NOACs用于非瓣膜性房颤患者左心耳封堵术后抗栓疗效和安全性的Meta分析

余巧玲; 翟葳葳; 刘平; 邱博; 吴惠珍

doi:10.6039/j.issn.1001-0408.2023.16.17

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NOACs用于非瓣膜性房颤患者左心耳封堵术后抗栓疗效和安全性的Meta分析

循证药学 | 更新时间：2023-08-24

- NOACs用于非瓣膜性房颤患者左心耳封堵术后抗栓疗效和安全性的Meta分析
- Efficacy and safety of new oral anticoagulants in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion：a meta-analysis
- 中国药房 2023年34卷第16期页码：2008-2013
- 作者机构：
  
  1.河北医科大学研究生学院，石家庄　050017
  2.河北省人民医院药学部，石家庄　050051
- 作者简介：
  
  硕士研究生。研究方向：临床药学。电话：0311-85988064。E-mail：yql2799340092@163.com
  主任药师，硕士生导师，硕士。研究方向：临床药学。电话：0311-85988064。E-mail：13582005982@163.com
- 基金信息：
  
  河北省自然科学基金资助项目(H2020307020)
- DOI：10.6039/j.issn.1001-0408.2023.16.17
  中图分类号： R973+.2;R541.7+5
- 纸质出版日期：2023-08-30，
  
  收稿日期：2023-01-30，
  
  修回日期：2023-07-09，
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余巧玲,翟葳葳,刘平等.NOACs用于非瓣膜性房颤患者左心耳封堵术后抗栓疗效和安全性的Meta分析 ^Δ[J].中国药房,2023,34(16):2008-2013.

YU Qiaoling,ZHAI Weiwei,LIU Ping,et al.Efficacy and safety of new oral anticoagulants in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion：a meta-analysis[J].ZHONGGUO YAOFANG,2023,34(16):2008-2013.
余巧玲,翟葳葳,刘平等.NOACs用于非瓣膜性房颤患者左心耳封堵术后抗栓疗效和安全性的Meta分析 ^Δ[J].中国药房,2023,34(16):2008-2013. DOI： 10.6039/j.issn.1001-0408.2023.16.17.

YU Qiaoling,ZHAI Weiwei,LIU Ping,et al.Efficacy and safety of new oral anticoagulants in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion：a meta-analysis[J].ZHONGGUO YAOFANG,2023,34(16):2008-2013. DOI： 10.6039/j.issn.1001-0408.2023.16.17.

摘要

目的

系统评价新型口服抗凝药（NOACs）用于非瓣膜性房颤患者左心耳封堵（LAAO）术后抗栓的有效性和安全性。

方法

计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方数据，收集NOACs（试验组）对比华法林或双联抗血小板药（对照组）的随机对照试验（RCT）和队列研究，检索时限为建库至2022年11月。筛选文献、提取数据、评价质量后，采用RevMan 5.4软件进行Meta分析。

结果

纳入10项研究，包括2项RCT、8项队列研究，共计2 653例患者。RCT结果显示，两组患者的器械相关性血栓（DRT）发生率、卒中/全身性栓塞（SSE）发生率、大出血事件发生率、总出血事件发生率、全因死亡率比较，差异均无统计学意义（

＞0.05）。队列研究结果显示，与双联抗血小板药比较，试验组患者的DRT发生率、卒中/SSE发生率、大出血事件发生率、全因死亡率差异均无统计学意义（

＞0.05）；与华法林比较，试验组患者的DRT发生率[RR＝0.40，95%CI（0.19，0.82），

＝0.01]、总出血事件发生率[RR＝0.28，95%CI（0.18，0.44），

＜0.000 01]均显著降低，而卒中/SSE发生率、大出血事件发生率、全因死亡率差异均无统计学意义（

＞0.05）。

结论

NOACs用于非瓣膜性房颤患者LAAO术后的疗效和安全性与双联抗血小板药相当，DRT发生率和总出血事件发生率低于华法林。

Abstract

OBJECTIVE

To systematically evaluate the efficacy and safety of new oral anticoagulants （NOACs） in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion （LAAO）.

METHODS

Retrieved from PubMed， Embase， Web of Science， the Cochrane Library， CNKI and Wanfang data， randomized controlled trials （RCTs） and cohort studies about NOACs （trial group） versus warfarin or dual antiplatelet agents （control group） were collected during the inception and November 2022. After literature screening， data extraction and quality evaluation， meta-analysis was performed by using RevMan 5.4 software.

RESULTS

A total of 10 studies were included， involving 2 RCTs and 8 cohort studies， with a total of 2 653 patients. RCT results showed that there was no statistically significant difference in the incidence of device-related thrombosis （DRT）， stroke/systemic embolism （SSE）， major bleeding events， total bleeding events or all-cause mortality between 2 groups （

＞0.05）. Results of cohort studies showed that compared with dual antiplatelet agents， there was no statistically significant difference in the incidence of DRT， stroke/SSE， major bleeding events or all-cause mortality in the trial group （

＞0.05）. Compared with warfarin， the incidence of DRT [RR＝0.40， 95%CI　（0.19，0.82），

＝0.01] and total bleeding events [RR＝0.28， 95%CI　（0.18， 0.44），

＜0.000 01] in the

trial group were decreased significantly； there was no statistical significance in the incidence of stroke/SSE， major bleeding events or all-cause mortality （

＞0.05）.

CONCLUSIONS

For patients with nonvalvular atrial fibrillation after LAAO， NOACs have comparable antithrombotic efficacy and safety with dual antiplatelet agents， and the incidence of DRT and total bleeding events are lower than warfarin.

关键词

新型口服抗凝药非瓣膜性房颤左心耳封堵术术后抗栓有效性安全性Meta分析

Keywords

nonvalvular atrial fibrillationleft atrial appendage occlusionpostoperative antithrombotic therapyefficacysafetymeta-analysis

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