窦性心力衰竭患者不同抗栓方案预防栓塞事件的有效性和安全性的Meta分析
Meta-analysis of the Efficacy and Safety of Different Antithrombotic Agents in Preventing Embolic Events in Heart Failure Patients with Sinus Rhythm
陈晶晶 1马翠 2谢珊珊 3万瑾瑾 3黄志英 3林环玉 3张卫芳3
作者信息
- 1. 泉州市光前医院,福建 泉州 362321;南昌大学第二附属医院,江西 南昌 330006
- 2. 富平县中医医院,陕西 渭南 711700
- 3. 南昌大学第二附属医院,江西 南昌 330006
- 折叠
摘要
目的 比较患有心力衰竭(HF)的窦性心律患者使用口服抗凝药(OAC)与抗血小板药(OAP)预防栓塞事件的有效性和安全性.方法 从PubMed、Springer、Cochrane图书馆、Elsevier、Wiley、中国知网、万方等电子数据库检索建库至 2023 年 12 月关于HF患者使用OAC或OAP的随机对照临床试验(RCTs)中提取人群的卒中、心肌梗死、全因死亡及大出血数据资料后用R语言进行荟萃及偏倚统计分析.结果 最终纳入 7 项大型RCTs(共 16823 例患者).分析结果显示,相较于OAP,无论是新型口服抗凝药物(NOAC)还是维生素K拮抗剂(VKA)都可显著降低窦性心律HF患者卒中风险(RR=0.59,95%CI:0.47-0.74,P<0.01,I2=0%),但不降低全因死亡风险(RR=0.87,95%CI:0.75-1.01,P>0.05,I2=65%).另外,VKA不降低患者心肌梗死的风险(RR=1.08,95%CI:0.80-1.46,P>0.05,I2=0%),却显著增加大出血风险(RR=2.15,95%CI:1.57-2.96,P<0.01,I2=0%).而NOAC在有效降低患者的心肌梗死风险的情况下(RR=0.78,95%CI:0.65-0.95,P<0.05,I2=0%),不增加大出血风险(RR=1.18,95%CI:0.86-1.62,P>0.05,I2=0%).结论 窦性心律HF患者使用VKA预防栓塞事件有效性与OAP效果相当,但安全性更差,使用NOAC预防栓塞的有效性较OAP效果好,且安全性相当.
Abstract
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.
关键词
口服抗凝药/利伐沙班/窦性心律/心力衰竭/Meta分析Key words
Oral anticoagulant/Rivaroxaban/Sinus rhythm/Heart failure/Meta-analysis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据