Department of Cardiology, West China Hospital, Sichuan University, #37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Cardiovasc Drugs Ther. 2024 Oct;38(5):1059-1064. doi: 10.1007/s10557-023-07451-2. Epub 2023 Apr 4.
Patients with atrial fibrillation (AF) and concomitant moderate-to-severe mitral stenosis (MS) are listed as a contraindicated population to direct oral anticoagulant (DOAC) because of the traditional tenet of high stroke risk, despite scarce evidence. With accumulating data, we sought to conduct a systematic meta-analysis to preliminarily explore the efficacy and safety of DOAC versus warfarin in patients with AF and concomitant significant MS.
We searched the Medline, Embase databases, and the Cochrane Library (assessed October 10th, 2022) for eligible studies. Risk ratios (RRs) and 95% confidence intervals (CIs) were synthesized in Stata 16.1 (StataCorp).
In random-effects meta-analyses, DOACs demonstrated a similar risk of stroke or systemic embolism (RR 0.51; 95% CI 0.09-2.96), all-cause death (RR 0.81; 95% CI 0.35-1.87), major or clinically relevant non-major bleeding (RR 0.57; 95% CI 0.24-1.39), and silent cerebral ischemia (RR 1.01; 95% CI 0.64-1.58) when compared with warfarin.
DOACs were similar to warfarin in the efficacy and safety profiles in patients with AF and concomitant significant MS. Future evidence is expected from other large trials.
患有心房颤动 (AF) 且同时伴有中度至重度二尖瓣狭窄 (MS) 的患者被列为直接口服抗凝剂 (DOAC) 的禁忌人群，这是基于传统观念认为中风风险高，尽管证据很少。随着数据的积累，我们试图进行系统的荟萃分析，初步探讨 DOAC 与华法林在 AF 合并严重 MS 患者中的疗效和安全性。
我们检索了 Medline、Embase 数据库和 Cochrane 图书馆（评估日期为 2022 年 10 月 10 日），以获取合格的研究。风险比 (RR) 和 95%置信区间 (CI) 在 Stata 16.1 (StataCorp) 中进行综合。
在随机效应荟萃分析中，DOAC 与华法林相比，卒中或全身性栓塞 (RR 0.51; 95% CI 0.09-2.96)、全因死亡 (RR 0.81; 95% CI 0.35-1.87)、大出血或临床相关非大出血 (RR 0.57; 95% CI 0.24-1.39) 和无症状性脑缺血 (RR 1.01; 95% CI 0.64-1.58) 的风险相似。
DOAC 在 AF 合并严重 MS 患者中的疗效和安全性与华法林相似。预计未来会有其他大型试验提供更多证据。
