持续口服华法林和肝素桥接对心房颤动消融术后并发症影响的Meta分析  

Meta-analysis of postoperative complications effect comparison between continuous warfarin and heparin bridging after ablation of atrial fibrillation

作　　者：吴慧婷[1] 钱成[1] 丁进叶 魏宝柱 皮阳[1] 王扬淦[1] 

机构地区：[1]武汉大学中南医院心内科,武汉430071

出　　处：《中国循证心血管医学杂志》2016年第5期520-523,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 比较持续口服华法林和肝素桥接两种不同的抗凝方案对心房颤动（房颤）消融术后并发症的影响.方法 系统检索Pubmed、The Cochrane Library、Embase、中国生物医学文献数据库（CBM）、中国知网（CNKI）及万方数据库,并查阅相关综述的参考文献,时间截至2015年6月31日,纳入满足入选标准的研究.结果 最终纳入文献共14篇,包括观察性研究13篇及随机对照试验1篇.总样本量为17 496例,其中持续华法林组7909例,肝素桥接组9587例.总体结果显示,与肝素桥接治疗相比,持续华法林治疗能减少围手术期卒中或短暂脑缺血事件（RR=0.29,95%CI0.16-0.69,P〈0.01）.在出血并发症发面,持续华法林治疗相比肝素桥接可降低大出血（RR=0.15,95%CI：0.08-0.29,P〈0.01）和小出血风险（RR=0.70,95%CI：0.55-0.88,P〈0.01）.结论 相比肝素桥接而言,房颤消融围手术期持续口服华法林可减少血栓栓塞事件,同时降低出血风险.Objective To compare the influence of postoperative complications after ablation of atrialfibrillation between two different anticoagulation strategies continuous warfarin and heparin bridging. MethodsPubmed, The Cochrane Library, Embase, CBM, CNKI and Wanfang database were systematically searched foreligible studies. We also searched the references of relevant reviews for more trials. Only studies that met ourpre-defined included criteria up to 31 June, 2015 were enrolled in our Meta-analysis. Results Fourteen studies,including 13 observational studies and 1 randomized controlled trial, were finally included in our study with atotal of 17 496 subjects. There were 7909 patients in continuous warfarin group and 9587 patients in heparinbridging group. Compared to heparin bridging, continuous warfarin was associated with fewer stroke or transientischemic attacks events [RR=0.29, 95%CI：（0.16,0.69）, P〈0.01]. For bleeding complications, continuous warfarinadministration could reduce the risk of major bleeding [RR=0.15, 95%CI：（0.08, 0.29）, P〈0.01] and minor bleeding[RR=0.70, 95%CI：（0.55, 0.88）, P〈0.01]. Conclusion Compared with heparin bridging, postoperative continuouswarfarin was associated with reduced risks of thromboembolism and bleeding in ablation of atrial fibrillation.

关 键 词：心房颤动 消融 抗凝 META分析 

分 类 号：R541.75[医药卫生—心血管疾病]