Adji Arga Setyo, de Liyis Bryan Gervais
Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia.
Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.
Egypt Heart J. 2024 Aug 9;76(1):102. doi: 10.1186/s43044-024-00535-w.
Atrial fibrillation (AF) poses a significant stroke risk in heart disease patients. This systematic review aims to evaluate the efficacy and safety of non-vitamin K oral antagonists (NOACs) versus vitamin K antagonists (VKAs) in AF patients with and without any valvular heart disease (VHD/N-VHD).
A systematic search was conducted on PubMed, Scopus, and Google Scholar up to March 3, 2022. Efficacy and safety parameters were analyzed.
A total of 85,423 subjects from 10 studies were included in this meta-analysis. NOACs and VKAs showed similar effects on ischemic stroke in AF patients with VHD/N-VHD (RR 0.97; 95% CI 0.72-1.30; p = 0.83) and also on systemic embolic events (RR 1.02; 95% CI 0.83-1.25; p = 0.86). Similar effects were seen in VHD and N-VHD subgroups. Both treatments had similar effects on myocardial infarction in AF patients with VHD/N-VHD (RR 0.79; 95% CI 0.49-1.26; p = 0.32), VHD (RR 0.78; 95% CI 0.59-1.02; p = 0.07), and N-VHD subgroups (RR 0.82; 95% CI 0.30-2.21; p = 0.69). NOACs reduced the risk of intracranial bleeding in AF VHD/N-VHD (RR 0.64; 95% CI 0.54-0.77; p < 0.0001), VHD (RR 0.59; 95% CI 0.42-0.82; p = 0.002), and N-VHD subgroups (RR 0.70; 95% CI 0.57-0.85; p = 0.0003). Additionally, NOACs reduced the risk of gastrointestinal bleeding in AF VHD/N-VHD (RR 0.80; 95% CI 0.66-0.96; p = 0.02), specifically in the VHD subgroup (RR 0.69; 95% CI 0.54-0.89; p = 0.004). Moreover, NOACs were associated with a decreased risk for minor and non-fatal bleeding in AF patients with VHD/N-VHD (RR 0.86; 95% CI 0.75-0.99; p = 0.04).
NOACs are effective and safe for ischemic stroke, systemic embolic events, myocardial infarction, intracranial bleeding, and gastrointestinal bleeding in AF patients with VHD/N-VHD.
心房颤动（AF）在心脏病患者中构成重大的中风风险。本系统评价旨在评估非维生素K口服抗凝剂（NOACs）与维生素K拮抗剂（VKAs）在有和没有任何瓣膜性心脏病（VHD/N-VHD）的AF患者中的疗效和安全性。
截至2022年3月3日，在PubMed、Scopus和谷歌学术上进行了系统检索。对疗效和安全性参数进行了分析。
本荟萃分析纳入了来自10项研究的总共85423名受试者。NOACs和VKAs在有VHD/N-VHD的AF患者中对缺血性中风（风险比[RR]0.97；95%置信区间[CI]0.72-1.30；p = 0.83）以及全身性栓塞事件（RR 1.02；95% CI 0.83-1.25；p = 0.86）显示出相似的效果。在VHD和N-VHD亚组中也观察到了相似的效果。两种治疗方法在有VHD/N-VHD的AF患者（RR 0.79；95% CI 0.49-1.26；p = 0.32）、VHD（RR 0.78；95% CI 0.59-1.02；p = 0.07）和N-VHD亚组（RR 0.82；95% CI 0.30-2.21；p = 0.69）中对心肌梗死的影响相似。NOACs降低了有VHD/N-VHD的AF患者（RR 0.64；95% CI 0.54-0.77；p < 0.0001）、VHD（RR 0.59；95% CI 0.42-0.82；p = 0.002）和N-VHD亚组（RR 0.70；95% CI 0.57-0.85；p = 0.0003）颅内出血的风险。此外，NOACs降低了有VHD/N-VHD的AF患者（RR 0.80；95% CI 0.66-0.96；p = 0.02），特别是VHD亚组（RR 0.69；95% CI 0.54-0.89；p = 0.004）胃肠道出血的风险。此外，NOACs与有VHD/N-VHD的AF患者轻微和非致命性出血风险降低相关（RR 0.86；95% CI 0.75-0.99；p = 0.04）。
对于有VHD/N-VHD的AF患者，NOACs在缺血性中风、全身性栓塞事件、心肌梗死、颅内出血和胃肠道出血方面是有效且安全的。
