Meta-analysis of the Efficacy and Safety of Different Antithrombotic Agents in Preventing Embolic Events in Heart Failure Patients with Sinus Rhythm
Objective To explore the efficacy and safety of oral anticoagulant(OAC)or oral antiplatelet(OAP)in heart failure(HF)and sinus rhythm patients.Methods Comprehensive literatures searches were conducted using the PubMed,Springer,Cochrane Library,Elsevier,Wiley,CNKI and WanFang from inception to December 2023.Randomized controlled trials(RCTs)focusing on efficacy and safety of OAC or OAP therapy in HF and sinus rhythm patients.Statistical analyses were performed using R Programming Language.Results Seven large RCTs(16 823 patients)were finally included.In patients with HF and sinus rhythm,NOAC and VKA had a favorable point estimate in stroke(RR=0.59,95%CI:0.47-0.74,P<0.01,I2=0%),but comparable to OAP for all cause death(RR=0.87,95%CI:0.75-1.01,P>0.05,I2=65%).In addition,VKA not only didn't reduce the risk of myocardial infarction(RR=1.08,95%CI:0.80-1.46,P>0.05,I2=0%)in patients but also increases the risk of major bleeding(RR=2.15,95%CI:1.57-2.96,P<0.01,I2=0%).While NOAC can effectively reduce the risk of myocardial infarction(RR=0.78,95%CI:0.65-0.95,P<0.05,I2=0%)in patients without increasing the risk of major bleeding(RR=1.18,95%CI:0.86-1.62,P>0.05,I2=0%).Conclusion Compared with OAP,VKA were similarly effective but less secure for the prevention of embolism event in patients with HF and sinus rhythm,while NOAC had more effective and similarly safe.
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