Benefit and safety of dual anti-platelet therapy after coronary artery bypass grafting: a Meta-analysis of 15 studies / 中华胸心血管外科杂志

ABSTRACT

Objective Under the method of a Meta-analysis, evaluate the early and long-term curative effect after coronary artery bypass grafting with the comparison of benefit and safety between dual anti-platelet therapy and aspirin therapy alone.Methods Medline, Embase, ScienceDirect and Cochrane Library were searched to identify randomized controlled trials concerning the comparison of benefit and safety between dual anti-platelet therapy and aspirin therapy alone, with extraction effect sizes including mortality, bleeding events, myocardial ischemia and graft occlusion.Newcastle-Ottawa Scale and Jadal scales were used to evaluate the quality of observational case-control studies and randomized controlled studies.Statistical analysis was performed using Meta R.15.2 software package.Results 15 literatures were enrolled for Meta-analyses, including 8randomized controlled studies, 3 prospective observational studies and 4 retrospective observational studies.Among a total of 31 365patiens, 8 642 patients were received combination therapy of aspirin and clopidogrel after CABG, and 22 723 patients were received combination therapy of aspirin and placebo or aspirin therapy alone.The Meta-analysis results, with comparison of the early postoperative curative effect in 13 literatures, showed that, relative to aspirin therapy alone, dual anti-platelet therapy could reduce the risk of graft occlusion(OR =0.53,95％ CI 0.37-0.76, P =0.001), reduce the risk of myocardial ischemia (OR =0.84, 95 ％ CI 0.71-0.99, P =0.038) , reduce the risk of mortality after CABG (OR =0.47,95 ％ CI 0.36-0.61, P ＜0.001), simultaneously not increase the risk of bleeding events.The Meta-analysis results, with comparison of the long-term postoperative curative effect in 2 literatures, showed that the significant difference could not be found between two method of therapy about affecting the risk of graft occlusion (OR =0.40, 95 ％ CI 0.02-6.90, P =0.523) , myocardial ischemia(OR =0.49, 95％ CI 0.04-6.10, P =0.597), and mortality (OR =0.55, 95 ％ CI 0.13-2.80, P =0.420).Conclusion Relative to aspirin therapy alone, dual anti-platelet therapy has better efficacy and safety in early postoperative term.However better long-term curative effect of dual anti-platelet therapy are not be confirmed, and more long-term follow-up studies are necessary to provide evidence based medicine.