临床心血管病杂志2024，Vol.40Issue(1) ：33-39.DOI:10.13201/j.issn.1001-1439.2024.01.007

心房颤动合并透析患者使用利伐沙班或阿哌沙班的有效性和安全性的meta分析

Efficacy and safety of rivaroxaban or apixaban in atrial fibrillation patients with dialysis:a meta-analysis

李佳琪 鲁静朝 靳雅琼 王梦肖 张洁 王科科 王莉华 刘凡
临床心血管病杂志2024，Vol.40Issue(1) ：33-39.DOI:10.13201/j.issn.1001-1439.2024.01.007
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  • 维普
  • 万方数据

心房颤动合并透析患者使用利伐沙班或阿哌沙班的有效性和安全性的meta分析

Efficacy and safety of rivaroxaban or apixaban in atrial fibrillation patients with dialysis:a meta-analysis

李佳琪 1鲁静朝 1靳雅琼 1王梦肖 1张洁 1王科科 1王莉华 2刘凡1
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作者信息

  • 1. 河北医科大学第二医院心内二科(石家庄,050000)
  • 2. 河北医科大学第二医院血液透析科
  • 折叠

摘要

目的:评估与维生素K 口服抗凝剂(VKA)相比,在心房颤动(房颤)合并透析患者中使用利伐沙班或阿哌沙班抗凝的有效性和安全性.方法:计算机检索PubMed、Embase、Cochrane Library、中国知网、万方、中国生物医学文献数据库(CBM)中收录的相关研究,检索时间为从各数据库建库到2023年4月16日.采用Rev-Man5.4软件进行meta分析.结果:最终纳入8项研究,其中随机对照试验(RCT)3项,回顾性队列研究5项,共纳入39 274例患者,其中7 727例接受利伐沙班或阿哌沙班抗凝,31 547例接受VKA抗凝.Meta分析结果显示,与VKA相比,在有效性结局方面,利伐沙班或阿哌沙班与卒中/系统性栓塞(RR=0.82,95％CI 0.71～0.95,P=0.01)和全因死亡(RR=0.83,95％CI 0.75～0.91,P＜0.000 1)的发生率降低相关;在安全性结局方面,利伐沙班或阿哌沙班与胃肠道出血(RR=0.80,95％CI 0.69～0.93,P=0.005)的发生风险降低相关,但在大出血和颅内出血发生风险上,与VKA相比差异无统计学意义.亚组分析表明,利伐沙班与胃肠道出血(RR=0.60,95％CI 0.40～0.92,P=0.02)风险降低相关;阿哌沙班与卒中/系统性栓塞(RR=0.85,95％CI 0.73～1.00,P=0.04)、全因死亡(RR=0.82,95％CI 0.74～0.90,P＜0.0001)、大出血(RR=0.71,95％CI 0.63～0.79,P＜0.000 01)及胃肠道出血(RR=0.84,95％CI 0.71～0.99,P=0.03)的发生风险降低相关;低剂量的利伐沙班或阿哌沙班与大出血(RR=0.69,95％CI 0.59～0.80,P＜0.000 01)风险降低相关.敏感性分析与总体meta分析得出相似结果.结论:在房颤合并透析患者中,相比于VKA,利伐沙班或阿哌沙班抗凝显示出良好的风险-收益特征,是VKA的合理替代品.

Abstract

Objective:To assess the efficacy and safety of rivaroxaban or apixaban compared to vitamin K anti-coagulants(VKA)in atrial fibrillation(AF)patients with dialysis.Methods:Relevant studies were identified through computer searches of databases including PubMed,Embase,Cochrane Library,CNKI,Wanfang Data,and China Biology Medicine(CBM),from the inception of each database until April 16,2023.Meta-analysis was performed using RevMan 5.4 software.Results:A total of 8 studies were included,comprising 3 randomized con-trolled trials(RCT)and 5 retrospective cohort studies,with a cumulative enrollment of 39 274 patients.Among them,7 727 patients received rivaroxaban or apixaban,while 31 547 patients received VKA.The meta-analysis results revealed that,in terms of efficacy outcomes,rivaroxaban or apixaban were associated with a decreased inci-dence of stroke/systemic embolism(RR=0.82,95％CI 0.71-0.95,P=0.01)and all-cause death(RR=0.83,95％CI 0.75-0.91,P＜0.000 1),compared to VKA.Regarding safety outcomes,rivaroxaban or apixaban were associated with a decreased risk of gastrointestinal bleeding(RR=0.80,95％CI 0.69-0.93,P=0.005).However,there was no statistically significant difference compared to VKA in terms of major bleeding and in-tracranial bleeding.Subgroup analysis indicated that rivaroxaban was only associated with a decreased risk of gas-trointestinal bleeding(RR=0.60,95％CI 0.40-0.92,P=0.02).On the other hand,apixaban was associated with a decreased risk of stroke/systemic embolism(RR=0.85,95％CI 0.73-1.00,P=0.04),all-cause death(RR=0.82,95％CI 0.74-0.90,P＜0.000 1),major bleeding(RR=0.71,95％CI 0.63-0.79,P＜0.00001),and gastrointestinal bleeding(RR=0.84,95％CI 0.71-0.99,P=0.03).Low-dose rivaroxaban or apixa-ban was associated with a decreased risk of major bleeding(RR=0.69,95％CI 0.59-0.80,P＜0.000 01).Sen-sitivity analysis was consistent with the overall meta-analysis findings.Conclusion:In AF patients with dialysis,using rivaroxaban or apixaban demonstrates a favorable risk-benefit profile compared to VKA.Rivaroxaban or apixaban may serve as reasonable alternatives to VKA.

关键词

心房颤动/透析/利伐沙班/阿哌沙班/维生素K/口服抗凝剂

Key words

atrial fibrillation/dialysis/rivaroxaban/apixaban/vitamin K anticoagulants

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出版年

2024
临床心血管病杂志
华中科技大学心血管病研究所 华中科技大学协和医院

临床心血管病杂志

CSTPCD
影响因子：0.653
ISSN：1001-1439
参考文献量28
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