心房颤动导管消融围术期不间断新型口服抗凝剂和不间断华法林抗凝导致心脏压塞风险的荟萃分析  

Risks of cardiac tamponade resulting from uninterrupted novel oral anticoagulants and uninterrupted warfarin during perioperative period of catheter ablation of atrial fibrillation:A meta-analysis

作　　者：马静红 杨倩[2] 贾永建 党懿[2] Ma Jinghong;Yang Qian;Jia Yongjian;Dang Yi(Graduate School of Hebei North University,Zhangjiakou 075000,China;Department of Cardiology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北北方学院研究生院,河北张家口075000 [2]河北省人民医院心内科,河北石家庄050051

出　　处：《临床荟萃》2022年第9期773-778,共6页Clinical Focus

摘　　要：目的综合评估心房颤动(房颤)导管消融围术期不间断新型口服抗凝剂(novel oral anticoagulants,NOACs)和华法林抗凝导致心脏压塞的风险。方法检索PubMed、EMBase和Cochrane Library数据库,获取从应用NOACs至2022年2月发表的房颤导管消融围术期NOACs不间断抗凝治疗和华法林不间断抗凝治疗导致心脏压塞的研究。并使用Cochrane偏倚风险评估工具和MINORS(methodological index for nonrandomized studies)进行文献质量评价,Review manager 5.3软件对所收集的数据进行统计学分析。结果共纳入13项研究,7701例房颤消融患者。此荟萃分析显示:房颤导管消融围术期不间断NOACs和华法林抗凝导致心脏压塞的风险差异无统计学意义(RR=0.79,95%CI:0.49~1.30,P=0.36)。亚组分析显示:房颤导管消融围术期NOACs和华法林不间断抗凝导致心脏压塞需要开胸手术干预或输血治疗的风险差异无统计学意义(RR=0.94,95%CI:0.48~1.86,P>0.05);不同种类的NOACs分别与华法林比较,均不增加心脏压塞的风险(P>0.05)。结论与不间断华法林抗凝相比,房颤导管消融围术期不间断NOACs抗凝并不增加心脏压塞的风险。Objective To comprehensively assess risks of cardiac tamponade resulting from uninterrupted novel oral anticoagulants(NOACs)versus uninterrupted warfarin during the perioperative period of catheter ablation(CA)of atrial fibrillation(AF).Methods PubMed,EMBase and Cochrane Library databases were searched for studies on cardiac tamponade during the perioperative period of CA of AF with uninterrupted NOACs and warfarin from the time of NOACs application to February 2022.The Cochrane risk of bias assessment tool and MINORS(methodological index for nonrandomized studies)were adopted to evaluate the quality of literature,and Review manager 5.3 software was applied for statistical analysis on the collected data.Results A total of 13 studies involving 7,701 patients were included.The meta-analysis showed that the difference in the risk of cardiac tamponade resulting from uninterrupted NOACs and warfarin during the perioperative period of CA of AF was statistically significant(RR=0.79,95%CI:0.49-1.30,P=0.36).Subgroup analysis showed that the difference in the risk of cardiac tamponade requiring thoracotomy intervention or blood transfusion between uninterrupted NOACs and warfarin during the perioperative period of CA of AF wasn’t statistically significant(RR=0.94,95%CI:0.48-1.86,P>0.05).The risk of cardiac tamponade wasn’t elevated in comparisons between different types of NOACs versus warfarin(P>0.05).Conclusion Uninterrupted NOACs don’t elevate the risk of cardiac tamponade during the perioperative period of CA of AF compared with uninterrupted anticoagulation of warfarin.

关 键 词：心房颤动 导管消融 新型口服抗凝剂 华法林 不间断 Meta分析 

分 类 号：R541.7[医药卫生—心血管疾病]