抗血小板与抗凝治疗对于有心力衰竭的人在鼻节律中的治疗
Monika Kozieł-Siołkowska1,2, Eduard Shantsila1,3, Alena Shantsila1
1Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
The Cochrane database of systematic reviews
|June 11, 2025
概括
服用华法林的口服抗凝药 (OAC) 可能不会为心力衰竭患者提供与阿司匹林相比的死亡率优势. 华法林可能会减少心血管事件,但会增加严重出血的风险,与克洛皮多格雷尔的类似发现.
科学领域:
- 心脏病学和血栓形成
- 药理干预心力衰竭的治疗方法
背景情况:
- 慢性心力衰竭患者面临高血栓事件的风险,导致高死亡率.
- 口服抗凝剂 (OAC) 和抗血小板剂是主要的抗血栓治疗方法,OAC标准用于心力衰竭与心房动.
- 关于OAC在心力衰竭患者的有效性和安全性仍然存在不确定性.
研究的目的:
- 评估OAC与抗血小板药物对所有原因死亡率的比较影响.
- 评估对非致命性心血管事件的影响,以及患有鼻腔节律心力衰竭的成年人严重出血的风险.
- 更新关于这个主题的以前的评论.
主要方法:
- 随机对照试验 (RCT) 的系统综述和元分析,比较OAC与抗血小板治疗.
- 在2025年4月更新的主要数据库 (CENTRAL,MEDLINE,Embase,ClinicalTrials.gov,ICTRP) 进行的搜索.
- 纳入标准:患有慢性心力衰竭的成年人在鼻腔节律中,治疗持续时间至少一个月.
主要成果:
- 华法林与阿司匹林在全因死亡率上没有显著差异 (中度确定性证据).
- 与华法林的口服抗凝药可能会减少非致命的心血管事件,但与阿司匹林相比,显著增加大出血风险 (中度确定性证据).
- 华法林与克洛皮多格雷尔相比,死亡率和心血管事件的趋势相似,华法林的出血风险更高 (低确定性证据).
结论:
- 用华法林进行口服抗凝药在心力衰竭患者中与鼻腔节律相比,对阿司匹林的死亡率几乎没有任何益处.
- 华法林使用与减少非致命性心血管事件有关,但增加重大出血的风险.
- 在这种患者群体中,缺乏心力衰竭与保存的喷射分数以及非维生素K对抗剂口服抗凝剂的数据.
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