背景:在短期(1-3个月)联合阿司匹林和替格瑞洛的双联抗血小板治疗(DAPT)后,替格瑞洛单药治疗可减少经皮冠状动脉介入治疗(PCI)后出血而不增加缺血事件。然而,其在糖尿病和非糖尿病个体中的作用至今尚未作为荟萃分析进行评估.
方法:本系统综述和荟萃分析涵盖PubMed,ISIWebofScience,和Scopus没有日期限制的英语发表的临床试验。作者搜索了上述数据库,筛查导致151项研究,其中40人接受了资格评估,最后,包括三项研究。这些试验比较了替格瑞洛单药治疗短期服用阿司匹林加替格瑞洛与常规12个月DAPT。
结果:结果显示,糖尿病患者和非糖尿病患者中,替格瑞洛单药治疗受试者的大出血风险(根据出血学术研究联盟(BARC)3型或5型)均较低。在非糖尿病患者中尤其显著(HR95CI:0.79(0.64,0.98);p=0.029)。在心血管事件评估中,替格瑞洛单药治疗的糖尿病患者心脏死亡的汇总估计值显著降低(HR95CI:0.71(0.51,1);p=0.05),而与接受12个月DAPT治疗的患者相比,非糖尿病患者(p=0.843)的这种降低并不显著。然而,在接受短期DAPT治疗的患者中,心肌梗死(MI)和缺血性卒中的发生率没有显著降低或升高.
结论:结论:在接受PCI治疗的糖尿病和非糖尿病患者中,短期DAPT后停用阿司匹林可将心源性死亡和BARC3型或5型出血的发生率降至最低,而不会增加MI和缺血性卒中.
BACKGROUND: Ticagrelor monotherapy after short-term (1-3 months) dual antiplatelet therapy (DAPT) with aspirin and ticagrelor can reduce bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). However, its effect in diabetic and non-diabetic individuals has not been evaluated as a meta-analysis so far.
METHODS: This systematic review and meta-analysis were conducted covering PubMed, ISI Web of Science, and Scopus without date restrictions for English published clinical trials. The authors searched the mentioned databases, wherein the screening led to 151 studies, of which 40 were assessed for eligibility, and finally, three studies were included. These trials compared ticagrelor monotherapy after a short duration of aspirin plus ticagrelor with conventional 12 months DAPT.
RESULTS: The results showed that the risk of major bleeding (based on Bleeding Academic Research Consortium (BARC) type 3 or 5) for ticagrelor monotherapy subjects was lower in both
diabetics and non-
diabetics. It was especially significant in non-diabetic patients (HR 95%CI: 0.79(0.64, 0.98); p=0.029). In cardiovascular events assessment, the pooled estimate on cardiac deaths was significantly lower in diabetic subjects treated by ticagrelor monotherapy (HR 95%CI: 0.71(0.51, 1); p=0.05), while this reduction was not significant for non-
diabetics (p=0.843) in comparison to patients treated by 12 months DAPT. However, there was no significant decrease or rise in myocardial infarction (MI) and ischemic stroke in patients treated by short-term DAPT strategy.
CONCLUSIONS: In conclusion, discontinuing aspirin after short-duration DAPT could minimize the incidence of cardiac death and BARC type 3 or 5 bleeding in diabetic and non-diabetic patients who underwent PCI, with no increase in MI and ischemic stroke.