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三联与双联抗凝孰优孰劣？

2015-10-23 傅向华 汪雁博 中国医学论坛报

三联抗凝双联抗凝TCT2015
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美国经导管心血管治疗学术会议（TCT2015）专题报道 作者：河北医科大学第二医院 傅向华 汪雁博 TCT2015大会上公布的一项META分析研究结果显示，在PCI术后需要长期抗凝的患者中，三联治疗患者比双联治疗患者的死亡率更低。 来自意大利的Lucia Barbieri博士指出，三联治疗在生存率方面的获益明显超过了其可能带来的出血风险增加。研究人员检索了PubMed

美国经导管心血管治疗学术会议（TCT2015）专题报道

作者：河北医科大学第二医院 傅向华 汪雁博

TCT2015大会上公布的一项META分析研究结果显示，在PCI术后需要长期抗凝的患者中，三联治疗患者比双联治疗患者的死亡率更低。

来自意大利的Lucia Barbieri博士指出，三联治疗在生存率方面的获益明显超过了其可能带来的出血风险增加。研究人员检索了PubMed、EMBASE和Cochrane数据库的相关资料，最终入选了1990年1月至2014年9月公开发表的12项研究，此外研究团队还检索并入选了主要国际会议中发表的摘要。总共入选患者7838例，这些患者均为接受PCI治疗并需要进行长期抗凝治疗的患者。

在入选患者中，5152例患者接受双联抗凝治疗，2686例接受三联治疗。随访时间270-2000天。结果发现，尽管三联抗凝治疗组患者出血事件增加，但是与双联治疗相比，接受三联治疗的患者死亡率下降。

META分析结果显示，出血风险和死亡风险之间并无相关性(P=0.01)。两组患者在复发心肌梗死(P=0.39)、支架内血栓形成(P=0.46)以及卒中(P=0.15)方面无差异。

在接受PCI治疗的患者中，由相当一部分需要长期抗凝治疗。“由于需要权衡出血和血栓形成的风险，已经植入冠脉支架的患者在制定长期口服抗凝治疗方案是仍存在矛盾。”Barbieri博士在接受TCT每日新闻采访时强调。该研究的结果提示，除了存在致命性出血风险的高危患者，上述患者中“着重考虑”应用三联抗凝治疗。

三联抗凝治疗改善生存率这一结果并不出乎意料，但仍需进行大规模随机对照研究来对这一结论进行确认，特别在使用新型药物洗脱支架、新型抗血小板药物和新型口服抗凝药时代，寻求最佳的药物组合方式和治疗时间更为重要。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=137408, encodeId=064d13e408a3, content=这个老爷子好像黑涩会, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Sep 28 22:36:58 CST 2016, time=2016-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=41053, encodeId=5d81410531b, content=有必要吗？风险相应也增加，个别个体可以考虑, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2be01625436, createdName=fatalmelanie, createdTime=Sun Oct 25 13:00:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40659, encodeId=b1d84065950, content=用药越来越多，考虑cost~effective了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Sat Oct 24 17:45:00 CST 2015, time=2015-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40466, encodeId=3257404663b, content=可否考虑间断治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJXCR8W80NNgQuicJU3aIm3JtiaNAFLYSMlBuVfGkSlw5Z5VpmZK4PyiaDURLAorhvwhWVnaM1gQdJXA/132, createdBy=a01444383, createdName=lixh1719, createdTime=Fri Oct 23 15:29:00 CST 2015, time=2015-10-23, status=1, ipAttribution=)]
    2016-09-28 四爷无名

    这个老爷子好像黑涩会

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=137408, encodeId=064d13e408a3, content=这个老爷子好像黑涩会, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Sep 28 22:36:58 CST 2016, time=2016-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=41053, encodeId=5d81410531b, content=有必要吗？风险相应也增加，个别个体可以考虑, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2be01625436, createdName=fatalmelanie, createdTime=Sun Oct 25 13:00:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40659, encodeId=b1d84065950, content=用药越来越多，考虑cost~effective了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Sat Oct 24 17:45:00 CST 2015, time=2015-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40466, encodeId=3257404663b, content=可否考虑间断治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJXCR8W80NNgQuicJU3aIm3JtiaNAFLYSMlBuVfGkSlw5Z5VpmZK4PyiaDURLAorhvwhWVnaM1gQdJXA/132, createdBy=a01444383, createdName=lixh1719, createdTime=Fri Oct 23 15:29:00 CST 2015, time=2015-10-23, status=1, ipAttribution=)]
    2015-10-25 fatalmelanie

    有必要吗？风险相应也增加，个别个体可以考虑

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=137408, encodeId=064d13e408a3, content=这个老爷子好像黑涩会, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Sep 28 22:36:58 CST 2016, time=2016-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=41053, encodeId=5d81410531b, content=有必要吗？风险相应也增加，个别个体可以考虑, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2be01625436, createdName=fatalmelanie, createdTime=Sun Oct 25 13:00:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40659, encodeId=b1d84065950, content=用药越来越多，考虑cost~effective了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Sat Oct 24 17:45:00 CST 2015, time=2015-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40466, encodeId=3257404663b, content=可否考虑间断治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJXCR8W80NNgQuicJU3aIm3JtiaNAFLYSMlBuVfGkSlw5Z5VpmZK4PyiaDURLAorhvwhWVnaM1gQdJXA/132, createdBy=a01444383, createdName=lixh1719, createdTime=Fri Oct 23 15:29:00 CST 2015, time=2015-10-23, status=1, ipAttribution=)]
    2015-10-24 nizongzan

    用药越来越多，考虑cost~effective了吗

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=137408, encodeId=064d13e408a3, content=这个老爷子好像黑涩会, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0ab71958514, createdName=四爷无名, createdTime=Wed Sep 28 22:36:58 CST 2016, time=2016-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=41053, encodeId=5d81410531b, content=有必要吗？风险相应也增加，个别个体可以考虑, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2be01625436, createdName=fatalmelanie, createdTime=Sun Oct 25 13:00:00 CST 2015, time=2015-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40659, encodeId=b1d84065950, content=用药越来越多，考虑cost~effective了吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ded71629504, createdName=nizongzan, createdTime=Sat Oct 24 17:45:00 CST 2015, time=2015-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=40466, encodeId=3257404663b, content=可否考虑间断治疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJXCR8W80NNgQuicJU3aIm3JtiaNAFLYSMlBuVfGkSlw5Z5VpmZK4PyiaDURLAorhvwhWVnaM1gQdJXA/132, createdBy=a01444383, createdName=lixh1719, createdTime=Fri Oct 23 15:29:00 CST 2015, time=2015-10-23, status=1, ipAttribution=)]
    2015-10-23 lixh1719

    可否考虑间断治疗

    0