Meta analysis of the effectiveness and safety of antiplatelet combined with anticoagulation therapy for peripheral arterial diseases
Objective To summarize the effectiveness and safety of antiplatelet combined with anticoagulant therapy for peripheral arterial disease(PAD).Method Using the search strategy developed by Cochrane Collaborative Network,the relevant literature from domestic and foreign databases as of November 1,2023 was searched and a meta-analysis of outcome indicators was conducted using Stata 14.0 software and Review Manager 5.4.1 software provided by Cochrane Collaboration Network.Results A total of 15 eligible literature and 15 383 patients were included,including 7 692 in the antiplatelet combined with anticoagulant therapy group(study group)and 7 691 in the control group(only antiplatelet drug therapy).The meta-analysis results showed that:① Symptoms:The ankle brachial index[mean difference(MD)and 95％confidence interval(95％CI)=0.04(0.02,0.06)]and the minimum lumen diameter[MD(95％CI)=0.48(0.40,0.55)]of the study group were greater than those of the control group;The plasma D-2 dimer level of the study group was lower than that of the control group[MD(95％CI)=-0.55(-0.57,-0.52)],and the probability of the limb ischemia risk of the study group was lower than that of the control group[risk ratio(RR)and 95％CI=0.67(0.56,0.80)].② Vascular patency:The probability of the vascular patency of the study group was higher than that of the control group[RR(95％CI)=1.13(1.08,1.17)];The subgroup analysis results:the vascular patency rate of the two antiplatelet drugs combined with anticoagulation therapy was highest among the different treatment regimens[effect size(ES)and 95％CI=0.90(0.86,0.94)],which of the other measures in descending order was only one antiplatelet drug combined with anticoagulation therapy[ES(95％CI)=0.82(0.76,0.89)],two antiplatelet drugs therapy[ES(95％CI)=0.79(0.72,0.85)],and only one antiplatelet drug therapy[ES(95％CI)=0.71(0.54,0.87)];The probability of the vascular patency using vitamin K antagonists in the study group was higher than that in the control group[RR(95％CI)=1.15(1.10,1.20)],which had no statistical difference using X a inhibitor between the study group and the control group[RR(95％CI)=1.04(0.95,1.15)].③ Bleeding risk:The risk of bleeding of the study group was higher than that of the control group[RR(95％CI)=1.55(1.27,1.89)];The subgroup analysis results:The bleeding rate of the only one antiplatelet drug therapy among the different intervention measures was the lowest[ES(95％CI)=0.02(0.01,0.02)],which of the other measures in ascending order was only one antiplatelet drug combined with anticoagulant therapy[ES(95％CI)=0.04(0.03,0.06)],two antiplatelet drugs therapy[ES(95％CI)=0.08(0.06,0.10)],and two antiplatelet drugs combined with anticoagulant[ES(95％CI)=0.12(0.06,0.18)];The probabilities of the bleeding occurring using the vitamin K antagonists and Xa inhibitor in the study group were higher than those in the control group[RR(95％CI)=1.76(1.28,2.42);RR(95％CI)=1.44(1.12,1.84)].Conclusions From the results of this meta-analysis,it can be seen that the combination of antiplatelet and anticoagulant therapy can effectively improve symptoms of patients with PAD,increase vascular patency rate,but it has a certain risk of bleeding.The combination of only one antiplatelet drug combined with anticoagulant therapy might achieve an optimum clinical effect and lower bleeding risk.
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