Coronary artery bypass grafting (CABG) is one of the most effective revascularization treatments for coronary heart disease. Secondary prevention strategies, which rely on antiplatelet and lipid-lowering drugs, are crucial after CABG to ensure the durability of revascularization treatment effects and prevent adverse cardiovascular and cerebrovascular events in the medium to long term. Previous research conducted by Professor Zhao Qiang's team from Ruijin Hospital of Shanghai Jiao Tong University, known as the DACAB study, indicated that dual antiplatelet therapy (DAPT, specifically ticagrelor+aspirin) after CABG can enhance venous graft patency. However, it remains uncertain whether DAPT can further improve the medium to long-term clinical outcomes of CABG patients. Recently, the team reported the medium to long-term follow-up results of the DACAB study, termed the DACAB-FE study, finding that DAPT administered after CABG can reduce the incidence of major cardiovascular events over five years and improve patients' medium to long-term clinical outcomes. This article will interpret the methodological highlights and significant clinical implications of the DACAB-FE study.
Substantial progresses have been made in cerebral vascular diseases in 2017. By retrospectively analyzing the clinical researches which Chinese experts participated in or were in charge of, this article briefly summarizes the update of stroke epidemiology, explorations of stroke-related risk factors, early management of acute stroke, secondary prevention and prognosis of stroke. These researches include the problems about the dose of thrombolysis medicine, new type of antiplatelet and anticoagulant drugs, prognosis of intracranial hemorrhage and signs of intracranial hematoma enlargement, which have close connection with clinical work and are valuable in practice.
Objective To systematically review the efficacy and safety of different duration of dual antiplatelet therapies in patients undergoing new-generation drug-eluting stents implantation. Methods Such databases as MEDLINE, The Cochrane Library (Issue 2, 2015), EMbase, CBM, CNKI and WanFang Data were searched to collect studies on the different duration of dual antiplatelet therapies in patients undergoing new-generation drug-eluting stents implantation from inception to April 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Six trials were included. The results of meta-analysis showed: compared with 12 months dual antiplatelet therapy group, the incidence of bleeding in the 6 months dual antiplatelet therapy group was lower (OR=0.48, 95%CI 0.26 to 0.89, P=0.02). There were no significant differences in incidence of myocardial infarction, all cause mortality, stroke and stent thrombosis between two groups. Compared with 24 months dual antiplatelet therapy group, the incidence of stent thrombosis in the 12 months dual antiplatelet therapy group was higher (OR=2.50, 95%CI 1.13 to 5.61, P=0.02), but the incidence of bleeding in 12 months dual antiplatelet therapy group was lower (OR=0.25, 95%CI 0.07 to 0.89, P=0.03). No significant differences were found in the incidence of myocardial infarction, all cause mortality and stroke between 12 months dual antiplatelet therapy group and 24 months dual antiplatelet therapy group. Conclusions 6 months dual antiplatelet therapy following new-generation drug-eluting stent implantation is relatively more safe and efficacy. There is significant increase of incidence of bleeding in 12 or 24 months dual antiplatelet therapy. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more high quality studies.
