus aspirin, ticagrelor added to aspirin after CABG may enhance the saphenous graft patency without the excess risk of bleeding 1 year post CABG.
ObjectiveTo retrieve currently-available best evidence to select the treatment plan of antithrombotic therapy for a gerontal patient lately admitted because of atrial fibrillation (AF) and coronary artery disease (CAD), and to provide references for clinical treatment. MethodsWe comprehensively searched PubMed, MEDLINE (Ovid), EMbase and The Cochrane Library (Issue 5, 2014) up to May 2014, for relevant evidence about antithrombotic therapy for patients with AF and CAD. After analysis and assessment, we developed the plan of the patient's antithrombotic therapy. ResultsCurrent evidence showed no best treatment plan of antithrombotic therapy for patients with AF and CAD. ConclusionCorrect evaluation of the risks of thrombosis and bleeding is the key point of beneficial antithrombotic therapy for patients with AF and CAD.