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 compare the effect of aspirin+ticagrelor and aspirin+clopidogrel on graft patency one year after coronary artery bypass grafting (CABG).MethodsA total of 67 patients who received CABG in our department from January 2014 to September 2017 were included in this study (52 males and 15 females). They were randomly divided into a group A (aspirin+clopidogrel) and a group B (aspirin+ticagrelor). There were 34 participants in the group A (28 males and 6 females) and 33 patients in the group B (24 males and 9 females). All patients were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis in 1 year postoperatively. Cardiovascular events, bleeding events and other adverse events were followed up.ResultsFour patients were lost to follow-up. Two patients died. A total of 61 patients (48 males and 13 females) completed coronary CTA, and 31 in the group A (25 males and 6 females) and 30 in the group B (23 males and 7 females). The total number of bridged vessels was 156 (59 internal thoracic artery bridges and 97 great saphenous vein bridges), including 79 in the group A (31 internal thoracic artery bridges and 48 great saphenous vein bridges) and 77 in the group B (28 internal thoracic artery bridges and 49 great saphenous vein bridges). Graft patency rate 1 year post CABG was 82.3% (65/79) in the group A and 92.2% (71/77) in the group B (P>0.05). Artery graft patency rate 1 year post CABG was 96.8% (30/31) in the group A and 96.4% (27/28) in the group B (P>0.05). Saphenous vein graft patency rate 1 year post CABG was 72.9% (35/48) in the group A and 89.8% (44/49) in the group B (P<0.05). Multivariable analysis with binary logistic regression showed ticagrelor use reduced graft occlusion (OR=0.282, 95%CI 0.093 to 0.862, P<0.05). There was no significant difference in adverse events between the two groups.ConclusionCompared with clopidogrel plus aspirin, ticagrelor added to aspirin after CABG may enhance the saphenous graft patency without the excess risk of bleeding 1 year post CABG.
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 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.
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.