From the Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (M.P., I.R., G.F.R., G.Y.H.L.); Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (M.P.); Department of Public Health and Infectious Disease, Sapienza-University of Rome, Italy (A.F.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Denmark (G.Y.H.L.).
Stroke. 2018 Jan;49(1):98-106. doi: 10.1161/STROKEAHA.117.018395. Epub 2017 Nov 22.
The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation.
We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs.
From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64-0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents (<0.00001 for all comparisons).
Use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.
由于非维生素 K 拮抗剂口服抗凝剂的出现，房颤卒中预防中口服抗凝剂的应用发生了转变。关于非维生素 K 拮抗剂口服抗凝剂的真实世界研究将有助于阐明其在日常临床实践中的有效性和安全性。阿哌沙班是第三种被引入临床实践的非维生素 K 拮抗剂口服抗凝剂，并且越来越多的真实世界研究已经发表。我们的目的是总结关于阿哌沙班预防房颤卒中的真实世界研究的现有证据。
我们对所有比较阿哌沙班与其他可用口服抗凝药物的观察性真实世界研究进行了系统评价和荟萃分析。
从最初检索到的 9680 个结果中，有 16 项研究纳入最终的荟萃分析。与华法林相比，阿哌沙班常规剂量在降低任何血栓栓塞事件方面更有效（优势比：0.77；95%置信区间：0.64-0.93），但卒中风险无显著差异。阿哌沙班在降低血栓栓塞事件和卒中方面与达比加群和利伐沙班同样有效。与华法林、达比加群和利伐沙班相比，阿哌沙班发生大出血的风险显著降低（相对风险降低分别为 38%、35%和 46%）。同样，与华法林和利伐沙班相比，阿哌沙班发生颅内出血的风险也显著降低（分别为 46%和 54%），但与达比加群无差异。与所有口服抗凝药物相比，阿哌沙班发生胃肠道出血的风险较低（所有比较均<0.00001）。
与华法林相比，阿哌沙班在真实世界中的应用在降低卒中及任何血栓栓塞事件方面总体上同样有效。与华法林、达比加群和利伐沙班相比，阿哌沙班具有更好的安全性。
