DOACs与华法林在AF与共发性CKD或膜疾病:一个系统的审查和元分析
Aileen Liang1, Cathy Wang1, Alla E Iansavitchene2
1Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Blood vessels, thrombosis & hemostasis
|December 24, 2025
概括
直接口服抗凝剂 (DOACs) 与心房 (AF) 和慢性病 (CKD) 或膜疾病患者的华法林相比,降低了出血和中风风险. 这些发现表明,在预防血栓栓塞事件和减少这些特定患者群体出血方面,DOACs可能更优越.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 直接口服抗凝剂 (DOAC) 通常不适用于心房 (AF) 的患者,这些患者有膜疾病或严重慢性病 (CKD).
- 华法林一直是这些患者群体的首选抗凝剂.
- 在这些特定群体中,DOACs的安全性和有效性需要彻底评估.
研究的目的:
- 评估与华法林相比,DOACs在AF患者的安全性和有效性.
- 具体评估同时患有膜疾病或CKD的患者的结果.
- 确定DOAC是否在这些人群中提供出血和血栓塞栓事件方面的好处.
主要方法:
- 进行了随机对照试验 (RCT) 和非RCT的系统审查.
- 搜索了包括MEDLINE,Embase和基于证据的医学评论在内的数据库.
- 包括报告AF和CKD或膜疾病患者出血,中风或血栓栓塞的研究,比较DOACs (rivaroxaban,dabigatran,apixaban,edoxaban) 与华法林.
- 使用随机效应模型进行了元分析.
主要成果:
- 包括110项研究,涉及超过40万名患者.
- 与华法林相比,在患有AF和CKD的患者中,DOACs显著减少出血 (OR,0.66;95%CI,0.49-0.88) 和中风 (OR,0.60;95%CI,0.43-0.85),特别是在晚期CKD和透析患者中.
- 与华法林相比,在患有AF和膜疾病的患者中,DOACs也显示出降低了出血 (OR,0.75;95% CI,0.57-0.97) 和中风发生率 (OR,0.66;95% CI,0.47-0.93).
结论:
- 在患有AF和同时出现的CKD或膜疾病的患者中,DOAC显示出有利的安全性和有效性.
- 在预防血栓栓塞事件和减少这些患者群体的出血方面,DOAC可能与华法林相当或优于华法林.
- 这些发现支持考虑对患有这些特定并发症的AF患者进行DOAC.
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