Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, NO.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
Henan Province Key Laboratory of Cardiac Injury and Repair, Zhengzhou, 450052, Henan, China.
BMC Cardiovasc Disord. 2019 Jul 31;19(1):182. doi: 10.1186/s12872-019-1165-5.
The development of novel oral anticoagulants (NOACs) has changed the landscape of non-valvular atrial fibrillation (NVAF) management. In this study, the effectiveness and the safety of several NOACs were evaluated in a real-world setting among Asian patients with NVAF.
The literature search was conducted crossing different databases including Embase, MEDLINE, and the Cochrane Library from inception through March 1, 2019, for studies which included real-world perspectives comparing the individual NOACs with each other or with warfarin among Asians with NVAF. The primary outcomes were defined as stroke or systemic embolism (SSE) and major bleeding; ischemic stroke, all-cause death as well as intracranial bleeding were classified as the secondary outcomes.
From sixteen real-world studies, a total of 312,827 Asian patients were included in this analysis. In comparison with warfarin, the utilization of apixaban, dabigatran, and rivaroxaban significantly lowered the risk of major bleeding (apixaban: HR 0.47, 95%CI 0.35-0.63; dabigatran: HR 0.59, 95%CI 0.47-0.73; rivaroxaban: HR 0.66, 95%CI 0.52-0.83) and lessened the all-cause death rate (apixaban: HR 0.29, 95%CI 0.16-0.52; dabigatran: HR 0.40, 95%CI 0.27-0.60; rivaroxaban: HR 0.42, 95%CI 0.28-0.65). Apixaban (HR 0.59; 95%CI 0.40-0.85) reduced the possibility of ischemic stroke when compared against dabigatran. Rivaroxaban showed a higher chance of causing an ischemic stroke (HR 1.61; 95%CI 1.08-2.41) and major bleeding (HR 1.39; 95%CI 1.02-1.90) than Apixaban.
Apixaban, dabigatran and rivaroxaban were more effective than warfarin on reducing the risks of stroke and haemorrhage; meanwhile, apixaban was likely to lower the risk of major bleeding comparing to rivaroxaban.
PROSPERO registry number: CRD42018086914 .
新型口服抗凝剂（NOACs）的发展改变了非瓣膜性心房颤动（NVAF）管理的格局。在这项研究中，评估了几种 NOAC 在亚洲 NVAF 患者中的真实世界环境中的有效性和安全性。
文献检索通过 Embase、MEDLINE 和 Cochrane 图书馆等不同数据库进行，检索时间从研究开始到 2019 年 3 月 1 日，纳入了比较亚洲 NVAF 患者中各种 NOAC 之间或与华法林之间的真实世界研究。主要结局定义为卒中或全身性栓塞（SSE）和大出血；缺血性卒中和全因死亡以及颅内出血被归类为次要结局。
在 16 项真实世界研究中，共有 312827 名亚洲患者纳入本分析。与华法林相比，阿哌沙班、达比加群和利伐沙班的使用显著降低了大出血的风险（阿哌沙班：HR 0.47，95%CI 0.35-0.63；达比加群：HR 0.59，95%CI 0.47-0.73；利伐沙班：HR 0.66，95%CI 0.52-0.83）和全因死亡率（阿哌沙班：HR 0.29，95%CI 0.16-0.52；达比加群：HR 0.40，95%CI 0.27-0.60；利伐沙班：HR 0.42，95%CI 0.28-0.65）。与达比加群相比，阿哌沙班（HR 0.59；95%CI 0.40-0.85）降低了缺血性卒中的可能性。与阿哌沙班相比，利伐沙班发生缺血性卒中和大出血的风险更高（HR 1.61；95%CI 1.08-2.41；HR 1.39；95%CI 1.02-1.90）。
阿哌沙班、达比加群和利伐沙班在降低卒中和出血风险方面优于华法林；同时，与利伐沙班相比，阿哌沙班可能降低大出血风险。
PROSPERO 注册号：CRD42018086914。
