直接口服抗凝剂与维生素K拮抗剂治疗左心室血栓形成的Meta分析
Direct Oral Anticoagulants versus Vitamin K Antagonists for the Treatment of Left Ventricular Thrombosis: A Meta-Analysis.
作者信息
Li Jian, Hu Yuecheng, Wu Zhenhua
机构信息
Intensive Care Unit, Tianjin Chest Hospital, 300222 Tianjin, China.
Department of Cardiology, Tianjin Chest Hospital, 300222 Tianjin, China.
出版信息
Rev Cardiovasc Med. 2022 Sep 13;23(9):312. doi: 10.31083/j.rcm2309312. eCollection 2022 Sep.
BACKGROUND
Vitamin K antagonists (VKAs) have been recommended as first-line anticoagulants for patients with left ventricular thrombosis (LVT). Direct oral anticoagulants (DOACs) are used as an alternative to the standard of care in anticoagulation. The aim of this meta-analysis was to compare the efficacy and safety of VKAs and DOACs in the treatment of patients with LVT.
MATERIALS AND METHODS
Studies were identified by searching the PubMed, Web of Science, and Embase. The main outcomes included stroke or systemic embolism (SSE), thrombus resolution, and bleeding events. The pooled risk ratio (RR) with 95% confidence intervals (CIs) was estimated with fixed effect or random effect models.
RESULTS
Seventeen studies were included. Pooled estimate showed that DOACs had comparable efficacy in prevention of SSE (RR = 0.96, 95% CI: 0.80, 1.16; = 0.677) and thrombus resolution as compared with VKAs (RR = 1.07, 95% CI: 0.97, 1.18; = 0.193). DOACs significantly decreased the risk of stroke in patients with LVT (RR = 0.68, 95% CI: 0.47, 1.00; = 0.048). However, this effect was not observed in the sensitive analysis by high-quality studies (RR = 0.69, 95% CI: 0.47, 1.02; = 0.06). In terms of safety outcomes, DOACs had similar risk of bleeding events (RR = 1.12, 95% CI: 0.80, 1.57; = 0.386) and clinically relevant bleeding events (RR = 0.49, 95% CI: 0.23, 1.03; = 0.060). Meta-regression analysis demonstrated that none of the variables (study design, concomitant antiplatelet medication, duration of follow-up, primary cause of LVT, sample size, types of DOACs) had an impact on the risk of SSE, thrombus resolution and bleeding events. Subgroup analysis based on the use of antiplatelet and treatment switching revealed that there were no significant differences among patients with different treatment regimens.
CONCLUSIONS
Based on the present evidence, both DOACs and VKA offered similar effective and safe outcomes in patients with LVT.
背景
维生素K拮抗剂（VKAs）已被推荐作为左心室血栓形成（LVT）患者的一线抗凝剂。直接口服抗凝剂（DOACs）被用作抗凝治疗标准的替代药物。本荟萃分析的目的是比较VKAs和DOACs在治疗LVT患者中的疗效和安全性。
材料与方法
通过检索PubMed、科学网和Embase来识别研究。主要结局包括中风或全身性栓塞（SSE）、血栓溶解和出血事件。采用固定效应或随机效应模型估计合并风险比（RR）及95%置信区间（CIs）。
结果
纳入了17项研究。汇总估计显示，与VKAs相比，DOACs在预防SSE（RR = 0.96，95% CI：0.80，1.16；P = 0.677）和血栓溶解方面具有相当的疗效（RR = 1.07，95% CI：0.97，1.18；P = 0.193）。DOACs显著降低了LVT患者中风的风险（RR = 0.68，95% CI：0.47，1.00；P = 0.048）。然而，在高质量研究的敏感性分析中未观察到这种效果（RR = 0.69，95% CI：0.47，1.02；P = 0.06）。在安全性结局方面，DOACs发生出血事件的风险相似（RR = 1.12，95% CI：0.80，1.57；P = 0.386），发生临床相关出血事件的风险也相似（RR = 0.49，95% CI：0.23，1.03；P = 0.060）。Meta回归分析表明，没有变量（研究设计、联合使用的抗血小板药物、随访时间、LVT的主要病因、样本量、DOACs类型）对SSE、血栓溶解和出血事件的风险有影响。基于抗血小板药物使用和治疗转换的亚组分析显示，不同治疗方案的患者之间没有显著差异。
结论
基于现有证据，DOACs和VKA在LVT患者中提供了相似的有效和安全结局。
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