东亚地区非瓣膜性心房颤动患者低强度华法林抗凝治疗有效性与安全性的Meta分析

发布时间：2018-03-28 20:17

本文选题：心房颤动　切入点：非瓣膜性　出处：《临床心血管病杂志》2017年10期

【摘要】：目的:探索低强度华法林抗凝治疗对东亚地区非瓣膜性心房颤动(房颤)患者的有效性与安全性。方法:检索Cochrane、Pubmed、Embase和CBM数据库,收集东亚地区非瓣膜性房颤患者使用不同强度华法林抗凝治疗的相关研究,用RevMan5.3软件进行统计分析。结果:共纳入文献12篇。比较INR 1.50~1.99组(低强度组)和2.0~2.5组的栓塞与出血事件发生率,结果发现,低强度组栓塞事件发生率并未增加[OR=1.12,95%CI:0.84~1.49,P=0.43],但出血事件发生率明显降低[OR=0.72,95%CI:0.56~0.93,P=0.01];进一步比较低强度组与标准强度组(INR 2.0~3.0),结果显示,低强度组的栓塞事件仍未增加[OR=1.30,95%CI:0.97~1.75,P=0.08],而出血事件[OR=0.62,95%CI:0.48~0.80,P0.01],甚至致命性出血事件发生率[OR=0.58,95%CI:0.38~0.88,P=0.01]显著降低。另外INR 2.6~3.0组的出血事件发生率高于2.0~2.5组[OR=0.67,95%CI:0.46~0.97,P=0.04]。结论:低强度(INR 1.50~1.99)是华法林治疗的有效范围,且比较安全,而INR 2.6~3.0时出血风险较大,故东亚地区非瓣膜性房颤患者使用华法林治疗时,其INR维持在1.5~2.5是较理想的范畴。
[Abstract]:Objective: to explore the efficacy and safety of low-intensity warfarin anticoagulant therapy in patients with non-valvular atrial fibrillation (AF) in East Asia. To collect the relevant studies of patients with non-valvular atrial fibrillation who received warfarin anticoagulant therapy of different intensities in East Asia. Results: a total of 12 papers were included. The incidence of embolism and hemorrhage in INR 1.50 1.99 group (low intensity group) and 2.0 渭 2.5 group were compared. The incidence of embolism in the low intensity group did not increase [OR1. 1295 CI0.84: 1.49P0. 43], but the incidence of haemorrhage was significantly decreased [ORO. 72C95 CI: 0. 563P0. 01]. Further comparison was made between the low intensity group and the standard intensity group. The incidence of embolism in the low-intensity group was still not increased [OR1.3095 CI0.97: 1.75P0.08], but the bleeding event [OR0.6295CI0.480.480.80P0.01], and even the incidence of fatal hemorrhage (OR0.580.88P0.01) was significantly decreased. In addition, the incidence of hemorrhage in INR 2.63.0 group was higher than that in the 2.0795 CI group [OR0.6795CI0.460.460.460.7P0.04]. Conclusion: low intensity of INR 1.501.99is the effective range of warfarin treatment. It was safe and safe, but the risk of bleeding was higher at INR 2.6C 3.0.Therefore, when warfarin was used in patients with non-valvular atrial fibrillation in East Asia, its INR was maintained at 1.5 to 2.5. it was an ideal range for patients with non-valvular atrial fibrillation in East Asia.
【作者单位】：苏州大学附属第一医院心内科;苏州大学附属第一医院麻醉手术科;
【分类号】：R541.75

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