An Qing, Su Shuwen, Tu Yan, Gao Lingfeng, Xian Gaopeng, Bai Yujia, Zhan Qiong, Xu Xingbo, Xu Dingli, Zeng Qingchun
State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, First Clinical Medical College, Southern Medical University, Guangzhou, China.
State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, First Clinical Medical College, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
Ther Adv Chronic Dis. 2021 Nov 15;12:20406223211056730. doi: 10.1177/20406223211056730. eCollection 2021.
A meta-analysis was performed to compare the efficacy and safety of antithrombotic therapy with non-vitamin K antagonist oral anticoagulants (NOACs) standard care in patients after successful transcatheter aortic valve replacement (TAVR).
A systematic search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE databases and ClinicalTrials.gov website (through 21 October 2020) was performed. Risk ratios (RRs) with 95% confidence intervals (CIs) for all outcomes were calculated using random-effects models.
Twelve studies (two studies were randomized controlled trials) comprising 6943 patients were included (5299 had indications for oral anticoagulation (OAC) and 1644 had none). No significant differences were found between NOACs and the standard care in the incidences of all stroke, a composite endpoint, and major/life-threatening bleeding. NOACs were associated with lower all-cause mortality than vitamin K antagonists (VKAs) in post-TAVR patients with indications for OAC after more than 1 year of follow-up [RR = 0.64; 95% CI, (0.42, 0.96); = 0.03], whereas NOACs exhibited poor outcomes than antiplatelet therapy (APT) in patients without indications for OAC [RR = 1.66; 95% CI, (1.12, 2.45); = 0.01]. In the prevention of valve thrombosis, NOACs and VKAs were not significantly different in patients with indications for OAC [RR = 0.66; 95% CI, (0.24, 1.84); = 0.43], whereas NOACs were better than APT in patients without indications for OAC [RR = 0.19; 95% CI, (0.04, 0.83); = 0.03].
In patients with indications for OAC, post-TAVR antithrombotic therapy with NOACs was more favorable due to its lower all-cause mortality after more than 1 year of follow-up. In those without indications for OAC, NOACs presented poorer outcomes due to its higher all-cause mortality.
进行一项荟萃分析，比较非维生素K拮抗剂口服抗凝药（NOACs）与标准治疗在经导管主动脉瓣置换术（TAVR）成功后的患者中进行抗血栓治疗的疗效和安全性。
对PubMed、Cochrane对照试验中央登记库、EMBASE数据库和ClinicalTrials.gov网站（截至2020年10月21日）进行系统检索。使用随机效应模型计算所有结局的风险比（RRs）及95%置信区间（CIs）。
纳入了12项研究（2项为随机对照试验），共6943例患者（5299例有口服抗凝治疗（OAC）指征，1644例无指征）。在所有卒中、复合终点以及严重/危及生命的出血发生率方面，NOACs与标准治疗之间未发现显著差异。在有OAC指征的TAVR术后患者中，随访超过1年后，NOACs与维生素K拮抗剂（VKAs）相比，全因死亡率更低[RR = 0.64；95% CI，（0.42，0.96）；P = 0.03]，而在无OAC指征的患者中，NOACs的结局比抗血小板治疗（APT）差[RR = 1.66；95% CI，（1.12，2.45）；P = 0.01]。在预防瓣膜血栓形成方面，有OAC指征的患者中，NOACs与VKAs无显著差异[RR = 0.66；95% CI，（0.24，1.84）；P = 0.43]，而在无OAC指征的患者中，NOACs优于APT[RR = 0.19；95% CI，（0.04，0.83）；P = 0.03]。
在有OAC指征的患者中，TAVR术后使用NOACs进行抗血栓治疗更有利，因为随访超过1年后其全因死亡率更低。在无OAC指征的患者中，NOACs因全因死亡率较高而结局较差。
