Alsultan Mohammed M, Alahmari Abdullah K, Mahmoud Mansour A, Almalki Ziyad S, Alzlaiq Wafa, Alqarni Faisal, Alsultan Fahad, Ahmed Nehad Jaser, Alenazi Ahmed O, Scharf Lucas, Guo Jeff Jianfei
Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
Front Pharmacol. 2023 Nov 16;14:1276491. doi: 10.3389/fphar.2023.1276491. eCollection 2023.
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia type. Patients with AF are often administered anticoagulants to reduce the risk of ischemic stroke due to an irregular heartbeat. We evaluated the efficacy and safety of edoxaban warfarin in patients with nonvalvular AF by conducting an updated meta-analysis of real-world studies. In this comprehensive meta-analysis, we searched two databases, PubMed and EMBASE, and included retrospective cohort observational studies that compared edoxaban with warfarin in patients with nonvalvular AF from 1 January 2009, to 30 September 2023. The effectiveness and safety outcomes were ischemic stroke and major bleeding, respectively. In the final analysis, six retrospective observational studies involving 87,236 patients treated with warfarin and 40,933 patients treated with edoxaban were included. To analyze the data, we used a random-effects model to calculate the hazard ratio (HR). Patients treated with edoxaban had a significantly lower risk of ischemic stroke [hazard ratio (HR) = 0.66; 95% confidence interval (CI) = 0.61-0.70; < 0.0001] and major bleeding (HR = 0.58; 95% CI = 0.49-0.69; < 0.0001) than those treated with warfarin. The sensitivity analysis results for ischemic stroke and major bleeding were as follows: HR = 0.66; 95% CI = 0.61-0.70; < 0.0001 and HR = 0.58; 95% CI = 0.49-0.69; < 0.0001, respectively. Our findings revealed that edoxaban performed better than warfarin against major bleeding and ischemic stroke.
心房颤动（AF）是最常见的心律失常类型。房颤患者常使用抗凝剂以降低因心跳不规则而导致缺血性中风的风险。我们通过对真实世界研究进行更新的荟萃分析，评估了依度沙班与华法林在非瓣膜性房颤患者中的疗效和安全性。在这项全面的荟萃分析中，我们检索了两个数据库，即PubMed和EMBASE，并纳入了2009年1月1日至2023年9月30日期间比较依度沙班与华法林在非瓣膜性房颤患者中的回顾性队列观察研究。有效性和安全性结果分别为缺血性中风和大出血。在最终分析中，纳入了六项回顾性观察研究，涉及87236例接受华法林治疗的患者和40933例接受依度沙班治疗的患者。为了分析数据，我们使用随机效应模型计算风险比（HR）。与接受华法林治疗的患者相比，接受依度沙班治疗的患者发生缺血性中风的风险显著更低[风险比（HR）=0.66；95%置信区间（CI）=0.61 - 0.70；P<0.0001]，大出血风险也更低（HR = 0.58；95% CI = 0.49 - 0.69；P<0.0001）。缺血性中风和大出血的敏感性分析结果如下：HR = 0.66；95% CI = 0.61 - 0.70；P<0.0001和HR = 0.58；95% CI = 0.49 - 0.69；P<0.0001。我们的研究结果表明，在预防大出血和缺血性中风方面，依度沙班的表现优于华法林。
