心房颤动患者左心耳封堵术（LAAO）与直接口服抗凝药（DOAC）的长期疗效和安全性：一项系统评价和荟萃分析
Long-Term Efficacy and Safety of Left Atrial Appendage Occlusion (LAAO) vs Direct Oral Anticoagulation (DOAC) in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.
作者信息
Razzack Aminah Abdul, Lak Hassan Mehmood, Erasani Greeshma, Rahman Sajedur, Hussain Nabeel, Ali Bilal Farhat, Eapi Srilatha, Yasmin Farah, Najeeb Hala, Mustafa Ahmad, Chawla Sanchit, Munir Muhammad Bilal, Barakat Amr F, Saliba Walid, Wazni Oussama, Hussein Ayman A
机构信息
Department of Internal Medicine, Dr. N.T.R University of Health Sciences, 520008 Vijayawada, India.
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
出版信息
Rev Cardiovasc Med. 2023 Feb 2;24(2):44. doi: 10.31083/j.rcm2402044. eCollection 2023 Feb.
BACKGROUND
Prevention of stroke by anticoagulation is essential in patients with Atrial fibrillation (AF); with direct oral anticoagulants (DOACs) being preferred over warfarin in most patients. The Long-term efficacy and safety of DOACs vs. Left Atrial Appendage Occlusion (LAAO) remain unknown.
METHODS
Electronic databases (PubMed, Embase, Scopus) were searched from inception to February 10th, 2021. The primary endpoint was cardiovascular mortality. Secondary outcomes included incidence of ischemic stroke/transient ischemic attack (TIA) and systemicembolism. The safety endpoint was clinically relevant bleeding (a composite of major or minor clinically relevant bleeding).
RESULTS
A total of three studies with 3039 participants (LAAO = 1465; DOACs = 1574) were included. Mean age was 74.2 and 75.3 years in the LAAO and DOAC group respectively. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.90, 95% CI 0.40-2.03; = 0.81), ischemic stroke/TIA (RR 1.15, 95% CI 0.80-1.65; = 0.46; = 0) and clinically significant bleeding (RR 0.77, 95% CI 0.50-1.17; = 0.22; = 69) between the groups.
CONCLUSIONS
Among patients with AF, LAAO was comparable to DOACs with similar efficacy and safety profiles.
背景
房颤（AF）患者通过抗凝预防中风至关重要；在大多数患者中，直接口服抗凝剂（DOACs）比华法林更受青睐。DOACs与左心耳封堵术（LAAO）的长期疗效和安全性尚不清楚。
方法
检索电子数据库（PubMed、Embase、Scopus），检索时间从建库至2021年2月10日。主要终点是心血管死亡率。次要结局包括缺血性中风/短暂性脑缺血发作（TIA）和系统性栓塞的发生率。安全终点是临床相关出血（主要或次要临床相关出血的综合）。
结果
共纳入三项研究，3039名参与者（LAAO组 = 1465名；DOACs组 = 1574名）。LAAO组和DOACs组的平均年龄分别为74.2岁和75.3岁。平均随访期为2年。两组在心脏死亡率（RR 0.90，95% CI 0.40 - 2.03；P = 0.81）、缺血性中风/TIA（RR 1.15，95% CI 0.80 - 1.65；P = 0.46；I² = 0）和临床显著出血（RR 0.77，95% CI 0.50 - 1.17；P = 0.22；I² = 69）方面无差异。
结论
在房颤患者中，LAAO与DOACs疗效和安全性相似。
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