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直接口服抗凝剂与华法林在房颤合并肝病患者中的疗效和安全性：一项更新的系统评价和荟萃分析

Efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver disease: an updated systematic review and meta-analysis.

作者信息

Bhagwan Riya, Ahmed Rushaan, Idrees Saad Ahmed, Javaid Saad, Mazhar Roha, Tauqeer Rahima, Ahmed Mushood, Kumar Satesh, Khatri Mahima, Gupta Ashish, Ramkumar Ramachandra, Baig Mudassar, Collins Peter, Ahmed Raheel

机构信息

Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.

Department of Medicine, Khyber Medical College, Peshawar, Pakistan.

出版信息

Arch Med Sci Atheroscler Dis. 2025 May 30;10:e78-e88. doi: 10.5114/amsad/205549. eCollection 2025.

DOI:10.5114/amsad/205549
PMID:40620744
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12223980/
Abstract

INTRODUCTION

Although previous meta-analyses have explored the efficacy and safety of direct oral anticoagulants (DOAC) compared to warfarin in patients with atrial fibrillation (AFib) and liver disease, recent studies and emerging data necessitate a re-evaluation of the topic. Therefore, we conducted an updated meta-analysis to incorporate the latest evidence and provide a more comprehensive understanding of the literature. This meta-analysis aimed to assess the safety and efficacy of DOAC in patients diagnosed with AFib and liver disease.

METHODS

Following PRISMA guidelines, this meta-analysis is registered with PROSPERO (2024 CRD42024584964). A detailed search up to August 2024 was conducted for the studies comparing DOAC with warfarin. The quality of the included observational studies was evaluated using the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool.

RESULTS

This meta-analysis included 53,224 participants with AFib and liver disease. The use of DOAC, in comparison to warfarin, was significantly linked to a lower risk of all-cause mortality (HR = 0.77; 95% CI: 0.60-0.98; = 0.04) and a decreased occurrence of intracranial haemorrhage (HR = 0.49; 95% CI: 0.40-0.59; < 0.00001). However, other outcomes did not demonstrate statistically significant differences.

CONCLUSIONS

Recent studies indicate that DOAC are at least non-inferior to warfarin concerning efficacy and safety of patients with AFib and liver disease.

摘要

引言

尽管之前的荟萃分析探讨了直接口服抗凝剂（DOAC）与华法林相比在心房颤动（AFib）和肝病患者中的疗效和安全性，但近期的研究和新出现的数据使得有必要对该主题进行重新评估。因此，我们进行了一项更新的荟萃分析，以纳入最新证据并更全面地理解相关文献。这项荟萃分析旨在评估DOAC在诊断为AFib和肝病的患者中的安全性和疗效。

方法

遵循PRISMA指南，这项荟萃分析已在PROSPERO（2024 CRD42024584964）注册。对截至2024年8月比较DOAC与华法林的研究进行了详细检索。使用非随机干预研究中的偏倚风险（ROBINS-I）工具评估纳入的观察性研究的质量。

结果

这项荟萃分析纳入了53224名患有AFib和肝病的参与者。与华法林相比，使用DOAC与全因死亡率较低（HR = 0.77；95% CI：0.60 - 0.98；P = 0.04）以及颅内出血发生率降低（HR = 0.49；95% CI：0.40 - 0.59；P < 0.00001）显著相关。然而，其他结果未显示出统计学上的显著差异。

结论

近期研究表明，在AFib和肝病患者的疗效和安全性方面，DOAC至少不劣于华法林。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/9b0e0204ed63/AMS-AD-10-205549-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/6fe8c9c8b94e/AMS-AD-10-205549-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/16d8a34ae31b/AMS-AD-10-205549-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/d01733874527/AMS-AD-10-205549-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/9b0e0204ed63/AMS-AD-10-205549-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/6fe8c9c8b94e/AMS-AD-10-205549-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/16d8a34ae31b/AMS-AD-10-205549-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/d01733874527/AMS-AD-10-205549-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f38/12223980/9b0e0204ed63/AMS-AD-10-205549-g004.jpg

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