新型口服抗凝药物用于非瓣膜性房颤治疗有效性和安全性的Meta分析

发布时间：2018-05-04 06:43

本文选题：新型口服抗凝药物 + 房颤　；参考：《中国药学杂志》2017年17期

【摘要】：目的系统评价新型口服抗凝药(达比加群酯、利伐沙班、阿哌沙班及依度沙班)用于非瓣膜性房颤治疗的有效性和安全性。方法计算机检索截止2016年9月,在Pubmed,Embase,Medline,Cochrane,Clinical Trials.gov,Web of Science,中国知网、万方及维普数据库中检索关于新型口服抗凝药用于非瓣膜性房颤治疗的随机对照研究,根据纳入标准和排除标准对文献进行筛选和质量评价,使用Rev Man 5.3和Stata 13.1软件对数据进行网络Meta分析。结果共纳入17篇随机对照研究,总计83 561例患者。网络Meta分析结果显示,新型口服抗凝药预防全因死亡率的作用按照由高至低依次排序为利伐沙班,阿哌沙班,依度沙班,达比加群酯;治疗卒中和体循环栓塞的作用按照由高至低依次排序为利伐沙班,达比加群酯,阿哌沙班,依度沙班;治疗缺血性卒中的作用按照由高至低依次排序为利伐沙班,阿哌沙班,达比加群酯,依度沙班;严重出血率按照由低至高依次排序为依度沙班,阿哌沙班,达比加群酯,利伐沙班;颅内出血率按照由低至高依次排序为达比加群酯,依度沙班,阿哌沙班,利伐沙班;心肌梗死率按照由低至高依次排序为利伐沙班,阿哌沙班,依度沙班,达比加群酯。所有结局指标的不一致性检测表明,直接比较与间接比较无显著的不一致性。异质性检验显示研究间不存在统计学异质性。结论充分比较新型口服抗凝药的有效性、安全性及经济性,阿哌沙班排序最佳,可考虑首选。
[Abstract]:Objective to evaluate the efficacy and safety of new oral anticoagulants (dabiganate, rivastabine, piperazabine and idusabine) in the treatment of non-valvular atrial fibrillation. Methods as of September 2016, a randomized controlled study on the use of new oral anticoagulants for non-valvular atrial fibrillation was searched in the Pubmedmedan Embase Medline, CochraneClinical Trials.govof Web of Science, China knowledge Web, Wanfang and Weip databases. According to the inclusion criteria and exclusion criteria, the literature was screened and evaluated, and the network Meta analysis was carried out by using Rev Man 5.3 and Stata 13.1 software. Results A total of 83,561 patients were enrolled in 17 randomized controlled trials. The results of network Meta analysis showed that the preventive effects of new oral anticoagulants on all-cause mortality were as follows: Lipashaban, Apiprazapan, Edozapan, Dabiganate according to the order from high to low. The therapeutic effects of stroke and systemic circulation embolism in order of high to low were Lipashaban, dapiquant, piperazabine, Eduzapan, and the effects of treating ischemic stroke were in the order of Levashaban, piperazaban, and Apiazaban in order of order from high to low. The rates of severe bleeding were in order from low to high to those from low to high: Eduzapan, piperazaban, dabiquin, Rivashaban, and intracranial hemorrhage rate was ranked from low to high for dabiganate, Eduzapan, and so on, and the rate of intracranial hemorrhage was in the order of Dabiganate, Iduzapan, and so on. The myocardial infarction rate in the order of low to high was Rivashaban, Apiprazapan, Eduzapan, and Dapiganate. The results showed that there was no significant inconsistency between direct comparison and indirect comparison. Heterogeneity test showed that there was no statistical heterogeneity among the studies. Conclusion to compare the efficacy, safety and economy of the new oral anticoagulant, the best ranking of piperazabine can be considered as the first choice.
【作者单位】：北京医院国家老年医学中心;吉林长春第二医院药品管理部;
【分类号】：R541.75

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