中国循证医学杂志

中国循证医学杂志

达比加群酯和利伐沙班用于非瓣膜性房颤导管消融围术期抗凝治疗有效性和安全性的 meta 分析

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目的 系统评价达比加群酯和利伐沙班用于非瓣膜性房颤导管消融围术期抗凝治疗的有效性和安全性。 方法 计算机检索 PubMed、EMbase、Web of Science、The Cochrane Library、WanFang Data、CNKI 和 VIP 数据库,搜集达比加群酯和利伐沙班用于非瓣膜性房颤导管消融围术期抗凝治疗有效性和安全性的队列研究,检索时间均从建库至 2018 年 7 月 1 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 和 Stata 12.0 软件进行 meta 分析。 结果 共纳入 12 个队列研究,包括 4 051 名患者。meta 分析结果显示:达比加群酯和利伐沙班在血栓栓塞发生率[OR=0.92,95%CI(0.36,2.35),P=0.86]、缺血性脑卒中发生率[OR=1.15,95%CI(0.22,6.07),P=0.87]、大出血发生率[OR=0.84,95%CI(0.43,1.66),P=0.61]、小出血发生率[OR=0.90,95%CI(0.60,1.34),P=0.60]、心包填塞发生率[OR=1.05,95%CI(0.45,2.47),P=0.90]方面的差异均无统计学意义。 结论 当前证据表明,达比加群酯和利伐沙班用于非瓣膜性房颤导管消融围术期抗凝治疗的有效性和安全性相似。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically evaluate the efficacy and safety of dabigatranvs.rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation. Methods PubMed, EMbase, Web of Science, The Cochrane Library, WanFang Data, CNKI and VIP databases were electronically searched to collect cohort studies on the efficacy and safety of dabigatranvs.rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation from inception to July 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 and Stata 12.0 software. Results A total of 12 cohort studies involving 4 051 patients were included. The results of meta-analysis showed that: there were no differences in the rate of thromboembolic (OR=0.92, 95%CI 0.36 to 2.35, P=0.86), ischemic stroke (OR=1.15, 95%CI 0.22 to 6.07, P=0.87), major bleeding (OR=0.84, 95%CI 0.43 to 1.66, P=0.61), minor bleeding (OR=0.90, 95%CI 0.60 to 1.34, P=0.60) and pericardial tamponade (OR=1.05, 95%CI 0.45 to 2.47, P=0.90) between dabigatran and rivaroxaban groups. Conclusions Current evidence shows that the efficacy and safety of dabigatranvs.rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

关键词: 达比加群酯; 利伐沙班; 心房颤动; 导管消融术; 抗凝; meta 分析; 系统评价; 队列研究

Key words: Dabigatran; Rivaroxaban; Atrial fibrillation; Catheter ablation; Anticoagulation; meta-analysis; Systematic review; Cohort study

引用本文: 樊衡, 张志辉. 达比加群酯和利伐沙班用于非瓣膜性房颤导管消融围术期抗凝治疗有效性和安全性的 meta 分析. 中国循证医学杂志, 2019, 19(2): 156-164. doi: 10.7507/1672-2531.201809047 复制

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