Wang Zhangsheng, Tang Zeng, Zhu Wenqing, Ge Lei, Ge Junbo
Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, 801, Heqing Rd, Minhang District, Shanghai 200240, China.
Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
Complement Ther Med. 2017 Jun;32:1-10. doi: 10.1016/j.ctim.2017.03.006. Epub 2017 Mar 19.
Traditional Chinese medicine (TCM) in combination with Western medicine (WM) has been widely used worldwide. This systematic review aimed to evaluate the efficacy and safety of TCM in prevention of thromboembolic events in patients with atrial fibrillation (AF).
Potential studies were searched through the Cochrane Library, PubMed, EMBASE, CBM, VIP, CNKI, and Wanfang databases up to February 2016. Randomized controlled trials (RCTs) investigating the thromboembolic events and/or safety outcome of TCM in patients with AF were included.
A total of 905 AF patients from 9 RCTs were identified. Meta-analysis showed that TCM in combination with warfarin was better than warfarin alone for preventing total thromboembolic events with a 68% reduction of risk (risk ratio [RR] 0.32; 95% confidence interval [CI] 0.13-0.78) without increasing the risk of total bleeding (RR 0.71; 95% CI 0.29-1.72). Compared with warfarin, TCM therapy was associated with lower risk of total bleeding (RR 0.13; 95% CI 0.04-0.47), but increased the risk of total thromboembolic events (RR 1.84; 95% CI 1.03-3.27).
This meta-analysis suggests that TCM combined with warfarin is superior to warfarin alone for the prevention of total thromboembolic events in patients with AF, with equal risk of bleeding as warfarin alone.
中西医结合疗法在全球已被广泛应用。本系统评价旨在评估中医在预防心房颤动（AF）患者血栓栓塞事件中的疗效和安全性。
通过检索考克兰图书馆、PubMed、EMBASE、中国生物医学文献数据库（CBM）、维普数据库（VIP）、中国知网（CNKI）和万方数据库，检索截至2016年2月的相关研究。纳入调查中医对AF患者血栓栓塞事件和/或安全性结局影响的随机对照试验（RCT）。
共纳入9项RCT中的905例AF患者。荟萃分析表明，与单用华法林相比，中药联合华法林预防总血栓栓塞事件的效果更好，风险降低68%（风险比[RR]0.32；95%置信区间[CI]0.13 - 0.78），且不增加总出血风险（RR 0.71；95% CI 0.29 - 1.72）。与华法林相比，中药治疗总出血风险较低（RR 0.13；95% CI 0.04 - 0.47），但总血栓栓塞事件风险增加（RR 1.84；95% CI 1.03 - 3.27）。
该荟萃分析表明，在预防AF患者总血栓栓塞事件方面，中药联合华法林优于单用华法林，且出血风险与单用华法林相当。