ObjectiveTo evaluate the efficacy and safety of perioperative dual antiplatelet treatment (DAPT) or single antiplatelet treatment (SAPT) for patients undergoing carotid endarterectomy (CEA).MethodsWe searched English and Chinese databases, including PubMed, Embase, Cochrane, Web of Science, Chinese National Knowledge Infrastructure, Wanfang database, Chongqing VIP, and relevant clinical trial registry platforms (searched from database establishment to January 2020). Cohort studies or randomized controlled trials (RCTs) were included to evaluated the use of DAPT and SAPT for patients undergoing CEA. Stroke, myocardial infarction, artery restenosis, and composite endpoint (stroke or myocardial infarction or artery restenosis) were used as effectiveness outcomes. Death and any bleeding event were used as safety outcomes. Meta-analysis was performed with Review Manager 5.3 and STATA 15.1 softwares.ResultsA total of 11 studies with 123 748 patients were included. The results of meta-analysis showed that there was no significant decrease in the risk of stroke [relative risk (RR)=0.82, 95% confidence interval (CI) (0.66, 1.01), P=0.06], myocardial infarction [RR=1.31, 95%CI (0.92, 1.87), P=0.13], artery restenosis [RR=0.55, 95%CI (0.18, 1.68), P=0.29], or composite endpoint event [RR=0.90, 95%CI (0.59, 1.37), P=0.62] for CEA patients with DAPT during the perioperative period compared with SAPT. The difference in mortality rate was not statistically significant between DAPT and SAPT for CEA patients during the perioperative period [RR=0.99, 95%CI (0.44, 2.22), P=0.97]. CEA patients with DAPT had a higher risk of any bleeding event [RR=1.64, 95%CI (1.08, 2.50), P=0.02].ConclusionsPerioperative CEA patients with DAPT are not associated with a lower risk of vascular events recurrence, but the risk of any bleeding event may increase. Therefore, SAPT during the perioperative period of patients undergoing CEA may be better than DAPT.
ObjectiveTo systematically review the efficacy and safety of triple antiplatelet therapy (TAT:aspirin, clopidogrel and cilostazol) for patients with coronary heart diseases after percutaneous coronary intervention. MethodsSuch databases as The Cochrane Library (Issue 2, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant randomized controlled trials (RCTs) on the efficacy and safety of TAT for patients with coronary heart diseases after percutaneous coronary intervention from inception to February 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 15 RCTs involved 6 980 patients were included. The results of meta-analysis showed that:a) the DAT group (DAT:aspirin and clopidogrel) and the TAT group were similar in non-fatal myocardial infarction (OR=0.72, 95%CI 0.47 to 1.10, P=0.05), stroke (OR=0.66, 95%CI 0.38 to 1.16, P=0.15), and hemorrhage (OR=1.03, 95%CI 0.74 to 1.44, P=0.85) with no significant difference; b) the TAT group was superior to the DAT group in reducing the incidences of the major cardiovascular and cerebrovascular events (MACCE) (OR=0.50, 95%CI 0.39 to 0.65, P < 0.000 01), cardiac death (OR=0.53, 95%CI 0.33 to 0.84, P=0.007), stent thrombosis (OR=0.52, 95% CI 0.27 to 0.99, P=0.05), target vessel revascularization (OR=0.63, 95%CI 0.51 to 0.76, P < 0.000 01), and target lesion revascularization (OR=0.44, 95%CI 0.28 to 0.70, P=0.000 6); and c) no significant difference was found between the two groups in the incidences of thrombocytopenia, leucopenia, and liver damage. The DAT group was superior to the TAT group in gastrointestinal reaction, palpitations, headache, and skin rashes between the two groups, with significant differences. ConclusionTAT therapy has good efficacy and safety in the treatment of patients with coronary heart diseases after percutaneous coronary intervention.
