Dual antiplatelet therapy after coronary artery bypass surgery: is there an increase in bleeding risk? A meta-analysis
Autor: | Xiaonan Li, Yejing Zhao, Jinghua Liu, Fangying Cao, Ding Peng, Hongyu Peng, Yujun Qin |
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Rok vydání: | 2017 |
Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty 030204 cardiovascular system & hematology Postoperative Hemorrhage Global Health law.invention 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Humans 030212 general & internal medicine Coronary Artery Bypass Postoperative Care business.industry Incidence (epidemiology) Incidence Publication bias Confidence interval Relative risk Meta-analysis Surgery Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors Cohort study |
Zdroj: | Interactive cardiovascular and thoracic surgery. 26(4) |
ISSN: | 1569-9285 |
Popis: | OBJECTIVES There is increasing evidence that dual antiplatelet therapy (DAPT) when compared with single antiplatelet therapy may improve venous graft patency after coronary artery bypass graft. However, it is not yet known whether postoperative administration of DAPT may increase the potential risk of bleeding, especially in the early postoperative period. METHODS We searched studies on PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials. Relative risk (RR) was pooled with 95% confidence intervals (CIs) for dichotomous data. Prior subgroup analyses were performed to look for potential heterogeneity. RESULTS Thirteen studies involving 23 591 participants were included. Our meta-analysis showed that DAPT does not increase the risk of major bleeding (randomized controlled trials group: RR = 1.28, 95% CI 0.95-1.71; cohort studies group: RR = 0.99, 95% CI 0.66-1.51) and minor bleeding (randomized controlled trials group: RR = 1.15, 95% CI 0.73-1.81; cohort studies group: RR = 0.84, 95% CI 0.37-1.93) when compared with single antiplatelet therapy. Meanwhile, DAPT does not increase the incidence of major bleeding events during hospitalization (randomized controlled trials group: RR = 1.27, 95% CI 0.91-1.78; cohort studies group: RR = 0.50, 95% CI 0.12-2.09). Sensitivity analyses showed that our results are stable, and there was no evidence of publication bias. CONCLUSIONS DAPT does not increase the risk of major bleeding and minor bleeding when compared with single antiplatelet therapy. Postoperative administration of DAPT is considered to be safe in patients after coronary artery bypass graft, even in the early postoperative period. |
Databáze: | OpenAIRE |
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