在TAVR后患有心房的患者:NOAC比VKA更好吗? - - 一个元分析
Lu Wang1,2, Wanyue Sang1,2, Yi Jian1,2
1Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Frontiers in cardiovascular medicine
|September 18, 2023
概括
新型口服抗凝剂 (NOACs) 显著降低大出血和全因死亡率相比,维生素K对抗剂 (VKAs) 在穿透管大动脉置换 (TAVR) 后心房患者. 在这两组抗凝剂中,中风的发生率与两组抗凝剂相似.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗器械 医疗器械
背景情况:
- 心房动 (AF) 是一个常见的透气管后大动脉置换 (TAVR).
- 抗凝剂对AF患者至关重要,新型口服抗凝剂 (NOAC) 和维生素K对抗剂 (VKA) 都是可选的.
- 在TAVR AF后的人群中比较NOAC和VKA对于优化患者护理至关重要.
研究的目的:
- 为了比较NOACs与VKAs在TAVR之后的AF患者的疗效和安全性.
- 评估关键的临床结果,包括中风,严重出血和全因死亡率.
主要方法:
- 在主要数据库 (PubMed,EMBASE,Medline,Cochrane) 进行了系统的文献搜索,截至2023年1月.
- 进行了对13项研究的元分析,其中包括30388名TAVR后的AF患者.
- 风险比率 (RR),几率比率 (OR),95%置信区间 (CI) 和需要治疗的数量 (NNT) 为复合终点,中风,重大出血和全因死亡率计算.
主要成果:
- 在NOAC和VKA组之间没有观察到中风发病率的显著差异.
- NOAC 组的复合终点事件率在数量上更高,但在统计学上并不显著.
- 与VKA组相比,NOAC组的重大出血率 (RR 0.82,95%CI [0.77,0.88]) 和所有原因死亡率 (RR 0.83,95%CI [0.79,0.88]) 在NOAC组中明显较低.
结论:
- 在TAVR后的AF患者中,NOAC显示大出血和全因死亡率与VKAs相比显著降低.
- 这些发现表明,NOAC可能是这种特定患者群体中抗凝药的更安全替代品.
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