Wang Lu, Sang Wanyue, Jian Yi, Zhang Xiaoxue, Han Yafan, Wang Feifei, Wang Liang, Yang Suxia, Wubulikasimu Subinuer, Yang Li, Sun Huaxin, Li Yaodong
Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Front Cardiovasc Med. 2023 Aug 31;10:1175215. doi: 10.3389/fcvm.2023.1175215. eCollection 2023.
This study aimed to compare the efficacy of novel oral anticoagulants (NOACs) with traditional anticoagulants vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) post transcatheter aortic valve replacement (TAVR).
Studies comparing the usage of NOACs and VKAs in AF patients with oral anticoagulant indication post-TAVR were retrieved from PubMed, EMBASE, Medline, and Cochrane databases from their building-up to Jan. 2023. The literature was screened in line of inclusion and exclusion criteria. Risk ratio (RR) or odds ratio (OR),95% confidence interval (CI) and number needed to treat (NNT) were calculated for four main indexes that composite endpoints composed mainly of any clinically relevant risk events, stroke, major bleeding, and all-cause mortality. Subsequently, a meta-analysis was performed using the RevMan5.3 and Stata 16.0 software.
In the aggregate of thirteen studies, contained 30388 post-TAVR patients with AF, were included in this meta-analysis. Our results indicated that there was no significant difference in stroke between the NOACs group and the VKAs group, and the NOACs group had a numerically but non-significantly higher number of composite endpoint events compared with the other group. Nevertheless, the incidence of major bleeding [11.29% vs. 13.89%, RR 0.82, 95%CI (0.77,0.88), < 0.00001, ² = 69%, NNT = 38] and all-cause mortality [14.18% vs. 17.61%, RR 0.83, 95%CI (0.79,0.88), < 0.00001, ² = 82%, NNT = 29] were significantly lower in the NOACs group than another group.
Taken together, our data indicated that the usage of NOACs reduced the incidence of major bleeding and all-cause mortality compared to VKAs in post-TAVR patients with AF.
本研究旨在比较新型口服抗凝药（NOACs）与传统抗凝药维生素K拮抗剂（VKAs）在经导管主动脉瓣置换术（TAVR）后房颤（AF）患者中的疗效。
从PubMed、EMBASE、Medline和Cochrane数据库中检索自建库至2023年1月比较NOACs和VKAs在TAVR后有口服抗凝指征的AF患者中使用情况的研究。按照纳入和排除标准对文献进行筛选。计算主要由任何临床相关风险事件、中风、大出血和全因死亡率组成的复合终点的四个主要指标的风险比（RR）或比值比（OR）、95%置信区间（CI）和需治疗人数（NNT）。随后，使用RevMan5.3和Stata 16.0软件进行荟萃分析。
本荟萃分析纳入了13项研究，共30388例TAVR术后AF患者。我们的结果表明，NOACs组和VKAs组在中风方面无显著差异，与另一组相比，NOACs组的复合终点事件数量在数值上较高，但无统计学意义。然而，NOACs组的大出血发生率[11.29%对13.89%，RR 0.82，95%CI（0.77，0.88），<0.00001，I² = 69%，NNT = 38]和全因死亡率[14.18%对17.61%，RR 0.83，95%CI（0.79，0.88），<0.00001，I² = 82%，NNT = 29]显著低于另一组。
总体而言，我们的数据表明，在TAVR术后AF患者中，与VKAs相比，使用NOACs可降低大出血发生率和全因死亡率。
