经导管主动脉瓣置入术后维生素K与非维生素K拮抗剂治疗高危心房颤动患者的系统评价与Meta分析  

Vitamin K vs.non-vitamin K antagonist treatment in high-risk atrial fibrillation patients after transcatheter aortic valve implantation:A systematic review and metaanalysis

作　　者：李露露 蒙延海[1] 曲开勇 李泽蒙 张燕搏[1] LI Lulu;MENG Yanhai;QU Kaiyong;LI Zemeng;ZHANG Yanbo(Postoperative Recovery Center,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院成人外科术后恢复中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2025年第4期534-540,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：中央高水平医院临床科研业务费(2023-GSP-GG-11,2023-GSP-QN-14)。

摘　　要：目的评价经导管主动脉瓣置入术(transcatheter aortic valve implantation,TAVI)后,合并高危心房颤动(atrial fibrillation,AF)患者应用非维生素K拮抗剂口服抗凝药(non-vitamin K antagonist oral anticoagulant,NOAC)和维生素K拮抗剂(vitamin K antagonist,VKA)的抗凝治疗效果。方法计算机检索PubMed、EMbase、The Cochrane Library、中国知网、中国医学生物文献服务系统及维普数据库,收集所有关于NOAC和VKA在合并高危AF患者TAVI后应用的相关研究。检索时限从建库至2023年1月。根据Cochrane风险评估工具和纽卡斯尔-渥太华量表(the Newcastle-Ottawa Scale,NOS)评价纳入文献的质量。利用RevMan 5.4软件进行Meta分析。结果共纳入7篇文献,包含24592例患者。Meta分析结果显示,与应用VKA患者相比,应用NOAC的患者全因死亡风险明显降低[RR=0.74,95%CI(0.58,0.94),P=0.01]。亚组分析表明,随访时间<1年时,NOAC和VKA组患者的全因死亡率差异无统计学意义[RR=0.57,95%CI(0.17,1.88),P=0.35];随访时间≥1年时,VKA组的全因死亡率高于NOAC组,差异具有统计学意义[RR=0.73,95%CI(0.57,0.95),P=0.02]。两组患者在早期卒中[RR=0.50,95%CI(0.19,1.28),P=0.15]、随访期卒中[RR=1.04,95%CI(0.88,1.22),P=0.64]及出血[RR=0.94,95%CI(0.73,1.21),P=0.61]、严重或危及生命的大出血[RR=0.80,95%CI(0.49,1.31),P=0.38]、急性肾损伤[RR=0.51,95%CI(0.16,1.59),P=0.24]方面差异均无统计学意义。结论与应用VKA相比,在合并高危AF患者TAVI后应用NOAC可降低患者的全因死亡风险,特别是在长期抗凝治疗中可能产生更多获益,但研究结果仍需要进一步循证医学证据的证实。Objective To evaluate the anticoagulation efficacy of non-vitamin K antagonist oral anticoagulants(NOACs)and vitamin K antagonists(VKAs)in patients with high-risk atrial fibrillation(AF)undergoing transcatheter aortic valve implantation(TAVI).Methods A computer-based search was conducted on PubMed,EMbase,The Cochrane Library,CNKI,SinoMed,and VIP databases to identify studies on the application of NOACs and VKAs in highrisk AF patients after TAVI.The search period was from database inception to January 2023.The quality of the included studies was assessed using the Cochrane risk assessment tool and the Newcastle-Ottawa Scale(NOS).Meta-analysis was performed using RevMan 5.4 software.Results A total of 7 studies involving 24592 patients were included.The metaanalysis results showed that compared to patients using VKAs,those treated with NOACs had a significantly lower risk of all-cause mortality[RR=0.74,95%CI(0.58,0.94),P=0.01].Subgroup analysis indicated that when the follow-up period was less than 1 year,there was no significant difference in all-cause mortality between the NOAC and VKA groups[RR=0.57,95%CI(0.17,1.88),P=0.35];however,when the follow-up period was≥1 year,the VKA group had a higher all-cause mortality rate than the NOAC group,with a statistically significant difference[RR=0.73,95%CI(0.57,0.95),P=0.02].No significant differences were found between the two groups regarding early stroke[RR=0.50,95%CI(0.19,1.28),P=0.15],stroke during follow-up[RR=1.04,95%CI(0.88,1.22),P=0.64],bleeding[RR=0.94,95%CI(0.73,1.21),P=0.61],major or life-threatening bleeding[RR=0.80,95%CI(0.49,1.31),P=0.38],or acute kidney injury[RR=0.51,95%CI(0.16,1.59),P=0.24].Conclusion Compared to VKAs,the use of NOACs in patients with high-risk AF undergoing TAVI may reduce the risk of all-cause mortality,especially during long-term anticoagulation therapy,potentially offering greater benefits.However,further evidence from randomized controlled trials is needed to confirm these findings.

关 键 词：非维生素K拮抗剂口服抗凝药 维生素K拮抗剂 经导管主动脉瓣置入术 心房颤动 系统评价/META分析 

分 类 号：R541.7[医药卫生—心血管疾病]