直接口服抗凝剂颅内出血风险的系统评价和贝叶斯网状meta 分析。
A systematic review and Bayesian network meta-analysis of risk of intracranial hemorrhage with direct oral anticoagulants.
机构信息
Guthrie Clinic/Robert Packer Hospital, Sayre, PA, USA.
Washington Hospital Healthcare System, Fremont, CA, USA.
出版信息
J Thromb Haemost. 2018 Jul;16(7):1296-1306. doi: 10.1111/jth.14131. Epub 2018 May 30.
UNLABELLED
Essentials Risk of intracranial hemorrhage (ICH) may differ between direct oral anticoagulants (DOACs). We compared the risk of ICH between DOACs using network meta-analysis. Dabigatran 110 mg and 150 mg were safer than rivaroxaban on Bayesian analysis. Dabigatran 110 mg ranked as the safest DOAC while rivaroxaban ranked last.
SUMMARY
Background The comparative risk of intracranial hemorrhage (ICH) among direct oral anticoagulants (DOACs) (dabigatran, rivaroxaban, apixaban and edoxaban) remains unclear. Objective To determine the difference in risk of ICH between DOACs Methods Seventeen randomized controlled trials (RCTs) were selected using PubMed/MEDLINE, EMBASE and CENTRAL (Inception, 31 December 2017). Estimates were reported as odds ratio (OR) with 95% credible interval (CR.I) in Bayesian network meta-analysis (NMA), and OR with 95% confidence interval (CI) in traditional meta-analyses. Relative ranking probability of each group was generated based on surface under the cumulative ranking curve (SUCRA). Results In NMA of 116 618 patients from 17 RCTs (apixaban = 19 495 patients, rivaroxaban = 14 157 patients, dabigatran = 16 074 patients, edoxaban = 11 652 patients, and comparator = 55 315 patients), all DOACs were safer than warfarin for risk of ICH. Dabigatran 110 mg ranked as the safest drug (SUCRA, 0.85) and reduced the risk of ICH by 56% compared to rivaroxaban (OR, 0.44; 95% Cr.I, 0.22-0.82). Pairwise meta-analysis validated these findings, showing that DOACs were safer than warfarin (OR, 0.46; 95% CI, 0.35-0.59). Subgroup analysis showed that the benefit was present when DOACs were used in non-valvular atrial fibrillation (NVAF) (OR, 0.51; 95% CI, 0.38-0.68) or venous thromboembolism (VTE) (OR, 0.32; 95% CI, 0.18-0.58). Conclusion Dabigatran 110 mg may be the safest choice among any anticoagulant regarding risk of ICH. Both dabigatran 110 mg and 150 mg were safer than rivaroxaban.
背景
直接口服抗凝剂（DOACs）（达比加群、利伐沙班、阿哌沙班和依度沙班）之间颅内出血（ICH）风险的比较风险仍不清楚。目的：确定 DOACs 之间 ICH 风险的差异。方法：使用 PubMed/MEDLINE、EMBASE 和 CENTRAL（起点，2017 年 12 月 31 日）选择了 17 项随机对照试验（RCTs）。估计值以贝叶斯网络荟萃分析（NMA）中的比值比（OR）和 95%可信区间（Cr.I）以及传统荟萃分析中的 OR 和 95%置信区间（CI）报告。基于累积排序曲线下面积（SUCRA）生成每组的相对排名概率。结果：在来自 17 项 RCT 的 116618 名患者的 NMA 中（阿哌沙班=19495 名患者，利伐沙班=14157 名患者，达比加群=16074 名患者，依度沙班=11652 名患者，和比较剂=55315 名患者），所有 DOACs 在 ICH 风险方面均比华法林更安全。达比加群 110mg 被评为最安全的药物（SUCRA，0.85），与利伐沙班相比，ICH 风险降低了 56%（OR，0.44；95%Cr.I，0.22-0.82）。两两荟萃分析验证了这些发现，表明 DOACs 比华法林更安全（OR，0.46；95%CI，0.35-0.59）。亚组分析表明，在非瓣膜性心房颤动（NVAF）（OR，0.51；95%CI，0.38-0.68）或静脉血栓栓塞（VTE）（OR，0.32；95%CI，0.18-0.58）中使用 DOACs 时存在益处。结论：达比加群 110mg 可能是任何抗凝剂中 ICH 风险最安全的选择。达比加群 110mg 和 150mg 均比利伐沙班更安全。
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