非维生素 K 拮抗剂口服抗凝剂与华法林在癌症合并心房颤动患者中的比较：系统评价和荟萃分析。

Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Patients With Cancer and Atrial Fibrillation: A Systematic Review and Meta-Analysis.

机构信息

Department of Cardiovascular Medicine The Third Affiliated Hospital of Nanchang University Nanchang of Jiangxi China.

Department of Hospital-acquired Infection Control The Third Affiliated Hospital of Nanchang University Nanchang of Jiangxi China.

出版信息

J Am Heart Assoc. 2019 Jul 16;8(14):e012540. doi: 10.1161/JAHA.119.012540.

Background Several studies have investigated the effect of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer, but the results remain controversial. Therefore, we conducted a meta-analysis to compare the efficacy and safety of NOACs versus warfarin in this population. Methods and Results We systematically searched the PubMed and Embase databases until February 16, 2019 for studies comparing the effect of NOACs with warfarin in AF patients with cancer. Risk ratios (RRs) with 95% CIs were extracted and pooled by a random-effects model. Five studies involving 8908 NOACs and 12 440 warfarin users were included. There were no significant associations between cancer status and risks of stroke or systemic embolism, major bleeding, or death in AF patients. Compared with warfarin, NOACs were associated with decreased risks of stroke or systemic embolism (RR, 0.52; 95% CI, 0.28-0.99), venous thromboembolism (RR, 0.37, 95% CI, 0.22-0.63), and intracranial or gastrointestinal bleeding (RR, 0.65; 95% CI, 0.42-0.98) and with borderline significant reductions in ischemic stroke (RR, 0.63; 95% CI, 0.40-1.00) and major bleeding (RR, 0.73; 95% CI, 0.53-1.00). In addition, risks of efficacy and safety outcomes of NOACs versus warfarin were similar between AF patients with and without cancer. Conclusions In patients with AF and cancer, compared with warfarin, NOACs had lower or similar rates of thromboembolic and bleeding events and posed a reduced risk of venous thromboembolism.

背景

几项研究调查了非维生素 K 拮抗剂口服抗凝剂（NOACs）在伴有癌症的心房颤动（AF）患者中的作用，但结果仍存在争议。因此，我们进行了一项荟萃分析，以比较这一人群中 NOACs 与华法林的疗效和安全性。

方法和结果

我们系统地检索了 PubMed 和 Embase 数据库，直到 2019 年 2 月 16 日，以比较 AF 伴癌症患者中 NOACs 与华法林的效果的研究。采用随机效应模型提取并汇总风险比（RR）及其 95%置信区间。纳入 5 项研究，共涉及 8908 例 NOACs 和 12440 例华法林使用者。癌症状态与 AF 患者中风或全身性栓塞、大出血或死亡风险之间无显著相关性。与华法林相比，NOACs 与中风或全身性栓塞（RR，0.52；95%CI，0.28-0.99）、静脉血栓栓塞（RR，0.37，95%CI，0.22-0.63）和颅内或胃肠道出血（RR，0.65；95%CI，0.42-0.98）风险降低相关，且缺血性中风（RR，0.63；95%CI，0.40-1.00）和大出血（RR，0.73；95%CI，0.53-1.00）风险有降低趋势，但无统计学意义。此外，NOACs 与华法林相比，在 AF 伴癌症和不伴癌症患者中的疗效和安全性结局风险相似。