经导管主动脉瓣植入术后患者的抗血栓治疗:一项网络荟萃分析。

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-08-14 DOI:10.1093/ehjcvp/pvad101
Ricky D Turgeon, Ursula M Ellis, Arden R Barry
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引用次数: 0

摘要

目的:平衡经导管主动脉瓣植入术(TAVI)患者血栓形成和出血风险的最佳抗血栓疗法尚不清楚。这项随机对照试验(RCTs)的系统综述/网络荟萃分析旨在评估不同的口服抗凝剂和抗血小板方案对经导管主动脉瓣植入术后患者的疗效和安全性:检索了从开始到 2023 年 4 月的 MEDLINE、Embase、CENTRAL 和 ClinicalTrials.gov。共同主要结局为全因死亡和大出血。我们进行了贝叶斯网络荟萃分析,以同时比较所有干预措施。对于每种结果,我们使用具有信息先验的随机效应模型生成了带有 95% 可信区间的几率比 (OR),并根据累积排序曲线下的平均表面对干预措施进行了排序。我们纳入了 11 项 RCT(n = 6415),包括一项未发表的 RCT。三项试验招募了有口服抗凝剂(OAC)适应症的患者。总体偏倚风险较低或存在一些问题。中位年龄为 81 岁。中位随访时间为 6 个月。与双联抗血小板疗法(DAPT)相比,联合使用 OAC 加单一抗血小板疗法(SAPT)会增加全因死亡风险(OR 1.78,95% 可信区间为 1.15-2.77)。其他全因死亡的比较结果均无明显差异。在大出血方面,与DAPT、直接作用OAC和OAC+SAPT相比,SAPT降低了风险(OR为0.20-0.40),而与OAC+SAPT相比,DAPT降低了风险。SAPT和DAPT对全因死亡的疗效最好,而SAPT对大出血的疗效最好:对于 TAVI 术后患者,SAPT 可在减少血栓事件的同时最大限度地降低出血风险,达到最佳平衡。
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Antithrombotic therapy in patients after transcatheter aortic valve implantation: a network meta-analysis.

Aims: The optimal antithrombotic therapy to balance the risk of thrombosis and bleeding in patients who undergo transcatheter aortic valve implantation (TAVI) is unknown. This systematic review/network meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of different oral anticoagulant (OAC) and antiplatelet regimens in patients post-TAVI.

Methods and results: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to April 2023. Co-primary outcomes were all-cause death and major bleeding. We conducted Bayesian network meta-analyses to compare all interventions simultaneously. For each outcome, we generated odds ratios (ORs) with 95% credible intervals using a random-effects model with informative priors, and ranked interventions based on mean surface under the cumulative ranking curve. We included 11 RCTs (n = 6415), including 1 unpublished RCT. Three trials enrolled patients with an indication for an OAC. Overall risk of bias was low or with some concerns. Median age was 81 years. Median follow-up was 6 months. The combination of OAC plus single antiplatelet therapy (SAPT) increased the risk of all-cause death compared with dual antiplatelet therapy (DAPT) (OR 1.78, 95% credible interval 1.15-2.77). No other comparisons for all-cause death were significantly different. For major bleeding, SAPT reduced the risk compared with DAPT, direct-acting OAC, and OAC + SAPT (OR 0.20-0.40), and DAPT reduced the risk compared with OAC + SAPT. SAPT and DAPT ranked best for all-cause death, while SAPT ranked best for major bleeding.

Conclusion: In post-TAVI patients, SAPT may provide the optimal balance of reducing thrombotic events while minimizing the risk of bleeding.

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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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