达比加群、利伐沙班和阿哌沙班在亚洲非瓣膜性心房颤动患者中优于华法林：一项更新的荟萃分析。

Dabigatran, rivaroxaban, and apixaban are superior to warfarin in Asian patients with non-valvular atrial fibrillation: An updated meta-analysis.

作者信息

Li Wei-Jia, Archontakis-Barakakis Paraschos, Palaiodimos Leonidas, Kalaitzoglou Dimitrios, Tzelves Lazaros, Manolopoulos Apostolos, Wang Yu-Chiang, Giannopoulos Stefanos, Faillace Robert, Kokkinidis Damianos G

机构信息

Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, United States.

Department of Surgery, 424 General Army Hospital of Thessaloniki, Thessaloniki 56429, Greece.

出版信息

World J Cardiol. 2021 Apr 26;13(4):82-94. doi: 10.4330/wjc.v13.i4.82.

BACKGROUND

Most of the randomized clinical trials that led to the wide use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) originated from western countries.

AIM

To systematically review and quantitatively synthesize the real-world data regarding the efficacy and safety of dabigatran, rivaroxaban, and apixaban compared to warfarin for stroke prevention in Asian patients with non-valvular AF.

METHODS

Medline, Cochrane, and ClinicalTrial.gov databases were reviewed. A random-effect model meta-analysis was used and I-square was utilized to assess the heterogeneity. The primary outcome was ischemic stroke. The secondary outcomes were all-cause mortality, major bleeding, intracranial hemorrhage, and gastrointestinal bleeding.

RESULTS

Twelve studies from East Asia or Southeast Asia and 441450 patients were included. Dabigatran, rivaroxaban, and apixaban were associated with a significant reduction in the incidence of ischemic stroke [hazard ratio (HR) = 0.78, 95% confidence interval (CI): 0.65-0.94; HR = 0.79, 95%CI: 0.74-0.85, HR = 0.70, 95%CI: 0.62-0.78; respectively], all-cause mortality (HR = 0.68, 95%CI: 0.56-0.83; HR = 0.66, 95%CI: 0.52-0.84; HR = 0.66, 95%CI: 0.49-0.90; respectively), and major bleeding (HR = 0.61, 95%CI: 0.54-0.69; HR = 0.70, 95%CI: 0.54-0.90; HR = 0.58, 95%CI: 0.43-0.78; respectively) compared to warfarin.

CONCLUSION

Dabigatran, rivaroxaban, and apixaban appear to be superior to warfarin in both efficacy and safety in Asians with non-valvular AF.

背景

大多数促使非维生素K拮抗剂口服抗凝药在心房颤动（AF）患者中广泛用于预防中风的随机临床试验都来自西方国家。

目的

系统评价并定量综合与华法林相比，达比加群、利伐沙班和阿哌沙班在亚洲非瓣膜性AF患者中预防中风的疗效和安全性的真实世界数据。

方法

检索了Medline、Cochrane和ClinicalTrial.gov数据库。采用随机效应模型进行荟萃分析，并使用I²评估异质性。主要结局为缺血性中风。次要结局为全因死亡率、大出血、颅内出血和胃肠道出血。

结果

纳入了来自东亚或东南亚的12项研究，共441450例患者。与华法林相比，达比加群、利伐沙班和阿哌沙班在缺血性中风发生率[风险比（HR）=0.78，95%置信区间（CI）：0.65-0.94；HR = 0.79，95%CI：0.74-0.85，HR = 0.70，95%CI：0.62-0.78；分别]、全因死亡率（HR = 0.68，95%CI：0.56-0.83；HR = 0.66，95%CI：0.52-0.84；HR = 0.66，95%CI：0.49-0.90；分别）和大出血（HR = 0.61，95%CI：0.54-0.69；HR = 0.70，95%CI：0.54-0.90；HR = 0.58，95%CI：0.43-0.78；分别）方面均有显著降低。