Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
Objective To compare the therapeutic effect of one-stage direct revascularization and medicine therapy for the treatment of ischemic moyamoya disease. Methods From March 2002 to March 2008, 18 patients with ischemic moyamoyadisease (12 males and 6 females) were treated, aged 9 to 33 years old. Eighteen patients presented with ischemic stroke, including 11 cases of cerebral infarction and 7 cases of transient ischemic attack. According to Chinese ischemic cardiovascular diseases evaluation tools, 17 patients were classified as low risk ischemic stroke and 1 as modernte risk ischemic stroke. Different levels of occlusion branch of the intracranial carotid arteries and pathosis collaterals were identified by DSA. Fourteen patients and 4 patients were showed unilateral and bilateral hypoperfusion of cerebral blood flow by single photon emission computed tomography, respectively. Eleven patients received superficial temporal artery-middle cerebral artery anastomosis and 7 patients received medicine (anti-PLT agglutinin and calcium channel blocker). Results All incisions healed at stage I. There was no stroke events during perioperation. Anastomosis vessel vasospasm occurred in 2 patients 5 days after operation; and hyperperfusion syndrome in 1 patient 2 weeks afteroperation. All patients were followed up 13-32 months (mean 18 months). In 11 anastomosis patients, 6 underwent 6 stroke events within 12 months; in 7 medicine patients, 6 underwent 11 stroke events within 12 months; and showing a significant difference (P lt; 0.05). The stroke recurrence rate was 85.7% in medicine patients and 54.5% in anastomosis patients 12 months after therapy. DSA showed pathosis collaterals in 7 anastomosis patients and 6 medicine patients 6 months after therapy. After 12 months according to modified Rankin scale, the scores of anastomosis patients were 3 points in 1 case, 2 points in 6 cases and 0-1 point in 4 cases, and the scores of medicine patients were 2 points in 2 cases and 0-1 point in 5 cases; showing no significant difference (P gt; 0.05). Conclusion As long as onset of stroke occurred and ischemic moyamoya disease is diagnosed, one-stage direct revascularization should be performed, which can reduce the rate of stroke recurrence risk and slow down the progression of disease.
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.
【摘要】 目的 比较薤白联合阿司匹林或单用阿司匹林防治心脑血管事件的疗效。 方法 2007年1月〖CD3/5〗2009年9月就诊的188例高危患者纳入研究,随机分为实验组(89例)和对照组(99例)。两组均予口服阿司匹林0.1 g,1次/d。实验组同时给予口服薤白0.9 g,3次/d。观察两组患者血管事件的发生率和不良反应的发生情况。 结果 实验组血管总事件发生率为6.7%,对照组为19.2%,两组间差异有统计学意义(Plt;0.05);实验组脑梗死发生率为1.1%,对照组为9.1%,两组间差异有统计学意义(Plt;0.05)。两组短暂性脑缺血、心绞痛、心肌梗死的发生率比较,差异无统计学意义(Pgt;0.05)。两组皮下出血、血尿、黑便、恶心、腹痛等不良反应的发生率比较,差异无统计学意义(Pgt;0.05)。 结论 服用阿司匹林加薤白可显著降低高危患者心脑血管总事件发生率和脑梗死发生率,增加疗效,而不良反应没有显著增加。【Abstract】 Objective Compare the curative effect of cerebrovascular diseases event prevented with llium macrostemon and aspirin or only with aspirin. Methods Divide the outpatient patients into experimental group (89 patients) and control group (99 patients). Use 0.1 g aspirin for two groups with oral administration once per day. The experimental group is used with 0.9 g allium macrostemon with oral administration three times per day. Observe the generation rate and adverse reaction of vascular events in two groups of patients. Results The Total generation rate of vascular events in the experimental group is 6.7% and the control group is 19.2%,the differences were statistically significant (Plt;0.05); the cerebral infarction generation rate in the experimental group is 1.1% and in the control group is 9.1%,the differences were statistically significant (Plt;0.05). There is no significant difference (Pgt;0.05) in TIA, angina pectoris, myocardial infarction generation rate in two groups. There is no significant difference (Pgt;005) in adverse reaction generation rate of subcutaneous hemorrhage, hematuria, melena, nausea, bellyache. Conclusion Taking aspirin with llium macrostemon can significantly decrease total cardiovascular and cerebrovascular events generation rate and cerebral infarction generation rate in high risk patients, improve the curative effect and the adverse reaction has not been significantly increased.
ObjectiveTo analyze the correlation of thrombopoietin (TPO) and anti-TPO antibody with thrombocytopenia in patients with primary Sjögren syndrome (PSS). MethodsWe included in our study 40 PSS patients with thrombocytopenia (group A), 22 PSS patients who once had thrombocytopenia and returned to normal (group B), 40 PSS patients with normal platelet counts (group C) and 40 healthy controls (group D) between September 2013 and October 2014. Anti-TPO antibody was detected by indirect enzyme-linked immunosorbent assay (ELISA), and serum TPO levels were measured by ELISA. We analyzed the relationship between the assay results and the clinical manifestations and parameters. ResultsThe serum TPO levels in groups A, B, and C were (129.74±17.47) , (330.23±18.07) and (364.19±12.25) pg/mL, respectively, and they were significantly higher than that in group D [(54.04±10.71) pg/mL] (P ＜ 0.05) . The serum level of TPO was positively correlated with CRP and IgA (rs=0.224, P=0.039; rs=0.239, P=0.033) , and was negatively correlated with C4 level (rs=?0.220, P=0.041) , but it was not significantly correlated with platelet count, erythrocyte sedimentation rate, the level of antiphospholipid antibodies and the titer of antinuclear antibodies (P ＞ 0.05) . The positive rate of PSS patients was 20.59% (21/102) and the rate in groups A, B, and C was respectively 17.5% (7/40) , 22.72% (5/22) , and 22.5% (9/40) . There was no statistically significant difference between the positive and negative groups in various clinical indexes (P ＞ 0.05) . ConclusionAntiTPO antibody may not be the main mechanism of thrombocytopenia in PSS patients, and there is a certain correlation between TPO and inflammatory factors.
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 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.
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.
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.