经导管主动脉瓣置换术后口服抗凝药与抗血小板治疗的Meta分析

Oral anticoagulation and antiplatelet therapy after transcatheter aortic valve replacement:A systematic review and Meta-analysis

目的评估经导管主动脉瓣置换术(TAVR)后不同抗血栓策略的有效性和安全性。方法计算机检索PubMed、EMbase、CNKI和万方医学数据库,搜集经导管主动脉瓣置换术后口服抗凝药与抗血小板治疗、维生素K拮抗剂与非维生素K拮抗剂口服抗凝药的非随机对照实验,并分析其术后出血、脑血管事件、全因死亡的发生率。采用Cochrane协作网提供的软件RevMan5.2进行Meta分析。结果9篇文献纳入此次研究。与抗血小板治疗比较,抗凝药的出血发生率增高(26.3%比20.3%;OR=1.20,95%CI:1.04~1.39,P=0.01),然而,脑血管事件和全因死亡率差异无统计学意义(P>0.05);在抗凝药组内,维生素K拮抗剂的全因死亡率低于非维生素K拮抗剂(9.8%比12.9%;OR=0.73,95%CI:0.55~0.97,P=0.03),然而脑血管事件和出血事件差异无统计学意义(P>0.05)。结论与抗血小板治疗的患者比较,抗凝药患者出血发生率高;在抗凝药组内,与非维生素K拮抗剂比较,维生素K拮抗剂能显著降低死亡率。

Objective To assess the efficacy and safety of different antithrombotic strategies in patients following transcatheter aortic valve replacement(TAVR).Methods A computerized search was performed to identify all relevant publications from PubMed,EMbase,CNKI and Wangfang databases.Non-randomized controlled trials of oral anticoagulant(OAC)vs.antiplatelet therapy(APT)and vitamin K antagonists(VKAs)vs.non-vitamin K antagonist oral anticoagulants(NOACs)after TAVR were collected,and the effects on postoperative bleeding,cerebrovascular events and all-cause mortality were analyzed.A meta-analysis was performed using RevMan 5.2 software provided by the Cochrane Collaboration.Results A total of 9 studies were included.Compared with APT,the incidence of bleeding events caused by OAC increased(20.3%vs.26.3%,OR=1.20,95%CI:1.04-1.39,P=0.01),while the incidence of cardiovascular events and all-cause mortality had no statistical difference.In the OAC group,all-cause mortality was lower in the VKAs group than in the NOACs group(9.8%vs.OR=0.73,95%CI:0.55-0.97,P=0.03).However,there was no statistical significance in cardiovascular and bleeding events(P>0.05).Conclusions Compared with patients receiving APT,the incidence of bleeding events is higher in patients taking OAC.In patients taking OAC,VKAs can significantly decrease the mortality compared with NOACs.