新型口服抗凝血剂在心房颤动患者中胃肠道出血和颅内出血的风险分析:系统回顾和网络meta分析（英文）

发布时间：2018-11-03 11:59

【摘要】：目的:评估新型口服抗凝药物在心房颤动患者中胃肠道出血和颅内出血的风险。创新点:首次用网络meta分析的方法评估新型口服抗凝血剂在心房颤动患者中胃肠道出血和颅内出血的风险。方法:我们搜集了20个随机控制试验共91 671位使用抗凝、抗血小板药物或安慰剂的房颤患者。采用贝叶斯网络meta分析,使用马尔可夫链蒙特卡罗方法模拟了比值比(OR)和95%置信区间(CI)。结论:通过与贝叶斯模型的间接比较证实,阿司匹林+氯吡格雷相比安慰剂大大增加房颤患者胃肠道出血的风险(OR 0.33,95%CI 0.01~0.92)。华法林与新型口服抗凝药物相比,大大增加了颅内出血风险,其中与依度沙班30 mg相比OR 3.42,95%CI 1.22~7.24,与达比加群11 mg相比OR 3.56,95%CI 1.10~8.45。我们进一步排名发现胃肠道出血风险最低的新型口服抗凝血剂是阿哌沙班5 mg,颅内出血最低的是阿哌沙班5 mg、达比加群110 mg和依度沙班30 mg。
[Abstract]:Objective: to evaluate the risk of gastrointestinal bleeding and intracranial hemorrhage in patients with atrial fibrillation by new oral anticoagulants. Innovation: the risk of gastrointestinal and intracranial hemorrhage in patients with atrial fibrillation was evaluated by network meta analysis for the first time. Methods: we collected 91,671 patients with atrial fibrillation using anticoagulant, antiplatelet drugs or placebo in 20 randomized controlled trials. Using Bayesian network meta analysis and Markov chain Monte Carlo method, the ratio (OR) and 95% confidence interval (CI). Are simulated. Conclusion: the indirect comparison with Bayesian model showed that aspirin clopidogrel significantly increased the risk of gastrointestinal bleeding in patients with atrial fibrillation compared with placebo (OR 0.33% 95 CI 0.01 卤0.92). Warfarin significantly increased the risk of intracranial hemorrhage compared with the new oral anticoagulant, including OR 3.42m95 CI 1.227.24 compared with Edozapan 30 mg, and OR 3.5695CI 1.108.45 compared with Darbigavan 11 mg. We further found that the new type of oral anticoagulant with the lowest risk of gastrointestinal bleeding was Apiprazaban 5 mg, intracranial hemorrhage with the lowest Apiprazaban 5 mg, Darbiga 110 mg and Edozapan 30 mg..
【作者单位】： Department
【基金】：Project supported by the National Natural Science Foundation of China(No.30800999)
【分类号】：R541.75

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