基于4种新型口服抗凝药预防非瓣膜性房颤患者脑卒中疗效的网状meta分析

Network meta-analysis based on four new oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation

目的通过网状meta分析评价阿哌沙班、达比加群110 mg与150 mg、利伐沙班、依度沙班30 mg与60 mg预防非瓣膜性心房颤动(房颤)患者脑卒中的疗效。方法全面检索PubMed、EMbase、The Cochrane Library、中国生物医学文献数据库、中国知网、维普、万方数据库,搜集有关新型口服抗凝药预防脑卒中的随机对照试验(RCT),检索日期自建库日期至2017年8月。对检索所得文献进行筛选后,通过R 3.4.1软件完成网状meta分析。结果共纳入11篇随机对照试验,总计74386例患者。结果表明,相比华法林,达比加群150 mg能显著降低脑卒中发生率(OR=0.43,95%CI:0.12~0.81),差异有统计学意义(P<0.05),其余比较差异均无统计学意义,采用累积排序概率图下面积值对干预措施预防脑卒中的疗效进行排序,结果提示达比加群150 mg疗效最好,依度沙班30 mg疗效最差,其他疗效优劣依次为阿哌沙班、利伐沙班、达比加群110 mg、依度沙班60 mg、华法林。结论非瓣膜性房颤患者预防脑卒中,可优先选用达比加群150 mg,其他依次可选用阿哌沙班、利伐沙班、达比加群110 mg、依度沙班60 mg、华法林、依度沙班30 mg。本研究为临床合理用药提供了一定的参考。

Objective To evaluate the efficacy of apixaban,dabigatran(110 and 150 mg),rivaroxaban,edoxaban(30 and 60 mg)for stroke prevention in patients with non-valvular atrial fibrillation by network meta-analysis.Methods PubMed,EMbase,The Cochrane Library,CBM,CNKI,VIP and WanFang Data were searched for the randomized controlled trials(RCTs)of new oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation from database establishment to August 2017.The obtained literature were analyzed by R3.4.1 software.Results A total of 11 RCTs involving 74386 patients were included.Compared with warfarin,dabigatran 150 mg could reduce the rate of stroke(OR=0.43,95%CI:0.12~0.81,P<0.05).The results of area under the cumulative ranking curve which ranked effectiveness of all thrombolytics for stroke prevention showed that dabigatran 150 mg had the best effectiveness and edoxaban 30 mg had the worst effectiveness.In term of other rank was apixaban,rivaroxaban,dabigatran 110 mg,edoxaban 60 mg,and warfrain.Conclusions Dabigatran 150 mg is the optimal choice for prevention of stroke in patients with non-valvular atrial fibrillation,followed by apixaban,rivaroxaban,dabigatran 110 mg,edoxaban 60 mg,warfarin and edoxaban 30 mg.This experiment provides reference for rational drug use in clinical setting.