利伐沙班与达比加群对心房颤动患者导管消融围术期抗凝治疗的系统评价

摘要

目的 系统评价利伐沙班与达比加群对心房颤动患者导管消融围术期抗凝治疗的有效性与安全性.方法 检索中国知网、维普、万方、PubMed、Web ofScience、EmBase及Cochrane图书馆等数据库,检索时间从建库至2016-12-15,查找导管消融围术期利伐沙班与达比加群用于治疗心房颤动患者的临床试验.对纳入的研究进行质量评价,用RevMan5.3软件进行Meta分析,最小成本分析法进行经济学评价.结果 共有6篇观察性研究与1篇随机对照试验文献研究符合入选标准.Meta分析结果显示:与达比加群相比,利伐沙班在血栓栓塞事件发生率(RR=1.03,95％ CI =0.27 ～4.00,P＞0.05)、大出血事件发生率(RR=1.02,95％ CI=0.42,2.48,P＞0.05)与卒中事件发生率(RR =0.87,95％CI =0.17～4.60,P＞0.05)方面差异均无统计学意义,2组成本比较差异有统计学意义(P＜0.05).结论 利伐沙班与达比加群治疗心房颤动患者导管消融围术期抗凝治疗有效性与安全性相近,但达比加群具有经济学优势.%Objective To evaluate the efficiency and safety of rivaroxaban and dabigatran for anticoagulant therapy which is a treatment for atrial fibrillation patients undergoing catheter ablation.Methods CNKI,VIP Database,Wangfang Database,PubMed,Web of science,EmBase and Cochrane library were searched until 2016-12-15.All clinical trials about anticoagulant therapy of rivaroxaban and dabigatran in patients undergoing catheter ablation for atrial fibrillation were selected.And research quality evaluation was done using RevMan5.3 software for Meta analysis.Minimum cost analysis method was used for economic evaluation.Results A total of 6 observational study and 1 randomized controlled trials met the inclusion criteria.Compared with dabigatran,rivaroxaban has no statistically significant differences in thromboembolism (RR =1.03,95％ CI =0.27-4.00,P ＞0.05),major bleeding (RR =1.02,95％CI =0.42-2.48,P ＞0.05),strokes (RR =0.87,95％CI =0.17-4.60,P ＞0.05),but there was statistical significance in costs between two groups(P ＜ 0.05).Conclusion Rivaroxaban and dabigatran have similar effectiveness and safety in anticoagulant therapy for patients undergoing catheter ablation for atrial fibrillation,but dabigatran has economic advantage.