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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               Δ



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          余巧玲     1, 2* ,翟葳葳 ,刘 平 ,邱 博 ,吴惠珍 (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)
          中图分类号  R973+.2;R541.7+5      文献标志码  A      文章编号  1001-0408(2023)16-2008-06
          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(P>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(P>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),P=0.01]、总出血事件发生率[RR=0.28,95%CI(0.18,0.44),P<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(P>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。
          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

          Efficacy  and  safety  of  new  oral  anticoagulants  in  patients  with  nonvalvular  atrial  fibrillation  after  left
          atrial appendage occlusion:a meta-analysis
          YU Qiaoling ,ZHAI Weiwei ,LIU Ping ,QIU Bo ,WU Huizhen (1.  Graduate  School  of  Hebei  Medical
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          University,  Shijiazhuang 050017,  China;2.  Dept.  of  Pharmacy,  Hebei  General  Hospital,  Shijiazhuang 050051,
          China)
          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 (P>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 (P>0.05). Compared with warfarin,
          the incidence of DRT [RR=0.40, 95%CI (0.19,0.82), P=0.01] and total bleeding events [RR=0.28, 95%CI (0.18, 0.44), P<
          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 (P>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.
              Δ 基金项目 河北省自然科学基金资助项目(No.H2020307020)
             *第一作者 硕士研究生。研究方向:临床药学。电话:0311-                   KEYWORDS    new  oral  anticoagulants;  nonvalvular  atrial
          85988064。E-mail:yql2799340092@163.com               fibrillation;  left  atrial  appendage  occlusion;  postoperative
              # 通信作者 主任药师,硕士生导师,硕士。研究方向:临床药学。                 antithrombotic therapy; efficacy; safety; meta-analysis
          电话:0311-85988064。E-mail:13582005982@163.com


          · 2008 ·    China Pharmacy  2023 Vol. 34  No. 16                            中国药房  2023年第34卷第16期
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