非维生素K拮抗剂口服抗凝药（NOACs）治疗的心房颤动患者复律后的结局：一项荟萃分析的见解

Outcomes After Cardioversion in Atrial Fibrillation Patients Treated with Non-Vitamin K Antagonist Oral Anticoagulants (NOACs): Insights from a Meta-Analysis.

作者信息

Sen Parijat, Kundu Amartya, Sardar Partha, Chatterjee Saurav, Nairooz Ramez, Amin Hossam, Aronow Wilbert S

机构信息

Department of Medicine, St. Michael's Medical Center, Newark, NJ, USA.

Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.

出版信息

Am J Cardiovasc Drugs. 2016 Feb;16(1):33-41. doi: 10.1007/s40256-015-0136-1.

DOI:10.1007/s40256-015-0136-1

PMID:26138204

Abstract

BACKGROUND

There are limited data on outcomes following cardioversion in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). A meta-analysis was performed to evaluate the efficacy and safety of NOACs in patients with AF undergoing cardioversion.

METHODS

PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched from January 1, 2001 through to October 30, 2014. Randomized controlled trials (RCTs) comparing NOACs (apixaban, rivaroxaban and dabigatran) with warfarin in AF patients undergoing cardioversion were selected. The primary efficacy outcome was stroke and systemic embolism, and the primary safety outcome was major or clinically relevant non-major (CRNM) bleeding. We used random-effects models.

RESULTS

Four RCTs were included, involving a total of 3635 randomized participants who underwent a total of 4257 cardioversions. A total of 12 events of stroke and systemic embolism were found in the NOAC group and ten events in the warfarin group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.31-1.72]. Risk of major or CRNM bleeding was not different with NOACs, when compared with warfarin (OR 1.41, 95% CI 0.87-2.28).

CONCLUSIONS

Data from patients enrolled in RCTs, showed that NOACs are effective and safe for AF patients undergoing cardioversion.

摘要

背景

关于接受非维生素K拮抗剂口服抗凝药（NOACs）治疗的心房颤动（AF）患者复律后的预后数据有限。进行了一项荟萃分析，以评估NOACs在接受复律的AF患者中的疗效和安全性。

方法

检索了2001年1月1日至2014年10月30日期间的PubMed、Cochrane图书馆、EMBASE、Web of Science和CINAHL数据库。选择了比较NOACs（阿哌沙班、利伐沙班和达比加群）与华法林用于接受复律的AF患者的随机对照试验（RCTs）。主要疗效结局为卒中及全身性栓塞，主要安全性结局为大出血或临床相关非大出血（CRNM）。我们使用随机效应模型。

结果

纳入了4项RCTs，共涉及3635名随机参与者，他们总共进行了4257次复律。在NOAC组中发现了12例卒中及全身性栓塞事件，在华法林组中发现了10例事件[比值比（OR）0.73，95%置信区间（CI）0.31 - 1.72]。与华法林相比，NOACs导致大出血或CRNM的风险没有差异（OR 1.41，95% CI 0.87 - 2.28）。