Zhang Hao, Xue Zhengbiao, Yi Dongqian, Li Xiaobo, Tan Yanwu, Li Jianwen
Department of Cardiovascular Medicine, Xiangdong Hospital Hunan normal University.
Department of Critical Care Medicine, First Affiliated Hospital of Gannan Medical University.
Int Heart J. 2020 Mar 28;61(2):231-238. doi: 10.1536/ihj.19-202. Epub 2020 Mar 14.
The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) with coronary or peripheral artery disease (CAD or PAD) remain largely unresolved. We, therefore, conducted a meta-analysis to explore the effect of NOACs compared with warfarin in these populations.We systematically searched the Cochrane Library, PubMed, and Embase databases for randomized controlled trials (RCTs) involving NOACs versus warfarin in AF patients with CAD or PAD. A random-effect model was selected to pool the risk ratios (RRs) and 95% confidence intervals (CIs).A total of 7 RCTs were included. In AF patients with CAD, compared with warfarin use, the use of NOACs was associated with reduced risks of stroke/systemic embolism (RR 0.82; 95% CI 0.70-0.96) and intracranial hemorrhage (RR 0.41; 95% CI 0.26-0.63), but NOACs versus warfarin showed similar risks of all-cause death (RR 0.95; 95% CI 0.86-1.05), cardiovascular death (RR 0.95; 95% CI 0.80-1.13), stroke (RR 0.80; 95% CI 0.64-1.00), myocardial infarction (RR 1.00; 95% CI 0.83-1.21), and major bleeding (RR 0.82; 95% CI 0.65-1.04). Among patients with AF and PAD, NOACs versus warfarin had similar risks for stroke (RR 0.93; 95% CI 0.61-1.42), myocardial infarction (RR 1.10; 95% CI 0.64-1.90), all-cause death (RR 0.91; 95% CI 0.70-1.19), major bleeding (RR 1.12; 95% CI 0.70-1.81), and intracranial hemorrhage (RR 0.54; 95% CI 0.16-1.85).NOACs seem to be at least as effective and safe as warfarin in AF patients with CAD. whereas NOACs versus warfarin have similar efficacy and safety in patients with PAD.
非维生素K拮抗剂口服抗凝药（NOACs）用于合并冠状动脉疾病或外周动脉疾病（CAD或PAD）的心房颤动（AF）患者时，其疗效和安全性在很大程度上仍未明确。因此，我们进行了一项荟萃分析，以探究在这些人群中，与华法林相比，NOACs的效果如何。我们系统检索了Cochrane图书馆、PubMed和Embase数据库，查找涉及CAD或PAD的AF患者使用NOACs与华法林对比的随机对照试验（RCTs）。选择随机效应模型来汇总风险比（RRs）和95%置信区间（CIs）。共纳入7项RCTs。在合并CAD的AF患者中，与使用华法林相比，使用NOACs与降低中风/全身性栓塞风险（RR 0.82；95% CI 0.70 - 0.96）和颅内出血风险（RR 0.41；95% CI 0.26 - 0.63）相关，但NOACs与华法林相比，全因死亡风险（RR 0.95；95% CI 0.86 - 1.05）、心血管死亡风险（RR 0.95；95% CI 0.80 - 1.13）、中风风险（RR 0.80；95% CI 0.64 - 1.00）、心肌梗死风险（RR 1.00；95% CI 0.83 - 1.21）和大出血风险（RR 0.82；95% CI 0.65 - 1.04）相似。在合并AF和PAD的患者中，NOACs与华法林相比，中风风险（RR 0.93；95% CI 0.61 - 1.42）、心肌梗死风险（RR 1.10；95% CI 0.64 - 1.90）、全因死亡风险（RR 0.91；95% CI 0.70 - 1.19）、大出血风险（RR 1.12；95% CI 0.70 - 1.81）和颅内出血风险（RR 0.54；95% CI 0.16 - 1.85）相似。在合并CAD的AF患者中，NOACs似乎至少与华法林一样有效和安全。而在合并PAD的患者中，NOACs与华法林的疗效和安全性相似。
