目的:在两个网络meta分析(NMA)中评估冠状动脉血运重建和/或急性冠状动脉综合征后12个月内或之后所有可用的抗血栓治疗。
结果:包括12个月内的43项(N=189.261)试验和12个月后的19项(N=139.086患者)试验用于疗效/安全性终点评估。在12个月内,替格瑞洛90mgbisindie(b.i.d.)(危险比[HR]0.66;95%置信区间[CI]:0.49-0.88),阿司匹林和替格瑞洛90mg(HR0.85;95CI:0.76-0.95),或者阿司匹林,氯吡格雷和利伐沙班2.5mgb.i.d.(HR0.66;95CI:0.51-0.86)是唯一与降低心血管死亡率相关的治疗方法。与阿司匹林和氯吡格雷相比,没有或具有更大的出血风险的第一和其他治疗方案,分别。超过12个月,无治疗策略降低死亡率;与阿司匹林相比;发现阿司匹林和氯吡格雷(HR0.68;95CI,0.55-0.85)或P2Y12抑制剂单药治疗(HR0.76;95CI,0.61-0.95)可最大程度地减少心肌梗死(MI),尤其是替格瑞洛90mg(HR0.54;95CI,0.32-0.92),和VKA的中风(HR,0.56;95CI,0.44-0.76)或阿司匹林和利伐沙班2.5mg(HR,0.58;95CI,0.44-0.76)。除P2Y12单药治疗外,所有治疗均增加出血,与阿司匹林相比。
结论:在12个月内,替格瑞洛90mg单药治疗是唯一与死亡率降低相关的治疗,与阿司匹林和氯吡格雷相比,没有出血风险权衡。超过12个月,P2Y12单药治疗,尤其是替格瑞洛90毫克,与较低的MI相关,没有出血权衡;阿司匹林和利伐沙班2.5mg最有效地减少了卒中,具有比VKA更可接受的出血风险,与阿司匹林相比。注册网址:https://www。crd.约克。AC.uk/PROSPERO/;唯一标识符:CRD42021243985和CRD42021252398。
To appraise all available antithrombotic treatments within or after 12 months following coronary revascularization and/or acute coronary syndrome in two network meta-analyses.
Forty-three (N = 189 261 patients) trials within 12 months and 19 (N = 139 086 patients) trials beyond 12 months were included for efficacy/safety endpoints appraisal. Within 12 months,
ticagrelor 90 mg bis in die (b.i.d.) [hazard ratio (HR), 0.66; 95% confidence interval (CI), 0.49-0.88], aspirin and
ticagrelor 90 mg (HR, 0.85; 95% CI, 0.76-0.95), or aspirin, clopidogrel and rivaroxaban 2.5 mg b.i.d. (HR, 0.66; 95% CI, 0.51-0.86) were the only treatments associated with lower cardiovascular mortality, compared with aspirin and clopidogrel, without or with greater bleeding risk for the first and the other treatment options, respectively. Beyond 12 months, no strategy lowered mortality; compared with aspirin; the greatest reductions of myocardial infarction (MI) were found with aspirin and clopidogrel (HR, 0.68; 95% CI, 0.55-0.85) or P2Y12 inhibitor monotherapy (HR, 0.76; 95% CI: 0.61-0.95), especially
ticagrelor 90 mg (HR, 0.54; 95% CI, 0.32-0.92), and of stroke with VKA (HR, 0.56; 95% CI, 0.44-0.76) or aspirin and rivaroxaban 2.5 mg (HR, 0.58; 95% CI, 0.44-0.76). All treatments increased bleeding except P2Y12 monotherapy, compared with aspirin.
Within 12 months,
ticagrelor 90 mg monotherapy was the only treatment associated with lower mortality, without bleeding risk trade-off compared with aspirin and clopidogrel. Beyond 12 months, P2Y12 monotherapy, especially
ticagrelor 90 mg, was associated with lower MI without bleeding trade-off; aspirin and rivaroxaban 2.5 mg most effectively reduced stroke, with a more acceptable bleeding risk than VKA, compared with aspirin.Registration URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifiers: CRD42021243985 and CRD42021252398.