[1]李典耕,陈瑶,李荣山.经皮冠脉介入术后应用不同剂量氯吡格雷对心血管事件影响的荟萃分析[J].介入放射学杂志,2011,(02):97-102.
 LI Dian-geng,CHEN Yao,LI Rong-shan.The impact of different doses of clopidogrel used after percutaneous coronary intervention on cardiovascular events:a Meta-analysis[J].journal interventional radiology,2011,(02):97-102.
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经皮冠脉介入术后应用不同剂量氯吡格雷对心血管事件影响的荟萃分析()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2011年02期
页码:
97-102
栏目:
心脏介入
出版日期:
2011-03-15

文章信息/Info

Title:
The impact of different doses of clopidogrel used after percutaneous coronary intervention on cardiovascular events:a Meta-analysis
作者:
李典耕陈瑶李荣山
030001太原山西医科大学第二医院肾脏内科
Author(s):
LI Dian-gengCHEN YaoLI Rong-shan
Department of Cardiology,the Second Hospital,Shanxi Medical University,Taiyuan030001,China
关键词:
氯吡格雷经皮冠脉介入术心血管事件荟萃分析
分类号:
R541.4
文献标志码:
A
摘要:
目的系统性评价经皮冠脉介入(PCI)术后应用不同剂量氯吡格雷预防心血管事件的有效性和安全性,为指导临床决策提供依据。方法计算机检索Pubmed-Medline、Cocharne Library、CNKI、万方数据库,手工检索有关引用文献,并结合文献追溯的方法,收集国内外公开发表的有关PCI术后应用氯吡格雷的随机对照试验(RCT)。采用RevMan4.2作荟萃分析。结果共检索到相关文献765篇排除759篇,纳入符合标准的6篇文献进行分析,共计1027例患者。分析结果示:与75mg氯吡格雷常规维持剂量相比,150mg的高维持剂量明显降低心脑血管事件发生率(OR=0.52,95%CI0.36,0.77);在严重并发症方面高维持剂量不增加严重出血风险(OR=1.25,95%CI0.43,3.63)和次要出血风险(OR=1.25,95%CI0.77,2.02)。结论氯吡格雷对血小板的抑制作用呈时间和剂量依赖性,可以通过增加氯吡格雷的剂量抑制血小板功能,减少PCI术后心血管不良事件的风险,且不会增加出血的风险。

参考文献/References:

[1] Keeley EG, Boura JA, Grines CL. Primary angioplasty vc'lBufl intravenous thrombolytic therapy for acute myocardial infarction: a quantitivative review of 23 randomised trials[J]. Lancet, 2003, 261: 13  20.
[2] Smith SC Jr, Feldman TE, Hirshfeld JW Jr, et al. Acc/AHA/SCAI 2005 guideline update for pereutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 200l Guidehnes for Pereutarteous Coronary/Intervention)[J]. J Am Coll Cardiol, 2006, 47: e1  121.
[3] King SB 3rd, Smith SC Jr, Hirsfeld JW Jr, et al. 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary Intervention: a report of the american college of cardiology/american heart association task force on practice guidelines: 2007 writing group to review new evidence and update the ACC/AHA/SCAI 2005 guideline update for pereutaneons coronary intervention, writing on behalf of the 2005 writing committee[J]. Circulation, 2008, 117: 261  295.
[4] Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. the task force for pereutaneons coronary interventions of the european society of cardiology[J]. Eur Heart J, 2005, 26: 804  847.
[5] Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by longterm therapy in patients undergoing percutaneous coronary intervention: the PCICURE study[J]. Lancet, 2001, 358(9281): 527  533.
[6] Steinhubl SR, Berger PB, Mann JT, 3 rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial[J]. JAMA, 2002, 288: 2411  2420.
[7] Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports randomized clinical trials: is blinding nessary Control Clin Trials, 1996, 17: 1  12.
[8] Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials[J]. JAMA, 1995, 273: 408  412.
[9] Abuzahra M, Pillai M, Caldera A, et al. Comparison of higher clopidogrel loading and maintenance dose to standard dose on platelet function and outcomes after percutaneous coronary intervention using drugeluting stents[J]. Am J Cardiol, 2008, 102: 401  403.
[10] Palmerini T,Barozzi C, Tomasi L, et a1. A randomised study comparing the antiplatelet and antinflammatory effect of clopidogrel 150 mg/day versus 75 mg/day in patients with STsegment elevation acute myocardial infarction and poor responsiveness to clopidogrel: results from the DOUBLE study[J]. Thrombosis Research, 2010, 125: 309  314.
[11] Von Beckerath N, Kastrati A, Wieczorek A, et al. A doubleblind, randomized study on platelet aggregation in patients treated with a daily dose of 150 or 75 mg of clopidogrel for 30 days[J]. Eur Heart, 2007, 28: 1814  1819
[12] 韩雅玲, 徐 凯, 李 毅, 等. 150 mg高维持量氯吡格雷提高急性冠脉综合征患者药物洗脱支架植入术后的长期疗效[J]. 第三军医大学学报, 2008, 30: 435  438.
[13] 黄晶晶. 氯吡格雷高维持量与标准维持量对血小板反应不全的急性冠脉综合征患者疗效及安全性的对比研究[D]. 河北医科大学, 2008, 03, 01.
[14] 彭 俊, 洪 浪. 不同维持剂量氯吡格雷对急性冠脉综合征介入治疗术后血小板功能的影响[J]. 实用临床医学, 2009, 10: 10  13.
[15] Smith SC Jr, Feldman TE, Hirshfeld JW Jr, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the american college of cardiology/american heart association task force on practice guidelines (ACC/AHA/SCAI writing committee to update the 2001 guidelines for percutaneous coronary intervention)[J]. J Am Coll Cardiol, 2006, 47: e1121.
[16] Silber S, Albertsson P, Avilés FF. et al. Guidelines for percutaneous coronary interventions. the task force for percutaneous coronary interventions of the european society of cardiology[J]. Eur Heart J, 2005, 26: 804  847.
[17] Dangas G, Mehran R, Abizaid AS, et al. Combination therapy with aspirin plus clopidogrel versus aspirin plus ticlopidine for prevention of subacute thrombosis after successful native coronary stenting[J]. Am J Cardiol, 2001, 87: 470  472.
[18] Morel O, Ohlmann P, Jesel L. Variable extent of platelet responsiveness to clopidogrel inhibition:“clopidogrel resistance”﹖[J]. Ann Cardiol Angeiol, 2005, 54: 194  200.
[19] Angiolillo DJ, Shoemaker SB, Desai B, et al. Randomized comparison of a high clopidogrel maintenance dose in patients with diabetes mellitus and coronary artery disease: results of the Optimizing Antiplatelet Therapy in DiabetesMellitus (OPTIMUS) study[J]. Circulation, 2007, 115: 708  716.
[20] Bennett MR, O’Sullivan M. Mechanisms of angioplasty and stent restenosis: implications for design of rational therapy[J]. Pharmacol Ther, 2001, 91: 149  166.
[21] Fox KA, Granger CB, Jolly S, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes[J]. N Engl J Med, 2010, 363: 930  942.

备注/Memo

备注/Memo:
收稿日期:20101006
更新日期/Last Update: 2011-03-15