近日，加拿大西部大学教授Rodrigo Bagur及其研究团队对冠状动脉搭桥术后抗血栓治疗进行了系统回顾和网络荟萃分析。该研究于2019年10月10日在线发表于《英国医学杂志》。

研究组从Medline、Embase、Web of Science等大型数据库中搜索2019年1月25日之前发表的论文，筛查口服抗血栓药物来预防冠状动脉搭桥术后隐静脉移植失败的随机对照试验。最终有20个试验被纳入网络荟萃分析，共包括4803名成人参与者，9种干预措施。

分析结果表明，与阿司匹林单药治疗相比，中度确定性证据支持双重抗血小板治疗，即阿司匹林+替卡格雷（比值比为0.50）或阿司匹林+氯吡格雷（0.60）可减少隐静脉移植失败。在不同的抗血栓治疗中，大出血、心肌梗死和死亡的发生率并无显著差异。然而，这些试验的异质性和不连贯性差异较大。

总之，这项网络荟萃分析结果提示阿司匹林+替卡格雷或氯吡格雷可有效预防冠状动脉搭桥术后隐静脉移植失败。术后的双重抗血小板治疗应充分权衡用药的安全性和有效性。

附：英文原文

Title: Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis

Author: Karla Solo, Shahar Lavi, Conrad Kabali, Glenn N Levine, Alexander Kulik, Ava A John-Baptiste, Stephen E Fremes, Janet Martin, John W Eikelboom, Marc Ruel, Ashlay A Huitema, Tawfiq Choudhury, Deepak L Bhatt, Nikolaos Tzemos, Mamas A Mamas, Rodrigo Bagur

Issue&Volume: 2019/10/10

Abstract: 

Objective To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery.

Design Systematic review and network meta-analysis.

Data sources Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019.

Eligibility criteria for selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery.

Main outcome measures The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death.

Results This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates.

Conclusions The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes.

DOI: 10.1136/bmj.l5476

Source: https://www.bmj.com/content/367/bmj.l5476