不同抗凝强度华法林对非瓣膜病心房颤动疗效和安全性的meta分析  

Efficacy and safety of warfarin with different anticoagulation intensities in treatment of nonvalvular atrial fibrillation:meta-analysis

作　　者：王航[1] 许晓刚[2] 黄品芳[1] 王长连[1] 

机构地区：[1]福建医科大学附属第一医院药学部,福州350005 [2]福建医科大学药学院,福州350004

出　　处：《第二军医大学学报》2016年第2期256-261,共6页Academic Journal of Second Military Medical University

摘　　要：目的比较不同抗凝强度的华法林对非瓣膜病心房颤动的安全性和疗效。方法检索中国知网（CNKI）、万方数据库（Wanfang Data）、维普科技期刊（VIP）、PubMed、Cochrane Library、EMbase相关随机对照试验,采用Review Manager5.3软件进行meta分析。结果最终有14个临床试验纳入研究,共3 295例患者,其中国际标准化比值（INR）目标区间在1.5~2.0（低抗凝强度组）1 403例,INR目标区间在2.0~3.0（标准抗凝强度组）1 892例。低抗凝强度组总出血发生率明显低于标准抗凝强度组（RR=0.47,95%CI：0.37~0.59,P〈0.000 01）;两组血栓栓塞发生率、缺血性脑卒中发生率、死亡率差异没有统计学意义（RR=1.35,95%CI：1.00~1.84,P=0.05;RR=1.44,95%CI：1.01~2.05,P=0.05;RR=1.06,95%CI：0.85~1.31,P=0.60）。结论低强度华法林抗凝与标准强度相比可降低包括致命和严重出血在内的出血发生率,可能不会提高血栓栓塞发生率。Objective To compare the efficacies and safety of warfarin with different anticoagulation intensities in treatment of nonvalvular atrial fibrillation. Methods Cochrane Library, EMbase, PubMed, Chinese Journal Full-text Database （CNKI）, Wanfang Data and VIP Database （VIP） were searched by computer for randomized controlled trials of warfarin with different anticoagulation intensities in treatment of nonvalvular atrial fibrillation. The analysis was performed using the Review Manager 5.3. Results Finally a total of 14 literatures involving 3 295 participants were included. The results of meta-analysis showed the following： low anticoagulation intensity group （INR： 1.5-2. 0, n= 1 403） had a total bleeding rate significantly lower than the standard anticoagulation intensity group （INR.. 2. 0-3. 0, n= 1 892） （RR= 0. 47, 95G CI： 0. 37-0. 59, P〈 0. 000 01）; there were no significant differences in the incidence of thromboembolism （RR= 1.35, 95 %CI： 1.00-1.84, P： 0.05）, ischemic stroke （RR=1. 44, 95%CI： 1.01-2.05, P=0.05） or mortality （RR=I. 06, 95% CI： 0.85-1.31, P=0.60） between the two groups. Conclusion Warfarin therapy in international normalized ratio of 1.5-2. 0 can reduce the risk of fatal and severe bleeding in patients with nonvalvular atrial fibrillation, and may not increase the incidence of thromboembolism.

关 键 词：华法林 非瓣膜病心房颤动 抗凝强度 META分析 

分 类 号：R541.7[医药卫生—心血管疾病]