在左心房尾封闭后的短期抗血栓策略:系统性审查和网络元分析
Li-Man Wang1,2, Yan Chen1,2, Li-Li Xu1,2
1Department of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, China.
Frontiers in pharmacology
|September 18, 2023
概括
在左心房附属物阻塞 (LAAO) 后最佳的抗血栓治疗仍在争论中. 这项研究发现,在双重抗血小板治疗,直接口服抗凝剂和维生素K对抗剂之间,中风,与设备相关的血栓或出血没有显著差异,尽管VKAs是首选的.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 穿皮左心房尾闭塞 (LAAO) 是针对非膜心房动 (NVAF) 的中风预防策略.
- 抗血栓治疗在LAAO后至关重要,但最佳治疗方案尚不清楚.
- 这项研究比较了根据LAAO程序的抗血栓策略.
研究的目的:
- 为了比较LAAO后不同抗血栓策略的安全性和有效性.
- 评估包括中风,器件相关血栓 (DRT) 和重大出血在内的结果.
- 为LAAO后的抗血栓治疗提供基于证据的建议.
主要方法:
- 在MEDLINE,Embase和Cochrane图书馆进行系统的文献搜索.
- 观察性研究的网络元分析,比较双抗血小板治疗 (DAPT),直接口服抗凝剂 (DOAC) 和维生素K对抗剂 (VKA).
- 风险比率和累积排名曲线 (SUCRA) 下的面积被计算为疗效和安全结果.
主要成果:
- 分析了10项涉及1674名患者的观察性研究.
- 在DAPT,DOAC和VKA之间没有观察到中风,DRT或严重出血的显著差异.
- DAPT显示中风,DRT和出血的排名最差 (SUCRA < 20%),而VKA在中风和DRT预防方面排名最高.
结论:
- 在LAAO后的DAPT,DOAC和VKA之间,关键结果没有显著差异.
- 根据Sucra的分析,DAPT与更高的风险有关,而VKA似乎更可取.
- 由于其方便性,DOAC值得考虑,尽管与VKA相比,中风和DRT的SUCRA排名略低.
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