连续服用非维生素K拮抗剂口服抗凝药对心房颤动射频消融术患者抗凝效果的荟萃分析

摘要

Objective To systematically evaluate the effect and safety of uninterrupted non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonist (VKA) for ablation of atrial fibrillation.Methods Databases including PubMed,EMbase,The Cochrane Library (Issue 12,2016),WanFang Data,CBM,CNKI were searched to collect the studies about NOACs versus VKA for ablation of atrial fibrillation from inception to December 2016.The meta-analysis was conducted using RevMan 5.3 software.Results A total of 9 studies involving 4 189 patients were included.The results of meta-analysis showed that thrombo-embolism (OR =1.68,95 ％ CI 0.51-5.49,P =0.39),transient ischemic attack/stroke (OR =1.26,95 ％ CI 0.43-3.69,P =0.67),massive hemorrhage (OR =0.76,95 ％ CI 0.41-1.42,P =0.39),mild bleeding (OR =0.89,95 ％ CI 0.68-1.17,P=0.40) cardiac tamponade(OR=1.68,95％ CI 0.51-5.49,P=0.39),subcutaneous hematoma (OR=1.00,95％ CI 0.72-1.40,P =0.98),there was no significant difference in effect and safety between group oral anticoagulants and group VKA.Conclusion Current studies suggested that uninterrupted NOACs were beneficial in terms of treatment and safety.Due to the limited region of the included studies,the above conclusion,especially in China,still need more high quality research to be verified.%目的 系统评价连续服用非维生素K拮抗剂口服抗凝药(NOACs)与维生素K拮抗剂(VKA)对心房颤动(房颤)射频消融术患者的安全性及抗凝效果,以期为房颤射频消融术患者抗凝药物的选择提供参考.方法 计算机检索PubMed、The Cochrane Library(2016年第12期)、EMbase、CBM、CNKI、WanFang Data,查找有关连续NOACs与VKA对房颤射频消融术患者抗凝安全性与抗凝效果的随机对照试验(RCT)或观察性试验.数据库检索时限为建库至2016年12月.各结局指标荟萃(Meta)分析采用RevMan 5.3软件进行.结果 最终纳入Meta分析文献9篇,共计4 189例患者.Meta分析结果显示:NOACs组患者血栓栓塞(OR=1.68,95％ CI 0.51～5.49,P=0.39)、短暂性脑缺血发作/脑卒中(OR=1.26,95％ CI0.43～3.69,P=0.67)、大出血(OR=0.76,95％ CI0.41～1.42,P=0.39)、轻微出血(OR=0.89,95％ CI0.68～1.17,P=0.40)、心脏压塞(OR=1.68,95％ CI0.51～5.49,P=0.39)、腹股沟皮下血肿(OR=1.00,95％ CI 0.72～1.40,P=0.98)发生率较VKA组差异无统计学意义.结论 NOACs能够为房颤射频消融术的患者提供较为良好的治疗效果,其安全性亦与VKA相似.但其对国内房颤射频消融术患者的有效性及安全性仍需更多国内高质量随机对照试验加以验证.