口服抗凝剂在患有痴呆症的房颤患者中的临床益处：一项系统评价和荟萃分析。
Clinical benefits of oral anticoagulants in atrial fibrillation patients with dementia: a systematic review and meta-analysis.
作者信息
Wang Dayang, Xu Xiaoqing, Han Xiaowan, Xie Jing, Zhou Hufang, Peng Wenhua, Pan Guozhong
机构信息
Cardiovascular Institute, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
出版信息
Front Cardiovasc Med. 2023 Sep 5;10:1265331. doi: 10.3389/fcvm.2023.1265331. eCollection 2023.
BACKGROUND
The management of atrial fibrillation (AF) with oral anticoagulants (OAC) is generally recommended to reduce the risk of stroke. However, the decision to prescribe these medications for patients with AF and dementia remains controversial.
METHODS
A systematic review and meta-analysis of retrospective cohort studies were conducted. The search encompassed PubMed, Cochrane Library, Web of Science, and Embase databases from inception until May 1st, 2023, with language limited to English. Eligible studies included comparisons between exposure to OAC vs. non-OAC in the AF population with dementia or cognitive impairment. Studies that compared the effects of direct oral anticoagulants (DOAC) and vitamin-K antagonists were also included. The primary outcome was all-cause mortality, and the secondary outcomes were ischemic stroke and major bleeding. This study was registered with PROSPERO (No. CRD42023420678).
RESULTS
A total of five studies ( = 21,962 patients) met the eligibility criteria and were included in this review. The follow-up duration ranged from 1 to 4 years. Meta-analysis demonstrated that OAC treatment was associated with a lower risk of all-cause mortality in AF patients with dementia with a hazard ratio (HR) of 0.79 and a 95% confidence interval (CI) ranging from 0.68 to 0.92, compared to non-OAC treatment. No statistical differences were observed in the risk of major bleeding (HR = 1.12, 95% CI: 0.88-1.42) or ischemic stroke (HR = 0.77, 95% CI: 0.58-1.00). Three studies reported comparisons between DOAC and warfarin; however, pooled analysis was not performed due to heterogeneity.
CONCLUSION
The use of OACs in individuals diagnosed with both AF and dementia holds the potential to reduce all-cause mortality rates, thereby improving the overall clinical prognosis within this specific population.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023420678, PROSPERO identifier, CRD42023420678.
背景
一般建议使用口服抗凝剂（OAC）治疗心房颤动（AF）以降低中风风险。然而，为患有房颤和痴呆症的患者开这些药物的决定仍存在争议。
方法
对回顾性队列研究进行系统评价和荟萃分析。检索范围包括从数据库建立至2023年5月1日的PubMed、Cochrane图书馆、科学网和Embase数据库，语言限于英语。符合条件的研究包括对患有痴呆或认知障碍的房颤人群中使用OAC与未使用OAC的比较。还纳入了比较直接口服抗凝剂（DOAC）和维生素K拮抗剂效果的研究。主要结局是全因死亡率，次要结局是缺血性中风和大出血。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册（编号CRD42023420678）。
结果
共有五项研究（n = 21,962例患者）符合纳入标准并纳入本评价。随访时间为1至4年。荟萃分析表明，与未使用OAC治疗相比，在患有痴呆症的房颤患者中，使用OAC治疗可降低全因死亡率，风险比（HR）为0.79，95%置信区间（CI）为0.68至0.92。大出血风险（HR = 1.12，95% CI：0.88 - 1.42）或缺血性中风风险（HR = 0.77，95% CI：0.58 - 1.00）未观察到统计学差异。三项研究报告了DOAC与华法林的比较；然而，由于异质性未进行汇总分析。
结论
在被诊断患有房颤和痴呆症的个体中使用OAC有可能降低全因死亡率，从而改善这一特定人群的总体临床预后。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023420678，PROSPERO标识符，CRD42023420678
Zotero 插件