The efficacy and safety of ticagrelor versus clopidogrel in patients with STEMI treated with fibrinolysis:a Meta-analysis
-
摘要: 目的:荟萃分析替格瑞洛和氯吡格雷用于接受溶栓治疗的ST段抬高型心肌梗死(STEMI)患者的有效性和安全性。方法:根据检索关键词,检索英文数据库PubMed、EMBASE和Cochrane Library建库至2020年10月的相关文献。根据纳入与排除标准筛选文献,并按照Cochrane系统评价手册对纳入研究进行风险评估。使用RevMan 5.3软件比较替格瑞洛和氯吡格雷应用于STEMI溶栓患者的主要心血管不良事件(MACE)、心肌梗死(MI)、全因死亡、卒中、主要出血事件、所有出血事件以及呼吸困难的发生率。结果:纳入4项RCT共4334例STEMI溶栓患者,接受双联抗血小板(DAPT)治疗,其中氯吡格雷组2149例,替格瑞洛组2185例。结果发现,两组患者的MACE发生率(OR=1.13,95%CI:0.82~1.54,P=0.46)、MI发生率(OR=1.32,95%CI:0.74~2.36,P=0.35)、全因死亡率(OR=1.12,95%CI:0.76~1.65,P=0.56)、卒中发生率(OR=1.07,95%CI:0.57~1.99,P=0.84)以及主要出血事件(OR=1.06,95%CI:0.62~1.80,P=0.84)均差异无统计学意义,但与氯吡格雷相比,替格瑞洛显著增加了所有出血风险(OR=0.65,95%CI:0.49~0.86,P=0.003)和呼吸困难风险(OR=0.51,95%CI:0.41~0.63,P<0.000 01)。结论:替格瑞洛在降低STEMI溶栓患者的MACE、MI、全因死亡、卒中、主要出血风险等方面与氯吡格雷相当,但显著增加了所有出血和呼吸困难风险。基于目前的循证证据,本研究结果不支持STEMI溶栓患者使用替格瑞洛用于抗血小板治疗,而应尽早使用氯吡格雷联合阿司匹林。
-
关键词:
- ST段抬高型心肌梗死 /
- 药物溶栓 /
- 双联抗血小板 /
- 氯吡格雷 /
- 替格瑞洛
Abstract: Objective: To analyze the efficacy and safety of ticagrelor and clopidogrel in patients with ST segment elevation myocardial infarction(STEMI) receiving thrombolytic therapy.Methods: According to the search keywords, the related literatures in PubMed, EMBASE, and Cochrane Library from the establishment of the database to October 2020 were searched. The literatures were screened according to the inclusion and exclusion criteria, and the risk assessment of the included studies was conducted using the Cochrane system evaluation manual. The incidence of major cardiovascular adverse events(MACE), myocardial infarction(MI), all-cause death, stroke, major bleeding events, all bleeding events, and dyspnea in patients with STEMI treated with ticagrelor and clopidogrel were compared using RevMan 5.3 software.Results: Four RCTs included 4334 patients with STEMI receiving dual antiplatelet(DAPT) therapy were selected: 2149 patients in the clopidogrel group and 2185 patients in the tigritol group. The results showed that there was no statistical significant difference in incidence of MACE(OR=1.13, 95%CI: 0.82-1.54, P=0.46), MI(OR=1.32, 95%CI: 0.74-2.36, P=0.35), all-cause mortality(OR=1.12, 95%CI: 0.76-1.65, P=0.56), stroke(OR=1.07, 95%CI: 0.57-1.99, P=0.84), and major bleeding events(OR=1.06, 95%CI: 0.62-1.80, P=0.84) between the two groups. However, compared with clopidogrel, ticagrelor significantly increased the risk of all bleeding(OR=0.65, 95%CI: 0.49-0.86, P=0.003) and dyspnea(OR=0.51, 95%CI: 0.41-0.63, P<0.000 01).Conclusion: Ticagrelor is comparable to clopidogrel in reducing the risk of MACE, MI, all-cause death, stroke, and major bleeding in patients with STEMI, but significantly increases the risk of all bleeding and dyspnea. Based on the current evidence-based evidence, the results of the study do not support the use of ticagrelor for antiplatelet therapy in patients with STEMI receiving thrombolytic therapy but should use clopidogrel combined with aspirin as soon as possible. -
-
[1] 中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2019概要[J].中国循环杂志,2020,35(9):833-854.
[2] 张新超,于学忠,陈凤英,等.急性冠脉综合征急诊快速诊治指南(2019)[J].临床急诊杂志,2019,20(4):253-262.
[3] 易加祎,郑昕.急性ST段抬高型心肌梗死溶栓患者的抗血小板治疗进展[J].临床心血管病杂志,2020,36(6):502-505.
[4] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J].中华心血管病杂志,2019,47(10):766-783.
[5] Yang A,Pon Q,Lavoie A,et al.Long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI[J].J Thromb Thrombolysis,2018,45(2):225-233.
[6] Wallentin L,Becker RC,Budaj A,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J].N Engl J Med,2009,361(11):1045-1057.
[7] Mehran R,Rao SV,Bhatt DL,et al.Standardized bleeding definitions for cardiovascular clinical trials:a consensus report from the Bleeding Academic Research Consortium[J].Circulation,2011,123(23):2736-2747.
[8] Alexopoulos D,Perperis A,Koniari I,et al.Ticagrelor versus high dose clopidogrel in ST-segment elevation myocardial infarction patients with high platelet reactivity post fibrinolysis[J].J Thromb Thrombolysis,2015,40(3):261-267.
[9] Berwanger O,Nicolau JC,Carvalho AC,et al.Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction:a randomized clinical trial[J].JAMA Cardiol,2018,3(5):391-399.
[10] Dehghani P,Lavoie A,Lavi S,et al.Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI[J].Am Heart J,2017,192:105-112.
[11] Hamilos M,Kanakakis J,Anastasiou I,et al.Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis:the MIRTOS trial[J].EuroIntervention,2021,16(14):1163-1169.
[12] Berwanger O,Lopes RD,Moia D,et al.Ticagrelor versus clopidogrel in patients with STEMI treated with fibrinolysis:TREAT trial[J].J Am Coll Cardiol,2019,73(22):2819-2828.
[13] Armstrong PW,Gershlick AH,Goldstein P,et al.Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction[J].N Engl J Med,2013,368(15):1379-1387.
[14] Mahmud E,Dauerman HL,Welt FGP,et al.Management of acute myocardial infarction during the COVID-19 pandemic[J].J Am Coll Cardiol,2020,76(11):1375-1384.
[15] 韩雅玲,李毅.急性冠状动脉综合征特殊人群抗血小板治疗中国专家建议[J].中华心血管病杂志,2018,46(4):255-266.
[16] Sabatine MS,Cannon CP,Gibson CM,et al.Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation[J].N Engl J Med,2005,352(12):1179-1189.
[17] Pereira NL,Rihal CS,So DYF,et al.Clopidogrel pharmacogenetics[J].Circulation,2019,12(4):e007811.
[18] Proctor P,Leesar MA,Chatterjee A.Thrombolytic therapy in the current ERA:Myocardial infarction and beyond[J].Curr Pharm Des,2018,24(4):414-426.
[19] Eikelboom JW,Connolly SJ,Bosch J,et al.Bleeding and new cancer diagnosis in patients with atherosclerosis[J].Circulation,2019,140(18):1451-1459.
-
计量
- 文章访问数: 216
- PDF下载数: 2
- 施引文献: 0
下载: