心房颤动患者血小板减少与不良结局的相关性：一项系统评价和荟萃分析。
Correlation between thrombocytopenia and adverse outcomes in patients with atrial fibrillation: a systematic review and meta-analysis.
作者信息
Ding Qiuhua, Xu Wenlin, Chen Yaoyao, Chang Sijie, Zhang Jinhua
机构信息
Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
出版信息
Front Cardiovasc Med. 2024 Dec 3;11:1383470. doi: 10.3389/fcvm.2024.1383470. eCollection 2024.
BACKGROUND
Thrombocytopenia is often associated with adverse outcomes in patients with atrial fibrillation. Therefore, we conducted a meta-analysis to comprehensively assess the impact of thrombocytopenia on ischemic stroke/systemic embolism, major bleeding and all-cause mortality in patients with atrial fibrillation.
METHODS
Two electronic databases, PubMed and Web of Science, were systematically searched from their inception to December 1, 2023, including the studies on the correlation between atrial fibrillation patients with thrombocytopenia and adverse outcomes. Relevant data was extracted, literature quality was evaluated, meta-analysis was performed by using REVMAN 5.4 software, and the results were reported with odds ratio (OR) of 95% confidence interval (CI).
RESULTS
A total of 12 studies included 73,824 patients with atrial fibrillation (average age: 72.67, males: 42,275, 57.3%), among them, there were 7,673 patients combined with thrombocytopenia. The average follow-up time of these studies was 87 days to 55 months. Compared to no thrombocytopenia, atrial fibrillation patients combined with thrombocytopenia have a significant risk reduction of ischemic stroke/systemic embolism [OR: 0.79, 95% CI: (0.69, 0.91); < 0.01]. Nevertheless, the risk of both major bleeding [OR: 1.51, 95% CI: (1.20, 1.79), < 0.01] and all-cause mortality [OR: 1.40, 95% CI: (1.23, 1.61); < 0.01] is significantly higher in thrombocytopenia group.
CONCLUSIONS
Thrombocytopenia has an important impact on the prognosis of patients with atrial fibrillation. Thrombocytopenia is significantly associated with a lower risk of ischemic stroke/systemic embolism but a higher risk of major bleeding and all-cause mortality. Attention to thrombocytopenia and optimization of treatment may be the effective way to improve the prognosis of atrial fibrillation with thrombocytopenia.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/, PROSPERO Registration Number: (CRD42023459916).
背景
血小板减少症常与心房颤动患者的不良预后相关。因此，我们进行了一项荟萃分析，以全面评估血小板减少症对心房颤动患者缺血性中风/全身性栓塞、大出血和全因死亡率的影响。
方法
系统检索了两个电子数据库，即PubMed和Web of Science，检索时间从建库至2023年12月1日，纳入关于血小板减少症的心房颤动患者与不良结局之间相关性的研究。提取相关数据，评估文献质量，使用REVMAN 5.4软件进行荟萃分析，并以95%置信区间（CI）的比值比（OR）报告结果。
结果
共12项研究纳入73824例心房颤动患者（平均年龄：72.67岁，男性：42275例，占57.3%），其中7673例患者合并血小板减少症。这些研究的平均随访时间为87天至55个月。与无血小板减少症相比，合并血小板减少症的心房颤动患者发生缺血性中风/全身性栓塞的风险显著降低[OR：0.79，95%CI：（0.69，0.91）；P<0.01]。然而，血小板减少症组的大出血风险[OR：1.51，95%CI：（1.20，1.79），P<0.01]和全因死亡率[OR：1.40，95%CI：（1.23，1.61）；P<0.01]均显著更高。
结论
血小板减少症对心房颤动患者的预后有重要影响。血小板减少症与缺血性中风/全身性栓塞风险较低显著相关，但与大出血和全因死亡率风险较高显著相关。关注血小板减少症并优化治疗可能是改善合并血小板减少症的心房颤动患者预后的有效途径。
系统评价注册
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