窦性心力衰竭患者不同抗栓方案预防栓塞事件的有效性和安全性的Meta分析  

Meta-analysis of the Efficacy and Safety of Different Antithrombotic Agents in Preventing Embolic Events in Heart Failure Patients with Sinus Rhythm

作　　者：陈晶晶 马翠 谢珊珊[2] 万瑾瑾 黄志英 林环玉 张卫芳[2] CHEN Jingjing;Ma Cui;XIE Shanshan;WAN Jinjin;HUANG Zhiying;LIN Huanyu;ZHANG Weifang(Quanzhou Guangqian Hospital,Quanzhou Fujian 362321,China;The Second Affiliated Hospital of Nanchang University,Nanchang Jiangxi 330006,China;Fuping Hospital of Traditional Chinese Medicine,Weinan Shanxi 711700,China)

机构地区：[1]泉州市光前医院,福建泉州362321 [2]南昌大学第二附属医院,江西南昌330006 [3]富平县中医医院,陕西渭南711700

出　　处：《药品评价》2024年第3期385-390,共6页Drug Evaluation

摘　　要：目的比较患有心力衰竭(HF)的窦性心律患者使用口服抗凝药(OAC)与抗血小板药(OAP)预防栓塞事件的有效性和安全性。方法从PubMed、Springer、Cochrane图书馆、Elsevier、Wiley、中国知网、万方等电子数据库检索建库至2023年12月关于HF患者使用OAC或OAP的随机对照临床试验(RCTs)中提取人群的卒中、心肌梗死、全因死亡及大出血数据资料后用R语言进行荟萃及偏倚统计分析。结果最终纳入7项大型RCTs(共16823例患者)。分析结果显示,相较于OAP,无论是新型口服抗凝药物(NOAC)还是维生素K拮抗剂(VKA)都可显著降低窦性心律HF患者卒中风险(RR=0.59,95%CI:0.47-0.74,P<0.01,I^(2)=0%),但不降低全因死亡风险(RR=0.87,95%CI:0.75-1.01,P>0.05,I^(2)=65%)。另外,VKA不降低患者心肌梗死的风险(RR=1.08,95%CI:0.80-1.46,P>0.05,I^(2)=0%),却显著增加大出血风险(RR=2.15,95%CI:1.57-2.96,P<0.01,I^(2)=0%)。而NOAC在有效降低患者的心肌梗死风险的情况下(RR=0.78,95%CI:0.65-0.95,P<0.05,I^(2)=0%),不增加大出血风险(RR=1.18,95%CI:0.86-1.62,P>0.05,I^(2)=0%)。结论窦性心律HF患者使用VKA预防栓塞事件有效性与OAP效果相当,但安全性更差,使用NOAC预防栓塞的有效性较OAP效果好,且安全性相当。Objective To explore the efficacy and safety of oral anticoagulant(OAC)or oral antiplatelet(OAP)in heart failure(HF)and sinus rhythm patients.Methods Comprehensive literatures searches were conducted using the PubMed,Springer,Cochrane Library,Elsevier,Wiley,CNKI and WanFang from inception to December 2023.Randomized controlled trials(RCTs)focusing on efficacy and safety of OAC or OAP therapy in HF and sinus rhythm patients.Statistical analyses were performed using R Programming Language.Results Seven large RCTs(16823 patients)were finally included.In patients with HF and sinus rhythm,NOAC and VKA had a favorable point estimate in stroke(RR=0.59,95%CI:0.47-0.74,P<0.01,I^(2)=0%),but comparable to OAP for all cause death(RR=0.87,95%CI:0.75-1.01,P>0.05,I^(2)=65%).In addition,VKA not only didn’t reduce the risk of myocardial infarction(RR=1.08,95%CI:0.80-1.46,P>0.05,I^(2)=0%)in patients but also increases the risk of major bleeding(RR=2.15,95%CI:1.57-2.96,P<0.01,I^(2)=0%).While NOAC can effectively reduce the risk of myocardial infarction(RR=0.78,95%CI:0.65-0.95,P<0.05,I^(2)=0%)in patients without increasing the risk of major bleeding(RR=1.18,95%CI:0.86-1.62,P>0.05,I^(2)=0%).Conclusion Compared with OAP,VKA were similarly effective but less secure for the prevention of embolism event in patients with HF and sinus rhythm,while NOAC had more effective and similarly safe.

关 键 词：口服抗凝药 利伐沙班 窦性心律 心力衰竭 META分析 

分 类 号：R541.6[医药卫生—心血管疾病] R969[医药卫生—内科学]