ObjectiveTo summarize the effectiveness and safety of antiplatelet combined with anticoagulant therapy for peripheral arterial disease (PAD). MethodUsing the search strategy developed by Cochrane Collaborative Network, the relevant literature from domestic and foreign databases as of November 1, 2023 was searched and a meta-analysis of outcome indicators was conducted using Stata 14.0 software and Review Manager 5.4.1 software provided by Cochrane Collaboration Network. ResultsA total of 15 eligible literature and 15 383 patients were included, including 7 692 in the antiplatelet combined with anticoagulant therapy group (study group) and 7 691 in the control group (only antiplatelet drug therapy). The meta-analysis results showed that: ① Symptoms: The ankle brachial index [mean difference (MD) and 95% confidence interval (95%CI)=0.04(0.02, 0.06)] and the minimum lumen diameter [MD (95%CI)=0.48(0.40, 0.55)] of the study group were greater than those of the control group; The plasma D-2 dimer level of the study group was lower than that of the control group [MD (95%CI)=–0.55(–0.57, –0.52)], and the probability of the limb ischemia risk of the study group was lower than that of the control group [risk ratio (RR) and 95%CI=0.67(0.56, 0.80)]. ② Vascular patency: The probability of the vascular patency of the study group was higher than that of the control group [RR (95%CI)=1.13(1.08, 1.17)]; The subgroup analysis results: the vascular patency rate of the two antiplatelet drugs combined with anticoagulation therapy was highest among the different treatment regimens [effect size (ES) and 95%CI=0.90(0.86, 0.94)], which of the other measures in descending order was only one antiplatelet drug combined with anticoagulation therapy [ES(95%CI)=0.82(0.76, 0.89)], two antiplatelet drugs therapy [ES(95%CI)=0.79(0.72, 0.85)], and only one antiplatelet drug therapy [ES(95%CI)=0.71(0.54, 0.87)]; The probability of the vascular patency using vitamin K antagonists in the study group was higher than that in the control group [RR(95%CI)=1.15(1.10, 1.20)], which had no statistical difference using Ⅹa inhibitor between the study group and the control group [RR(95%CI)=1.04 (0.95, 1.15)]. ③ Bleeding risk: The risk of bleeding of the study group was higher than that of the control group [RR(95%CI)=1.55(1.27, 1.89)]; The subgroup analysis results: The bleeding rate of the only one antiplatelet drug therapy among the different intervention measures was the lowest [ES(95%CI)=0.02(0.01, 0.02)], which of the other measures in ascending order was only one antiplatelet drug combined with anticoagulant therapy [ES(95%CI)=0.04(0.03, 0.06)], two antiplatelet drugs therapy [ES(95%CI)= 0.08(0.06, 0.10)], and two antiplatelet drugs combined with anticoagulant [ES(95%CI)=0.12(0.06, 0.18)]; The probabilities of the bleeding occurring using the vitamin K antagonists and Ⅹa inhibitor in the study group were higher than those in the control group [RR(95%CI)=1.76(1.28, 2.42); RR(95%CI)=1.44(1.12, 1.84)]. ConclusionsFrom the results of this meta-analysis, it can be seen that the combination of antiplatelet and anticoagulant therapy can effectively improve symptoms of patients with PAD, increase vascular patency rate, but it has a certain risk of bleeding. The combination of only one antiplatelet drug combined with anticoagulant therapy might achieve an optimum clinical effect and lower bleeding risk.
Objective To assess the effectiveness and safety of different dual antiplatelet therapies in patients undergoing percutaneous coronary intervention. Methods Such databases as The Cochrane Library, MEDLINE, EMbase, CBM, CNKI and WanFang Data were searched to collect the randomized controlled trials (RCTs) and observational studies on the effectiveness and safety of dual antiplatelet therapies both short-duration (≤6 months) and long-duration (gt;6 months) after percutaneous coronary intervention. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, the quality was evaluated, the data were extracted, and meta-analyses were performed by using RevMan 5.1 software. Results Eight trials were included, of which 3 were RCTs involving 7 475 patients, and 5 were observational studies involving 12 744 patients. Meta-analyses on RCTs showed that the incidence of death or myocardial infarction in the long-duration treatment group was lower than that of the short-duration treatment group (OR=0.74, 95%CI 0.56 to 0.98, Plt;0.000 1), while meta-analyses on observation studies showed the similar result (OR=0.7, 95%CI 0.45 to 1.08, P=0.11). With the variables of published year and follow-up time, the heterogeneity of cohort studies was discussed through meta-regression (Z=3.61, P=0.000) which indicated that both published year and follow-up time might be the source of heterogeneity due to their contribution. For RCTs, the incidence of severe bleeding events in the short-duration treatment group was lower than that in the long-duration treatment group (OR=1.29, 95%CI 0.99 to 1.69, P=0.06). For observational studies, the incidence of late stent thrombosis in the long-duration treatment group was lower than that in the short-duration treatment group (OR=0.40, 95%CI 0.15 to 1.07, P=0.07). Conclusion The long duration (gt;6months) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention can reduce the incidence of death or myocardial infarction and decrease the tendency of late stent thrombosis, but cannot obviously increase the incidence rate of severe bleeding events. The current evidence shows no marked superiority in longer duration (gt;12months) of dual antiplatelet therapy.
