新功能、新界面、新体验,扫描即可下载生物谷APP!
首页 » 情绪与健康 » Ann int med:急性冠脉综合征肾病患者未能从抗血小板药物中获益

Ann int med:急性冠脉综合征肾病患者未能从抗血小板药物中获益

来源:医脉通 2012-03-22 11:59

3月20日,国际著名杂志《内科学年鉴》Annals of internal medicine上在线刊登了国外研究着的一项最新研究,文章中,根据Suetonia C Palmer医生(奥塔哥大学)和同事的一项包括近10000例患者的荟萃分析,患急性冠脉综合征(ACS)的慢性肾病(CKD)患者似乎不会因使用抗血小板药物进行二级预防而获益,实际上,还有可能受到这些药物的伤害。

资深学者Giovanni FM Strippoli医生指出,他们首次证明了抗血小板药物对肾病患者的潜在益处有可能被危险(特别是出血)抵消。本质上,肾病(和ACS)患者用这些药物,例如GP IIb/IIIa抑制剂和氯吡格雷,几乎对全因死亡率或MI没有影响,因为它们无法预防心脏事件,但它们会增加严重出血,主要是严重颅内出血,这是一种非常非常凶猛的事件。

Palmer医生和同事还回顾了近12000例有稳定性冠脉疾病风险或有稳定性冠脉疾病的肾病患者的数据,在这种情况下,抗血小板药物的确可预防心肌梗死,但对死亡率和轻微出血增加的影响不确定。Strippoli指出,血小板药物的益处与那些患稳定型冠脉疾病或没有冠脉疾病的CKD患者更相关,而非ACS的患者。

首次从心脏病学试验的肾病患者中获得数据

Strippoli解释说,目前还没有在CKD患者中进行的关于抗血小板药物的特异性试验,因此治疗建议是基于在大型心脏病学研究中所见的益处而做出的。但非动脉粥样硬化病况,例如心力衰竭、心脏性猝死和心律失常是CKD者发生心血管事件的常见原因。

应重新评估,改变临床实践

在他们的分析中,纳入了比较抗血小板药物与安慰剂、标准治疗或无治疗在成人中效果的试验,并获取了有CKD的参与者的数据。9项试验—均为CKD的事后亚组分析—被纳入,共包括9969名有ACS或进行PCI者。此外还进行了一项单独分析:包括31项试验,11701例有CVD风险或有CVD的肾病患者。

他们发现在ACS患者中,抗血小板药物对有CKD者几乎没有益处,而严重出血的风险大约升高40%,这意味着与无CKD者相比,那些肾病患者的出血风险至少翻倍,同样重要的是,应记住在现实生活中的人发生出血的风险甚至高于试验参与者。

研究者希望指南委员会根据该项研究结果深入审查,重新评估抗血小板药对ACS肾病患者的效用。

(生物谷Bioon.com)

paper link

PMC:
PMID:

Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease

Suetonia C. Palmer, MB ChB, PhD; Lucia Di Micco, MD; Mona Razavian, MB BS; Jonathan C. Craig, MB ChB, DCh, MM, PhD; Vlado Perkovic, MB BS, PhD; Fabio Pellegrini, MSc; Massimiliano Copetti, MSc, PhD; Giusi Graziano, MSc; Gianni Tognoni, MD; Meg Jardine, MB BS, PhD; Angela Webster, MB BS, PhD; Antonio Nicolucci, MD; Sophia Zoungas, MD, PhD; and Giovanni F.M. Strippoli, MD, PhD, MPH, MM

Background: Antiplatelet agents are used to prevent cardiovascular events; however, treatment effects may differ in persons with chronic kidney disease (CKD) because atherosclerotic disease is less prevalent, whereas bleeding hazards may be increased in this population.

Purpose: To summarize the effects of antiplatelet treatment on cardiovascular events, mortality, and bleeding in persons with CKD.

Data Sources: Embase and Cochrane databases through November 2011 without language restriction.

Study Selection: Randomized trials that included adults with CKD and compared antiplatelet agents with standard care, placebo, or no treatment.

Data Extraction: Data for populations, interventions, outcomes, and risk for bias were extracted. Quality of evidence for treatment effects on myocardial infarction, death, and bleeding was summarized by using Grading of Recommendations Assessment, Development, and Evaluation guidelines.

Data Synthesis: Nine trials (all post hoc subgroup analyses for CKD) involving 9969 persons who had acute coronary syndromes or were undergoing percutaneous coronary intervention and 31 trials involving 11 701 persons with stable or no cardiovascular disease were identified. Low-quality evidence has found that in persons with acute coronary syndromes, glycoprotein IIb/IIIa inhibitors or clopidogrel plus standard care compared with standard care alone had little or no effect on all-cause or cardiovascular mortality or on myocardial infarction but increased serious bleeding. Compared with placebo or no treatment in persons with stable or no cardiovascular disease, antiplatelet agents prevented myocardial infarction but had uncertain effects on mortality and increased minor bleeding according to generally low-quality evidence.

Limitations: Data for antiplatelet agents in persons with CKD are frequently derived from post hoc analyses of trials of broader populations. Definitions for bleeding outcomes and trial duration were heterogeneous.

onclusion: Benefits for antiplatelet therapy among persons with CKD are uncertain and are potentially outweighed by bleeding hazards.

温馨提示:87%用户都在生物谷APP上阅读,扫描立刻下载! 天天精彩!


相关标签

最新会议 培训班 期刊库