Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany.
Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
Eur J Med Res. 2018 Oct 23;23(1):49. doi: 10.1186/s40001-018-0350-9.
To assess the frequency of left atrium/left atrial appendage (LA/LAA) thrombus under treatment with non-vitamin K oral anticoagulants (NOACs) in comparison with vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (AF).
PubMed, Web of Science™, EMBASE and the Cochrane Library databases were searched for studies comparing NOACs with VKAs in AF patients who underwent diagnostic transoesophageal echocardiography (TEE).
A total of four trials were considered eligible and were included in the meta-analysis. Four RCTs comprising n = 2397 AF patients (NOACs: n = 1412, VKAs: n = 985) were included in the meta-analysis. The frequency of LA/LAA thrombus formation under treatment with NOACs was similar to VKAs [odds ratio (OR) 1.14, 95% confidence intervals (95% CIs) 0.97-1.65, p = 0.48]. Both treatment groups revealed an approximately 5% frequency of thrombus formation, although a precise calculation is not possible due to Simpson paradox. Indications of heterogeneity between the included trials were not found (χ test p = 0.99, I = 0%).
The findings of this meta-analysis suggest that NOACs are similar to VKAs regarding the frequency of LA/LAA thrombus in patients with AF. An unknown number of patients in the original studies did not receive sufficient anticoagulation for at least 3 weeks prior to TEE examination, and therefore the present results should be interpreted with caution. Systematic review registration- http://www.crd.york.ac.uk/PROSPERO . Unique identifier: PROSPERO CRD42017059293.
评估非维生素 K 口服抗凝剂（NOACs）与维生素 K 拮抗剂（VKAs）在非瓣膜性心房颤动（AF）患者中的左心房/左心耳（LA/LAA）血栓形成频率。
检索 PubMed、Web of Science™、EMBASE 和 Cochrane 图书馆数据库，比较 AF 患者经诊断性经食管超声心动图（TEE）检查的 NOACs 与 VKAs 的研究。
共有 4 项试验被认为符合条件，并纳入荟萃分析。荟萃分析纳入了 4 项 RCT，共 2397 例 AF 患者（NOACs：n=1412，VKAs：n=985）。NOACs 治疗下 LA/LAA 血栓形成的频率与 VKAs 相似[比值比（OR）1.14，95%置信区间（95%CI）0.97-1.65，p=0.48]。两组的血栓形成频率均约为 5%，但由于辛普森悖论，无法精确计算。未发现纳入试验之间存在异质性迹象（χ检验 p=0.99，I=0%）。
本荟萃分析的结果表明，NOACs 在 AF 患者中与 VKAs 相比，LA/LAA 血栓形成的频率相似。由于对 TEE 检查前至少 3 周进行充分抗凝治疗的患者数量未知，因此应谨慎解释本研究结果。系统评价注册- http://www.crd.york.ac.uk/PROSPERO. 独特标识符：PROSPERO CRD42017059293。
