Dong Shu-Jie, Luo Cong-Yan, Xiao Cui-Lan, Zhang Feng-Zhe, Li Lei, Han Zhong-Ling, Zhai Suo-Di
Department of Pharmacy, Peking University Third Hospital, Beijing, China.
Department of Pharmacy, Karamay Second People's Hospital, Karamay, China.
Curr Ther Res Clin Exp. 2022 Apr 4;96:100670. doi: 10.1016/j.curtheres.2022.100670. eCollection 2022.
The presence of left atrial/left atrial appendage thrombosis is associated with a higher risk of thromboembolic events in patients with atrial fibrillation. The optimal antithrombotic strategy is not established to date.
Our aim was to compare the efficacy and safety profile of novel oral anticoagulants with warfarin in the treatment of left atrial/left atrial appendage thrombosis.
We conducted a systematic search in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and 3 Chinese databases for all randomized controlled trials and cohort studies (PROSPERO, CRD42021238952) from inception to 7 May 2021. Two authors independently performed the articles selection, data extraction, and quality assessment. The efficacy outcome was the resolution of left atrial/left atrial appendage thrombosis, and the safety outcomes were bleeding and stroke/transient ischemic attack.
One randomized controlled trial and 5 cohort studies were included, with a total of 353 patients. Compared with warfarin, novel oral anticoagulants were associated with increased probability of left atrial/left atrial appendage thrombosis resolution (OR = 2.20; 95% CI, 1.35-3.60; = 0%). Compared with warfarin, novel oral anticoagulants had a similar risk of bleeding (OR = 0.91; 95% CI, 0.39-2.13; = 0%). There was no evidence of increased risk of stroke/transient ischemic attack (OR = 0.42; 95% CI, 0.12-1.45; = 0%).
Novel oral anticoagulants were more effective than warfarin in promoting the resolution of left atrial/left atrial appendage thrombosis, without increased risks of bleeding and stroke/transient ischemic attack. Our study provides valuable insight into clinical practice. Further well-designed randomized controlled trials are needed to fully evaluate the benefits and risks in these patients. PROSPERO Registration No.: CRD42021238952.
左心房/左心耳血栓的存在与房颤患者血栓栓塞事件的较高风险相关。迄今为止，最佳抗栓策略尚未确立。
我们的目的是比较新型口服抗凝药与华法林治疗左心房/左心耳血栓的疗效和安全性。
我们在PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov和3个中文数据库中进行了系统检索，以查找从开始到2021年5月7日的所有随机对照试验和队列研究（PROSPERO，CRD42021238952）。两名作者独立进行文章筛选、数据提取和质量评估。疗效结局为左心房/左心耳血栓溶解，安全性结局为出血和中风/短暂性脑缺血发作。
纳入1项随机对照试验和5项队列研究，共353例患者。与华法林相比，新型口服抗凝药与左心房/左心耳血栓溶解概率增加相关（OR = 2.20；95%CI，1.35 - 3.60；P = 0%）。与华法林相比，新型口服抗凝药的出血风险相似（OR = 0.91；95%CI，0.39 - 2.13；P = 0%）。没有证据表明中风/短暂性脑缺血发作风险增加（OR = 0.42；95%CI，0.12 - 1.45；P = 0%）。
新型口服抗凝药在促进左心房/左心耳血栓溶解方面比华法林更有效，且不会增加出血和中风/短暂性脑缺血发作风险。我们的研究为临床实践提供了有价值的见解。需要进一步设计良好的随机对照试验来全面评估这些患者的获益和风险。PROSPERO注册号：CRD42021238952。
