窦性心律慢性心力衰竭患者抗凝治疗安全性及有效性系统评价  

Efficacy and safety of anticoagulant therapy for patients with heart failure in sinus rhythm

作　　者：李姮 李永辉[1] 孙小强[1] 王琳[1] 何峰[1] Li Heng;Li Yonghui;Sun Xiaoqiang;Wang Lin;He Feng(Department of Cardiology,Tianjin Fourth Central Hospital,Tianjin 300140,China)

机构地区：[1]天津市第四中心医院心脏科,天津300140

出　　处：《临床荟萃》2022年第5期406-411,共6页Clinical Focus

摘　　要：目的探讨窦性心律慢性心力衰竭患者预防性应用抗凝治疗的安全性及有效性。方法采用荟萃分析方法,检索Pubmed、Embass、Cochrane数据库建库至2021年6月1日窦性心律心力衰竭患者抗凝治疗相关研究,探讨预防性抗凝药物应用在窦性心律心力衰竭患者中的安全性及有效性。结果共纳入9项研究,meta分析显示:抗凝治疗组与非抗凝治疗组相比,全因病死率(OR=0.87,95%CI:0.75~1.01,P=0.08)、心肌梗死发生率(OR=0.86,95%CI:0.71~1.04,P=0.12)、心力衰竭相关再入院率(OR=0.90,95%CI:0.75~1.07,P=0.23)差异无统计学意义,相对于非抗凝治疗患者,积极抗凝治疗能够显著降低缺血性卒中风险(OR=0.38,95%CI:0.16~0.93,P=0.03),但同时,增加主要出血事件风险(OR=1.69,95%CI:1.43~2.00,P<0.05)。结论在窦性心律心力衰竭患者中预防性应用抗凝治疗,能够有效降低卒中风险,其全因病死率及心肌梗死发生率有降低趋势,同时也可显著增加出血风险。Objective To investigate the safety and efficacy of prophylactic anticoagulant therapy in patients with heart failure in sinus rhythm.Methods The related research of anticoagulant therapy for patients with heart failure in sinus rhythm were collected from Pubmed,Embass,Cochrane databases for a Meta-analysis,the deadline was until June 1,2021.The safety and efficacy of anticoagulant drugs preventing heart failure in sinus rhythm were assessed.Results Eligible 9 studies were included.Meta-analysis confirmed the difference was not statistically significant in the all-cause mortality rate(OR=0.87,95%CI:0.75-1.01,P=0.08),myocardial infarction rate(OR=0.86,95%CI:0.71-1.04,P=0.12),related readmission rate(OR=0.90,95%CI:0.75-1.07,P=0.23)between anticoagulant therapy and non-anticoagulant therapy.Compared with non-anticoagulant therapy,anticoagulant therapy could significantly reduce the risk of ischemic stroke(OR=0.38,95%CI:0.16-0.93,P=0.03),but meantime,increase the bleeding risk(OR=1.69,95%CI:1.43-2.00,P<0.05).Conclusion Anticoagulant therapy can effectively reduce stroke risk for patients with heart failure in sinus rhythm.Although the all-cause mortality rate and myocardial infarction rate of these patients tend to decrease,bleeding risk should be attention.

关 键 词：心力衰竭 窦性心律 抗凝药 血小板聚集抑制剂 

分 类 号：R541.6[医药卫生—心血管疾病]