Zhao Jie, Wu Xiaojuan, Li Siyuan, Gu Qiuping
Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, China.
Department of Gastroenterology, Ganzhou People's Hospital, Ganzhou, China.
Front Cardiovasc Med. 2022 Jul 27;9:937320. doi: 10.3389/fcvm.2022.937320. eCollection 2022.
Gastrointestinal bleeding (GIB) commonly complicates anticoagulant therapy for patients with atrial fibrillation (AF). However, AF patients with prior GIB were excluded from most randomized controlled trials on anticoagulation therapy. Therefore, we conducted a systematic review and meta-analysis to assess the effect of oral anticoagulant (OAC) therapy in this specific population.
Randomized trials and observational studies reporting the data about the resumption of OAC therapy among AF patients with prior GIB were included. The search was performed in the PubMed and Embase databasesup to March 2022. The adjusted hazard ratios (s) and 95% confidence intervals (s) were pooled by a random-effects model with an inverse variance method.
A total of 7 studies involving 57,623 patients were included. Compared with no anticoagulant therapy, OAC therapy was associated with decreased risks of stroke or systemic embolism ( = 0.71, 95% : 0.59-0.84) and all-cause death ( = 0.66, 95% : 0.60-0.72), but there was no significant difference in the risk of recurrent GIB ( = 1.22, 95% : 0.94-1.59). Compared with vitamin K antagonists, non-vitamin K antagonist oral anticoagulants (NOACs) were associated with reduced risks of stroke or systemic embolism ( = 0.61, 95% : 0.54-0.68), all-cause mortality ( = 0.86, 95% : 0.75-0.99), major bleeding ( = 0.75, 95% : 0.66-0.84), and GIB recurrence ( = 0.83, 95% : 0.72-0.96).
In AF patients with prior GIB, OAC therapy (especially NOACs) demonstrated superior effectiveness compared with no anticoagulant therapy.
胃肠道出血（GIB）是心房颤动（AF）患者抗凝治疗常见的并发症。然而，大多数关于抗凝治疗的随机对照试验都将既往有GIB的AF患者排除在外。因此，我们进行了一项系统评价和荟萃分析，以评估口服抗凝剂（OAC）治疗在这一特定人群中的效果。
纳入报告既往有GIB的AF患者恢复OAC治疗数据的随机试验和观察性研究。检索截至2022年3月的PubMed和Embase数据库。采用随机效应模型和逆方差法汇总调整后的风险比及95%置信区间。
共纳入7项研究，涉及57623例患者。与不进行抗凝治疗相比，OAC治疗与降低卒中或全身性栓塞风险（风险比=0.71，95%置信区间：0.59-0.84）和全因死亡风险（风险比=0.66，95%置信区间：0.60-0.72）相关，但复发性GIB风险无显著差异（风险比=1.22，95%置信区间：0.94-1.59）。与维生素K拮抗剂相比，非维生素K拮抗剂口服抗凝剂（NOACs）与降低卒中或全身性栓塞风险（风险比=0.61，95%置信区间：0.54-0.68）、全因死亡率（风险比=0.86，95%置信区间：0.75-0.99）、大出血风险（风险比=0.75，95%置信区间：0.66-0.84）和GIB复发风险（风险比=0.83，95%置信区间：0.72-0.96）相关。
在既往有GIB的AF患者中，与不进行抗凝治疗相比，OAC治疗（尤其是NOACs）显示出更好的疗效。
