Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B18 7QH, UK.
Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Age Ageing. 2018 Jan 1;47(1):9-17. doi: 10.1093/ageing/afx103.
the study analysed the effectiveness and safety of warfarin use compared with warfarin non-use and non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients aged ≥65 years.
after searching PubMed and the Cochrane Library, 26 studies were included, with 10 comparing warfarin with warfarin non-use and 16 comparing warfarin with NOACs, in older AF patients (≥65 years).
warfarin use was superior to no antithrombotic therapy [relative risk (RR) 0.59, 95% confidence interval (CI) 0.51-0.76, I2 = 12.3%, n = 8] and aspirin (RR 0.44, 95% CI 0.24-0.64, I2 = 0.0%, n = 5) for stroke/thromboembolism (TE) prevention. Warfarin use was associated with a non-significant increase in risk of major bleeding compared with no antithrombotic therapy (RR 1.26, 95% CI 0.99-1.52, I2 = 0.0%, n = 7) and aspirin (RR 1.20, 95% CI 0.91-1.50, I2 = 0.0%, n = 5). NOACs were superior to warfarin for stroke/TE prevention [hazard ratio (HR) 0.81, 95% CI 0.73-0.89, I2 = 56.6%, n = 9], and also were associated with reduced risk of major bleeding compared to warfarin (HR 0.87, 0.77-0.97, I2 = 86.1%, n = 9).
warfarin use was superior to warfarin non-use, aspirin and no antithrombotic therapy in reducing the risk of stroke/TE in older AF patients, but with a possible increase in major bleeding. NOACs were superior to warfarin for stroke/TE prevention, with reduced risk of major bleeding.
本研究分析了华法林在年龄≥65 岁的房颤（AF）患者中的使用与不使用华法林和非维生素 K 拮抗剂口服抗凝剂（NOACs）的有效性和安全性。
在搜索 PubMed 和 Cochrane 图书馆后，纳入了 26 项研究，其中 10 项比较了华法林与不使用华法林，16 项比较了华法林与 NOACs，涉及年龄较大的 AF 患者（≥65 岁）。
与无抗血栓治疗[相对风险（RR）0.59，95%置信区间（CI）0.51-0.76，I2=12.3%，n=8]和阿司匹林[RR 0.44，95%CI 0.24-0.64，I2=0.0%，n=5]相比，华法林的使用更能预防中风/血栓栓塞（TE）。与无抗血栓治疗（RR 1.26，95%CI 0.99-1.52，I2=0.0%，n=7）和阿司匹林（RR 1.20，95%CI 0.91-1.50，I2=0.0%，n=5）相比，华法林的使用与大出血风险的非显著性增加相关。NOACs 在预防中风/TE 方面优于华法林[风险比（HR）0.81，95%CI 0.73-0.89，I2=56.6%，n=9]，与华法林相比，也降低了大出血风险（HR 0.87，95%CI 0.77-0.97，I2=86.1%，n=9）。
华法林的使用在降低年龄较大的 AF 患者中风/TE 风险方面优于不使用华法林、阿司匹林和无抗血栓治疗，但可能增加大出血风险。NOACs 在预防中风/TE 方面优于华法林，且大出血风险降低。
