心房颤动相关急性缺血性脑卒中早期抗凝治疗有效性和安全性的Meta分析
Efficacy and safety of early anticoagulation in patients with acute ischemic stroke due to atrial fibrillation:a Meta-analysis
王运香 1齐旭慧 2蔡焕焕 1鲁志兵1
作者信息
- 1. 武汉大学中南医院心血管内科(武汉 430071);武汉大学心肌损伤与修复研究所(武汉 430071)
- 2. 武汉大学中南医院消化内科(武汉 430071)
- 折叠
摘要
目的 评估心房颤动(atrial fibrillation,AF)相关的急性缺血性脑卒中(acute ischemic stroke,AIS)患者早期(≤3 d)应用新型口服抗凝药的有效性和安全性.方法 对中国知网、万方、维普、PubMed、The Cochrane Library、Embase数据库进行系统检索,筛选AF相关的AIS患者早期抗凝治疗的临床研究,检索时间为建库至 2022 年 11 月 4日,同时手动检索参考文献.由 2 名研究者独立筛选文献、资料提取与质量评价.采用RevMan 5.4 软件进行Meta分析,合并二分类效应量采用相对危险度(relative risk,RR)以及 95%置信区间(confidence interval,CI)表示.结果 纳入 2 篇随机对照试验和 5 篇非随机对照试验,共包括 2 226 例患者,Meta分析结果显示,早期抗凝治疗(≤3 d)与延迟抗凝(＞3 d)相比,在总缺血事件[RR=1.04,95%CI(0.67,1.61),P=0.88]、卒中复发或短暂性脑缺血发作[RR=0.88,95%CI(0.58,1.34),P=0.56]、大出血[RR=1.24,95%CI(0.59,2.62),P=0.56]、症状性脑出血[RR=0.98,95%CI(0.44,2.17),P=0.96]方面发生率相似,在全部脑出血方面,发生率低于延迟抗凝组[RR=0.59,95%CI(0.44,0.77),P=0.000 5].结论 AF相关AIS发生后早期抗凝与延迟抗凝相比,在有效性方面相似,且不增加患者出血风险.
Abstract
Objective To evaluate the efficacy and safety of early use of new oral anticoagulants(≤3 days)in patients with acute ischemic stroke(AIS)due to atrial fibrillation(AF).Method After systematic retrieval of CNKI,WanFang Data,VIP,PubMed,The Cochrane Library and Embase database,clinical studies on early anticoagulation therapy for AF-related AIS patients were screened.The search was conducted from the time of database construction to November 4,2022,while the references were searched manually.Literature screening,data extraction and quality assessment were performed independently by 2 investigators.Meta-analysis was performed using RevMan 5.4 software,and the combined dichotomous effect sizes were expressed as relative risk(RR)and 95%confidence interval(CI).Result A total of 2 randomized controlled trials and 5 non-randomized controlled trials including 2 226 patients were included,and the analysis suggested that early anticoagulation treatment(≤3 days)was similar to delayed anticoagulation(＞3 days)in terms of total ischemic events[RR=1.04,95%CI(0.67,1.61),P=0.88],recurrent ischemic strokes or transient ischemic attack[RR=0.88,95%CI(0.58,1.34),P=0.56],major bleeding[RR=1.24,95%CI(0.59,2.62),P=0.56],and symptomatic intracerebral haemorrhage[RR=0.98,95%CI(0.44,2.17),P=0.96].In terms of total cerebral hemorrhages,the incidence was lower than in the delayed anticoagulation group.Conclusion Anticoagulation started early after the occurrence of atrial fibrillation related ischemic stroke is similar to delayed anticoagulation in terms of effectiveness,and does not increase the risk of bleeding in patients.
关键词
心房颤动/急性缺血性脑卒中/新型口服抗凝药/Meta分析/早期Key words
Atrial fibrillation/Acute ischemic stroke/New oral anticoagulants/Meta-analysis/Early引用本文复制引用
基金项目
湖北省自然科学基金创新群体项目(2021CFA051)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据