Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People's Republic of China.
Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, People's Republic of China.
J Thromb Thrombolysis. 2018 Apr;45(3):386-396. doi: 10.1007/s11239-018-1612-7.
The purpose of this study is to evaluate the efficacy and safety of novel oral anticoagulant (NOAC) versus warfarin therapy in patients undergoing different operations. We performed a systematic review of MEDLINE, EMBASE, Cochrane Controlled Trials Register, and reports presented at scientific meetings. The efficacy and safety of NOACs during the perioperative period was compared to that using warfarin. Of the 2652 studies initially reviewed, we identified 9 that included 15,880 patients for the meta-analysis. Compared to warfarin, dabigatran increased the risk of major bleeding (RR 1.37, 95% CI 1.06-1.78, P = 0.02). Apixaban (RR 0.63, 95% CI 0.40-0.99, P = 0.04) reduced thrombotic events. NOAC therapy decreased thrombotic events in patients undergoing non-cardiac surgery (RR 0.68, 95% CI 0.50-0.92, P = 0.02). Compared to warfarin, the administration of NOACs in the perioperative period has the same risk of thromboembolism and major bleeding. But patients undergoing non-cardiac surgery may benefit more from perioperative NOAC therapy. Apixaban may reduce thrombotic events and dabigatran increases the risk of major bleeding during the perioperative period.
本研究旨在评估新型口服抗凝剂（NOAC）与华法林治疗在接受不同手术的患者中的疗效和安全性。我们对 MEDLINE、EMBASE、Cochrane 对照试验登记处和科学会议上报告的文献进行了系统评价。在围手术期，NOAC 与华法林相比的疗效和安全性。在最初审查的 2652 项研究中，我们确定了 9 项研究，共纳入了 15880 名患者进行荟萃分析。与华法林相比，达比加群增加了大出血的风险（RR 1.37，95%CI 1.06-1.78，P=0.02）。阿哌沙班（RR 0.63，95%CI 0.40-0.99，P=0.04）降低了血栓事件的风险。NOAC 治疗降低了非心脏手术患者的血栓事件（RR 0.68，95%CI 0.50-0.92，P=0.02）。与华法林相比，围手术期使用 NOAC 具有相同的血栓栓塞和大出血风险。但接受非心脏手术的患者可能从围手术期 NOAC 治疗中获益更多。阿哌沙班可能降低血栓事件风险，达比加群增加围手术期大出血风险。
