在左前庭尾闭塞后初始抗血栓治疗方案的网络元分析
Pedro E P Carvalho1, Douglas M Gewehr2, Isabele A Miyawaki3
1Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Journal of the American College of Cardiology
|August 23, 2023
概括
直接口服抗凝剂 (DOACs) 显示出降低左心房附属物阻塞 (LAAO) 后血栓栓塞事件和死亡率的承诺. 双重抗血小板治疗 (DAPT) 与单一抗血小板治疗 (SAPT) 相比也减少了事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成研究研究
背景情况:
- 对于非膜性心房动 (AF) 的左心房尾闭塞 (LAAO) 后的最佳抗血栓治疗尚未确定.
- 目前的证据缺乏关于最有效和安全的抗血栓策略的明确指导.
研究的目的:
- 通过LAAO,比较各种抗血栓策略的疗效和安全性.
- 为了确定接受LAAO的患者最佳的抗血栓治疗方案.
主要方法:
- 在多个数据库 (Medline,Cochrane,EMBASE,LILACS,ClinicalTrials.gov) 中进行了系统的文献搜索.
- 对41项研究 (12,451名患者) 进行了一项频率随机效应模型网络元分析.
- 结果按抗血栓治疗分层:DOACs,VKAs,SAPT,DAPT和组合,与没有治疗相比.
主要成果:
- 在预防设备相关血栓形成方面,DAPT,DOAC,DOAC加SAPT和VKA优于没有治疗.
- 在DOAC单一治疗中,所有原因的死亡率都低于VKA.
- 与SAPT相比,DAPT显示出较少的血栓栓塞事件,但没有增加重大出血.
结论:
- 单一的DOAC治疗似乎是最有利的策略,可以减少血栓栓塞事件和LAAO后的大型出血.
- 对于无法耐受抗凝药的患者,DAPT可能是一个合适的替代方案,与SAPT相比,它可以减少血栓栓塞事件.
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