Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, Henan Province, China.
Department of Intensive Care Unit, Huaihe Hospital of Henan University, Kaifeng, Henan Province, China.
Medicine (Baltimore). 2024 Oct 18;103(42):e39937. doi: 10.1097/MD.0000000000039937.
Various oral anticoagulants have been used for stroke prevention in older patients with atrial fibrillation (AF). However, the optimal anticoagulants for stroke prevention has not yet been developed. We performed a systematic review and network meta-analysis to determine the optimal instructions.
We searched for randomized controlled trials (RCTs) from PubMed, Embase, and the Cochrane Library without restriction for publication date or language at January 2024. Any RCTs that compared the effectiveness of a direct oral anticoagulant and a vitamin K antagonist (VKA) for stroke prevention in older patients with AF were included in this network meta-analysis. The Bayesian network meta-analysis used a random effects model and surface under the cumulative ranking curve analysis to rank results. All analyses were done using R software with gemtc package, with statistical significance set at P < .05.
We included 7 RCTs (79,003 patients) comparing 8 different instructions including Apixaban 5 mg, Dabigatran 110 mg, Dabigatran 150 mg, Edoxaban 30 mg, Edoxaban 60 mg, Rivaroxaban 15 mg, Rivaroxaban 20 mg, and VKA. Apixaban 5 mg, Dabigatran 110 mg, and Dabigatran 150 mg was more effective than the VKA for reducing stroke or systemic embolism risks, and the difference was statistically significant (P < .05). Apixaban 5 mg, Dabigatran 110 mg, Dabigatran 150 mg, Edoxaban 30 mg, and Edoxaban 60 mg was associated with a reduction of the intracranial hemorrhage rate than the VKA (P < .05). The surface under the cumulative ranking curve shows that Dabigatran 110 mg ranked first for reducing stroke or systemic embolism risks. Edoxaban 60 mg ranked first for major bleeding. Dabigatran 110 mg ranked first for intracranial hemorrhage. Apixaban 5 mg ranked first for all bleeding events.
Direct oral anticoagulants were found to have lower rates of thromboembolic events compared to VKAs in older patients with AF. Apixaban 5 mg, Dabigatran 110 mg, Dabigatran 150 mg, Edoxaban 30 mg, and Edoxaban 60 mg were also associated with a reduction of intracranial hemorrhage than VKA.
各种口服抗凝剂已被用于预防老年房颤（AF）患者的中风。然而，预防中风的最佳抗凝剂尚未开发出来。我们进行了系统评价和网络荟萃分析，以确定最佳的抗凝剂。
我们从 PubMed、Embase 和 Cochrane 图书馆中搜索了无发表日期或语言限制的随机对照试验（RCT），直到 2024 年 1 月。本网络荟萃分析纳入了比较直接口服抗凝剂与维生素 K 拮抗剂（VKA）预防老年 AF 患者中风效果的任何 RCT。贝叶斯网络荟萃分析采用随机效应模型和累积排序曲线下面积分析来对结果进行排名。所有分析均使用 R 软件和 gemtc 包进行，统计显著性设为 P<0.05。
我们纳入了 7 项 RCT（79003 名患者），比较了 8 种不同的治疗方案，包括阿哌沙班 5mg、达比加群 110mg、达比加群 150mg、依度沙班 30mg、依度沙班 60mg、利伐沙班 15mg、利伐沙班 20mg 和 VKA。阿哌沙班 5mg、达比加群 110mg 和达比加群 150mg 比 VKA 更能有效降低中风或全身性栓塞风险，差异具有统计学意义（P<0.05）。阿哌沙班 5mg、达比加群 110mg、达比加群 150mg、依度沙班 30mg 和依度沙班 60mg 与颅内出血发生率降低相关，与 VKA 相比，差异具有统计学意义（P<0.05）。累积排序曲线下面积显示，达比加群 110mg 对降低中风或全身性栓塞风险排名第一。依度沙班 60mg 对大出血的排名第一。达比加群 110mg 对颅内出血的排名第一。阿哌沙班 5mg 对所有出血事件的排名第一。
与 VKA 相比，直接口服抗凝剂在老年 AF 患者中可降低血栓栓塞事件的发生率。阿哌沙班 5mg、达比加群 110mg、达比加群 150mg、依度沙班 30mg 和依度沙班 60mg 与颅内出血发生率降低相关，与 VKA 相比，差异具有统计学意义。
