缺血性心脏病双联抗血小板治疗最佳时长：随机对照试验的系统评价与网状Meta分析

原文

BACKGROUND: Shorter dual antiplatelet therapy (DAPT) regimens may offer a more favourable risk-benefit profile compared with longer treatment. The aim of this study was to determine the optimal duration by assessing net adverse clinical events (NACE). METHODS: We searched for randomised controlled trials that compared clinical outcomes of different DAPT durations in patients with ischaemic heart disease from Medline, Scopus and the Cochrane Library. A network meta-analysis was subsequently conducted for DAPT durations of 1 month, 3 months, 6 months, 12 months and >12 months. The primary outcome was defined as NACE, a composite of death, myocardial infarction, stroke, stent thrombosis and bleeding events. Individual components of NACE served as secondary outcomes. Five DAPT durations were ranked for each outcome using surface under the cumulative ranking. RESULTS: This analysis included 31 randomised controlled trials comprising 95 910 patients. 1-month DAPT was associated with a significantly lower risk of NACE compared with 3-month, 6-month, 12-month and >12 month DAPT (risk ratio (CI): 0.74 (0.58 to 0.93); 0.63 (0.50 to 0.80); 0.64 (0.53 to 0.78); and 0.67 (0.51 to 0.87), respectively). There were no significant differences in death, myocardial infarction, stroke or stent thrombosis with 1-month DAPT, except for a higher risk of myocardial infarction compared with >12 month DAPT (risk ratio (CI): 1.53 (1.02 to 2.30)). Notably, 1-month DAPT was associated with a significantly lower risk of bleeding events compared with 12-month and >12 month DAPT (risk ratio (CI): 0.57 (0.40 to 0.83) and 0.47 (0.29 to 0.77), respectively). The SUCRA value for NACE was the highest for the 1-month regimen (99.8, 65.4, 24.6, 21.9 and 38.3 for 1 month, 3 months, 6 months, 12 months and >12 months, respectively). CONCLUSIONS: 1-month DAPT may offer the lowest risk balance between ischaemic and bleeding risks; however, these findings should be applied within an individualised, patient-specific risk management framework.