达比加群与利伐沙班在非瓣膜性心房颤动患者中疗效和安全性的Meta分析
发布时间：2018-02-23 07:34
本文关键词： 非瓣膜性心房颤动 达比加群 利伐沙班 疗效 安全性 出处：《广西医科大学》2017年硕士论文 论文类型：学位论文
【摘要】：目的:探讨达比加群与利伐沙班在非瓣膜性心房颤动(NVAF)患者中抗凝治疗的疗效和安全性。方法:计算机检索PubMed、Embase、The Cochrane Library及中文数据库获得有关NVAF患者接受达比加群与利伐沙班抗凝治疗的研究。疗效事件包括缺血性脑卒中或系统性栓塞、心肌梗死和全因死亡,安全性事件包括颅内出血、胃肠道出血、严重出血和任何出血。采用STATA 12.0进行统计分析,计算相对危险度(RRs)及95%可信区间(CI)来表示汇总效应。如合并后P㩳0.05,表示差异有统计学意义。结果:纳入14篇队列研究,1篇样本量较小的RCT,抗凝时间在90天-2.5年。结果显示,与达比加群比较利伐沙班有较低的缺血性脑卒中或系统性栓塞的风险(RR:1.273;95%CI:1.154-1.416;P=0.000)。利伐沙班增加颅内出血(RR:0.607;95%CI:0.508-0.725;P=0.000)及胃肠道出血的风险(RR:0.789;95%CI:0.733-0.849;P=0.000)。全因死亡、心肌梗死、严重出血及任何出血事件的发生率无显著差异。基于抗凝时间的亚组分析显示,抗凝治疗≥12个月时,利伐沙班有较低的缺血性脑卒中或系统性栓塞的风险(RR:1.33;95%CI:1.18-1.50),但同时颅内出血(RR:0.64;95%CI:0.47-0.85)及胃肠道出血风险(RR:0.84;95%CI:0.73-0.96)增加。抗凝治疗6个月时,利伐沙班有较高的颅内出血(RR:0.53;95%CI:0.41-0.6)、胃肠道出血(RR:0.75;95%CI:0.68-0.83)及严重出血风险(RR:0.63;95%CI:0.47-0.84)。结论:抗凝≥12个月时,在减少缺血性脑卒中或系统性栓塞风险方面,利伐沙班优于达比加群,但同时利伐沙班的颅内出血及胃肠道出血风险增加。抗凝6个月时,利伐沙班的颅内出血、胃肠道出血及严重出血风险多于达比加群。
[Abstract]:Objective: to investigate the efficacy and safety of dabigac and rivastaban in the treatment of patients with non-valvular atrial fibrillation (NV). Methods: to search the Cochrane Library and Chinese database of PubMedbase in patients with NVAF. A study of the anticoagulant therapy of rivastaban. Therapeutic events include ischemic stroke or systemic embolism. Myocardial infarction and all-cause death, safety events include intracranial hemorrhage, gastrointestinal bleeding, severe bleeding and any bleeding. Statistical analysis using STATA 12.0, calculate the relative risk of RRs and 95% CI) to indicate the aggregate effect. Results: in 14 cohort studies, RCTs with a small sample size ranged from 90 days to 2.5 years. The risk of ischemic stroke or systemic embolism is lower than that of Dapiga group. RR: 1.273c95CI1.154-1.416Ph 0.0000.0000.000%. Levasaban increases the risk of intracranial hemorrhage by RR: 0.60795 CIW 0.508-0.725P0.000) and gastrointestinal hemorrhage by RR: 0.789 95 CIW 0.733-0.849P0.0000.0000.000. There was no significant difference in the incidence of severe bleeding and any bleeding events. Subgroup analysis based on anticoagulant time showed that when anticoagulant therapy was more than 12 months, Rivasaban had a lower risk of ischemic stroke or systemic embolism (RR: 1.3395), but at the same time the risk of intracerebral hemorrhage was increased by R: 0.6495 (CI: 0.47-0.85) and gastrointestinal hemorrhage risk (RR0.84 + 95CIW 0.73-0.96). After 6 months of anticoagulant therapy, Rivasaban had higher risk of intracranial hemorrhage (RR: 0.53 ~ 95CI: 0.41-0.610, Gastrointestinal hemorrhage: 0.75 / 95CI: 0.68-0.83) and severe risk of hemorrhage. Conclusion: when anticoagulant 鈮，
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