稳定性冠心病合并心房颤动抗栓策略的Meta分析(1)
摘要：目的 比較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(OR=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。
关键词：稳定性冠心病;房颤;抗栓;抗凝
中图分类号：R541 文献标识码：A DOI：10.3969/j.issn.1006-1959.2020.03.024
文章编号：1006-1959(2020)03-0082-05
Meta-analysis of Antithrombotic Strategies for Stable Coronary Heart Disease
with Atrial Fibrillation
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)
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 (OR=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., http://www.100md.com(吴小燕 刘杰 刘文锋 姜昕)
关键词：稳定性冠心病;房颤;抗栓;抗凝
中图分类号：R541 文献标识码：A DOI：10.3969/j.issn.1006-1959.2020.03.024
文章编号：1006-1959(2020)03-0082-05
Meta-analysis of Antithrombotic Strategies for Stable Coronary Heart Disease
with Atrial Fibrillation
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)
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 (OR=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., http://www.100md.com(吴小燕 刘杰 刘文锋 姜昕)
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