Liu Ting, Hui Jie, Hou Yun-Ying, Zou Yan, Jiang Wen-Ping, Yang Xiang-Jun, Wang Xiao-Hua
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China; School of Nursing Soochow University, No.1. Shizi Street, Suzhou, China.
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Am J Cardiol. 2017 Nov 1;120(9):1562-1567. doi: 10.1016/j.amjcard.2017.07.050. Epub 2017 Jul 31.
For patients with nonvalvular atrial fibrillation (NVAF) receiving warfarin therapy, the target international normalized ratio range of 2.0 to 3.0 is recommended by Western countries. However, this treatment carries a higher risk of bleeding which suggests more researches on whether low-intensity warfarin therapy (range <2.0 to 3.0) is suitable for East Asian patients. Three databases were searched from inception to April 21, 2016. Studies that reported thromboembolic and hemorrhagic events in low- and standard-intensity warfarin groups were included. Finally, seven studies were included in the analysis. There was a significantly decreased risk of hemorrhagic events (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.43 to 0.82, p = 0.002) with no statistically increased risk of thromboembolic events (OR 1.14, 95% CI 0.80 to 1.62, p = 0.47) in the 1.5 to 2.0 group compared with that of the 2.0 to 3.0 group. Meanwhile, there was no significant difference of cardiovascular mortality (OR 1.58, 95% CI 0.89 to 2.83, p = 0.12) between the 2 groups. Further analysis showed there was no significance in thromboembolic events (OR 1.15, 95% CI 0.83 to 1.60, p = 0.40), major bleeding events (OR 0.74, 95% CI 0.50 to 1.09, p = 0.13), and cardiovascular mortality (OR 1.45, 95% CI 0.79 to 2.65, p = 0.23) between 1.5 to 2.5 and 2.0 to 3.0 groups. Although no significant difference was found in hemorrhagic events (OR 0.76, 95% CI 0.57 to 1.01, p = 0.06), there was a decreased trend in it. In conclusion, low-intensity warfarin therapy can achieve reduced hemorrhage without increasing thromboembolism for East Asian patients with NVAF receiving warfarin therapy.
对于接受华法林治疗的非瓣膜性心房颤动（NVAF）患者，西方国家推荐的国际标准化比值目标范围为2.0至3.0。然而，这种治疗方法出血风险较高，这表明需要更多关于低强度华法林治疗（范围<2.0至3.0）是否适用于东亚患者的研究。检索了三个数据库，时间跨度从建库至2016年4月21日。纳入报告低强度和标准强度华法林组血栓栓塞和出血事件的研究。最终，七项研究纳入分析。与2.0至3.0组相比，1.5至2.0组出血事件风险显著降低（比值比[OR]0.59，95%置信区间[CI]0.43至0.82，p = 0.002），血栓栓塞事件风险无统计学意义上的增加（OR 1.14，95%CI 0.80至1.62，p = 0.47）。同时，两组心血管死亡率无显著差异（OR 1.58，95%CI 0.89至2.83，p = 0.12）。进一步分析显示，1.5至2.5组与2.0至3.0组在血栓栓塞事件（OR 1.15，95%CI 0.83至1.60，p = 0.40）、大出血事件（OR 0.74，95%CI 0.50至1.09，p = 0.13）和心血管死亡率（OR 1.45，95%CI 0.79至2.65，p = 0.23）方面无显著差异。虽然出血事件无显著差异（OR 0.76，95%CI 0.57至1.01，p = 0.06），但有下降趋势。总之，对于接受华法林治疗的东亚NVAF患者，低强度华法林治疗可在不增加血栓栓塞的情况下减少出血。
