左心室尾关闭与心房的口服抗凝剂:系统性审查和元分析
Chen Wang1,2,3, Dan Zhu1,2,3, Jinliang Nan1,2,3
1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
Journal of cardiovascular development and disease
|December 24, 2025
概括
左心房附属体 (LAA) 关闭是一种安全有效的替代口服抗凝剂,用于预防心房患者中风. 这种程序显著降低死亡率和复合终点,而不会增加中风或出血风险.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床试验 临床试验
背景情况:
- 心房动 (AF) 需要预防中风,口服抗凝剂 (OAC) 作为标准治疗.
- 左心房附属体 (LAA) 关闭提供了OAC的替代方案,但比较的疗效和安全性数据需要系统的评估.
研究的目的:
- 系统地评估LAA关闭与OAC在AF患者中风预防中的比较有效性和安全性.
- 综合来自随机对照试验 (RCT) 和倾向得分匹配 (PSM) 研究的证据.
主要方法:
- 在主要数据库 (PubMed,EmBase,Cochrane图书馆,Web of Science) 进行了全面的文献搜索.
- 包括的研究包括到2025年9月发表的RCT和PSM研究.
- 使用随机效应模型进行的元分析估计了治疗效果 (相对风险与95%信心区间).
主要成果:
- 分析了15项涉及17116名AF患者的研究.
- 关闭LAA显著降低了复合终点 (RR:0.79;95%CI:0.66-0.95) 和所有原因死亡率 (RR:0.58;95%CI:0.49-0.69).
- 在LAA关闭和OAC之间,在中风 (任何,缺血性,出血性) 或重大出血的风险上没有发现显著差异.
结论:
- 与AF患者的OAC相比,LAA关闭表明死亡率和复合临床终点显著降低.
- 脑卒中和严重出血的风险在LAA关闭和OAC之间是可比的.
- 关闭LAA对于不适合长期抗凝药的AF患者来说是一个有利的选择.
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