新型口服抗凝药对我国非瓣膜性心房颤动患者治疗效果与安全性的Meta分析

发布时间：2018-11-21 11:51

【摘要】：背景非瓣膜性心房颤动(NVAF)是临床常见的心律失常,常引起栓塞事件发生,故抗凝治疗在NVAF治疗中尤为重要。华法林已被证实为有效的传统口服抗凝药,但出血风险高等缺点限制了其临床应用。近年来出现的新型口服抗凝药(NOACs)弥补了华法林的缺陷而备受临床关注。目的评价NOACs对国内NVAF患者治疗的效果与安全性。方法 2015年9月——2016年8月,计算机检索Cochrane Library、Pub Med、Web of Science、EMBase、中国知网、中国生物医学文献数据库、维普网和万方数据知识服务平台,筛选关于NOACs与华法林对NVAF患者治疗比较的随机对照试验(RCT)。提取纳入文献相关信息,并评价纳入文献质量。结果纳入15篇文献,共2 246例患者,文献质量评分为4~5分。Meta分析显示,与华法林比较,NOACs可降低NVAF患者脑卒中发生率〔OR=0.65,95%CI(0.43,0.97),P=0.04〕、非严重性出血发生率〔OR=0.44,95%CI(0.31,0.61),P0.001〕及严重性出血发生率〔OR=0.45,95%CI(0.22,0.91),P=0.03〕;而非神经系统性血栓栓塞发生率比较,差异无统计学意义〔OR=0.72,95%CI(0.46,1.14),P=0.16〕。结论采用NOACs治疗NVAF患者脑卒中、非严重性出血及严重性出血发生率低于华法林,非神经系统性血栓栓塞发生率与华法林无差异,NOACs用于治疗国内NVAF患者具有良好的效果和安全性。
[Abstract]:Background non-valvular atrial fibrillation (NVAF) is a common arrhythmia, which often causes embolism. Therefore, anticoagulant therapy is particularly important in the treatment of NVAF. Warfarin has been proven to be an effective oral anticoagulant, but its clinical application is limited by its high risk of bleeding. In recent years, the new oral anticoagulant (NOACs) has made up for the defects of warfarin and has attracted much clinical attention. Objective to evaluate the efficacy and safety of NOACs in the treatment of NVAF patients in China. Methods from September 2015 to August 2016, Cochrane Library,Pub Med,Web of Science,EMBase, China knowledge Network, Chinese Biomedical Literature Database, Weipu Web and Wanfang data knowledge Service platform were searched. Screening of a randomized controlled trial, (RCT)., on the comparison of NOACs and warfarin in the treatment of NVAF patients Extract the relevant information and evaluate the quality of the literature. Results A total of 2 246 patients were included in 15 articles. The score of literature quality was 4 ~ 5. Meta analysis showed that compared with warfarin, NOACs could reduce the incidence of stroke in NVAF patients (OR=0.65,95%CI (0. 43 卤0. 97), P0. 04). The incidence of non-severe hemorrhage (OR=0.44,95%CI (0.31) 0.61, P0.001) and severe hemorrhage (OR=0.45,95%CI (0.220.91), P0. 03); However, there was no significant difference in the incidence of non-neurological thromboembolism (OR=0.72,95%CI (0. 46 卤1. 14), P < 0. 16). Conclusion the incidence of non-severe hemorrhage and severe hemorrhage in patients with NVAF treated with NOACs is lower than that of warfarin, and there is no difference between non-neurological thromboembolism and warfarin. NOACs has good effect and safety in treating NVAF patients in China.
【作者单位】：暨南大学附属第一医院心内科;暨南大学附属第一医院急诊科;暨南大学附属第一医院肿瘤科;
【基金】：广州市天河区2015年度科技计划项目(201504KW021)
【分类号】：R541.75

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