ObjectiveTo retrieve currently-available best evidence to select the treatment plan of antithrombotic therapy for a gerontal patient lately admitted because of atrial fibrillation (AF) and coronary artery disease (CAD), and to provide references for clinical treatment. MethodsWe comprehensively searched PubMed, MEDLINE (Ovid), EMbase and The Cochrane Library (Issue 5, 2014) up to May 2014, for relevant evidence about antithrombotic therapy for patients with AF and CAD. After analysis and assessment, we developed the plan of the patient's antithrombotic therapy. ResultsCurrent evidence showed no best treatment plan of antithrombotic therapy for patients with AF and CAD. ConclusionCorrect evaluation of the risks of thrombosis and bleeding is the key point of beneficial antithrombotic therapy for patients with AF and CAD.
Traditional surgical aortic valve replacement is associated with a high risk of serious complications, especially in elderly patients with other preoperative diseases and unable to undergo thoracotomy. Therefore, transcatheter aortic valve implantation (TAVI) is now the accepted standard treatment for patients with symptomatic severe aortic stenosis at elevated risk for conventional surgical valve replacement. Currently, guidelines propose the use of dual antiplatelet therapy for the prevention of thromboembolic events after TAVI in the patients without an indication for oral anticoagulation. While, this strategy is empiric and largely based on expert consensus extrapolated from the arena of percutaneous coronary intervention. Antithrombotic therapy is associated with a significant occurrence of both thrombotic and bleeding complications, thus, the balance between thrombotic and bleeding risk is critical. This review summarizes current guidelines and the evidence underpinning them and explores the rational for using antiplatelet and/or anticoagulant strategies after TAVI.
ObjectiveTo systematically review the effectiveness and safety of aspirin-clopidogrel combined anti-platelet therapy after coronary artery bypass grafting (CABG). MethodsDatabases including The Cochrane Library (Issue 2, 2013), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to September 2013 for randomized controlled trials (RCTs) about aspirin-clopidogrel combined anti-platelet therapy after CABG. Two reviewers selected literature independently according to the inclusion and exclusion criteria. After data extraction and methological quality assessment of the included studies, meta-analysis was performed using RevMan 5.2 software. ResultsA total of six RCTs involving 901 patients were included, of which 449 cases were in the aspirin-clopidogrel group (A+C) and 452 cases were in the aspirin with or without placebo group (A+P). The results of meta-analysis showed that: compared with A+P, A+C significantly reduced occlusion rates of the saphenous vein graft (RR=0.59, 95% CI 0.43 to 0.80, P=0.000 6). But no significant difference was found between the two groups in occlusion rates of the left internal mammary artery graft (RR=0.88, 95% CI 0.35 to 2.18, P=0.78), radial artery graft (RR=0.43, 95% CI 0.13 to 1.46, P=0.18), pleural fluid drainage volume (MD=-1.68, 95%CI-48.69 to 45.32, P=0.94), incidence of major bleeding events (RR=1.20, 95% CI 0.39 to 1.65, P=0.75), major cardiovascular events (OR=0.81, 95% CI 0.38 to 1.72, P=0.58), and mortality within 30 days (RR=0.64, 95% CI 0.17 to 2.44, P=0.52). ConclusionIn reducing occlusion rates of the saphenous vein graft, the A+C group is more effective than the A+P group. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.