心房颤动合并透析患者使用利伐沙班或阿哌沙班的有效性和安全性的meta分析  

Efficacy and safety of rivaroxaban or apixaban in atrial fibrillation patients with dialysis: a meta-analysis

作　　者：李佳琪 鲁静朝[1] 靳雅琼[1] 王梦肖[1] 张洁[1] 王科科 王莉华[2] 刘凡[1] LI Jiaqi;LU Jingchao;JIN Yaqiong;WANG Mengxiao;ZHANG Jie;WANG Keke;WANG Lihua;LIU Fan(Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang,050000,China;Department of Hemodialysis,the Second Hospital of Hebei Medical University,Shijiazhuang,050000,China)

机构地区：[1]河北医科大学第二医院心内二科,石家庄050000 [2]河北医科大学第二医院血液透析科

出　　处：《临床心血管病杂志》2024年第1期33-39,共7页Journal of Clinical Cardiology

摘　　要：目的:评估与维生素K口服抗凝剂(VKA)相比,在心房颤动(房颤)合并透析患者中使用利伐沙班或阿哌沙班抗凝的有效性和安全性。方法:计算机检索PubMed、Embase、Cochrane Library、中国知网、万方、中国生物医学文献数据库(CBM)中收录的相关研究,检索时间为从各数据库建库到2023年4月16日。采用RevMan5.4软件进行meta分析。结果:最终纳入8项研究,其中随机对照试验(RCT)3项,回顾性队列研究5项,共纳入39 274例患者,其中7 727例接受利伐沙班或阿哌沙班抗凝,31 547例接受VKA抗凝。Meta分析结果显示,与VKA相比,在有效性结局方面,利伐沙班或阿哌沙班与卒中/系统性栓塞(RR=0.82,95%CI 0.71~0.95,P=0.01)和全因死亡(RR=0.83,95%CI 0.75~0.91,P<0.000 1)的发生率降低相关;在安全性结局方面,利伐沙班或阿哌沙班与胃肠道出血(RR=0.80,95%CI 0.69~0.93,P=0.005)的发生风险降低相关,但在大出血和颅内出血发生风险上,与VKA相比差异无统计学意义。亚组分析表明,利伐沙班与胃肠道出血(RR=0.60,95%CI 0.40~0.92,P=0.02)风险降低相关;阿哌沙班与卒中/系统性栓塞(RR=0.85,95%CI 0.73~1.00,P=0.04)、全因死亡(RR=0.82,95%CI 0.74~0.90,P<0.0001)、大出血(RR=0.71,95%CI 0.63~0.79,P<0.000 01)及胃肠道出血(RR=0.84,95%CI 0.71~0.99,P=0.03)的发生风险降低相关;低剂量的利伐沙班或阿哌沙班与大出血(RR=0.69,95%CI 0.59~0.80,P<0.000 01)风险降低相关。敏感性分析与总体meta分析得出相似结果。结论:在房颤合并透析患者中,相比于VKA,利伐沙班或阿哌沙班抗凝显示出良好的风险-收益特征,是VKA的合理替代品。Objective To assess the efficacy and safety of rivaroxaban or apixaban compared to vitamin K anticoagulants(VKA)in atrial fibrillation(AF)patients with dialysis.Methods Relevant studies were identified through computer searches of databases including PubMed,Embase,Cochrane Library,CNKI,Wanfang Data,and China Biology Medicine(CBM),from the inception of each database until April 16,2023.Meta-analysis was performed using RevMan 5.4 software.Results A total of 8 studies were included,comprising 3 randomized controlled trials(RCT)and 5 retrospective cohort studies,with a cumulative enrollment of 39274 patients.Among them,7727 patients received rivaroxaban or apixaban,while 31547 patients received VKA.The meta-analysis results revealed that,in terms of efficacy outcomes,rivaroxaban or apixaban were associated with a decreased incidence of stroke/systemic embolism(RR=0.82,95%CI 0.71-0.95,P=0.01)and all-cause death(RR=0.83,95%CI 0.75-0.91,P<0.0001),compared to VKA.Regarding safety outcomes,rivaroxaban or apixaban were associated with a decreased risk of gastrointestinal bleeding(RR=0.80,95%CI 0.69-0.93,P=0.005).However,there was no statistically significant difference compared to VKA in terms of major bleeding and intracranial bleeding.Subgroup analysis indicated that rivaroxaban was only associated with a decreased risk of gastrointestinal bleeding(RR=0.60,95%CI 0.40-0.92,P=0.02).On the other hand,apixaban was associated with a decreased risk of stroke/systemic embolism(RR=0.85,95%CI 0.73-1.00,P=0.04),all-cause death(RR=0.82,95%CI 0.74-0.90,P<0.0001),major bleeding(RR=0.71,95%CI 0.63-0.79,P<0.00001),and gastrointestinal bleeding(RR=0.84,95%CI 0.71-0.99,P=0.03).Low-dose rivaroxaban or apixaban was associated with a decreased risk of major bleeding(RR=0.69,95%CI 0.59-0.80,P<0.00001).Sensitivity analysis was consistent with the overall meta-analysis findings.Conclusion In AF patients with dialysis,using rivaroxaban or apixaban demonstrates a favorable risk-benefit profile compared to VKA.Rivaroxaban or apixaban may serve a

关 键 词：心房颤动 透析 利伐沙班 阿哌沙班 维生素K口服抗凝剂 

分 类 号：R541.7[医药卫生—心血管疾病]