新型口服抗凝药治疗70岁以上老年心房颤动患者疗效及安全性的Meta分析

Efficacy and safety of new oral anticoagulants for the treatment of patients over 70 years with atrial fibrillation:A meta-analysis

目的系统评价新型口服抗凝药(NOACs)治疗70岁以上老年心房颤动(房颤)患者疗效及安全性。方法计算机检索PubMed、Embase、Cochrane library等数据库,检索时间均从建库至2021年3月,收集其中收录的公开发表的关于NOACs(达比加群、利伐沙班、阿哌沙班、西美加群、艾多沙班)与华法林治疗70岁以上老年房颤患者比较的文献。采用Stata15.0软件进行Meta分析。结果研究共纳入19篇文献,215471例患者。与华法林相比,低剂量(110 mg)和常规剂量(150 mg)达比加群均可降低70岁以上老年房颤患者卒中/系统性栓塞(SSE)发生率;常规剂量达比加群不降低严重出血发生率,但低剂量可降低严重出血风险;常规剂量(20 mg)利伐沙班可降低70岁以上老年房颤患者卒中/SSE发生率,而不增加严重出血发生率;常规剂量阿哌沙班(5 mg)可降低70岁以上老年房颤患者卒中/SSE以及严重出血发生率;常规剂量(36 mg)西美加群降低70岁以上老年房颤患者卒中/SSE发生率不亚于华法林,但降低严重出血风险。低剂量(15~30 mg)和常规剂量(30~60 mg)艾多沙班降低70岁以上老年房颤患者卒中/SSE发生率不亚于华法林,但降低严重出血风险。结论和华法林相比,大多数新型口服抗凝药具有良好的抗凝效果。对于70岁以上老年房颤患者来说,常规剂量新型口服抗凝药严重出血风险增加,而使用低剂量的新型口服抗凝药安全有效。

Objective To systematically review the efficacy and safety of new oral anticoagulants(NOACs)for the treatment of patients over 70 years with atrial fibrillation.Methods Studies comparing NOACs(dabigatran,rivaroxaban,apixaban,ximelagatran and edoxaban)versus warfarin for the treatment of patients over 70 years with atrial fibrillation were searched through databases including PubMed,Embase and the Cochrane Library,from the earliest electronic records to those published in March 2021.Stata15.0 software was used for meta-analysis.Results A total of 19 studies and 215471 patients were included.Meta-analysis results showed that,compared with warfarin,either a low-dose(110 mg)or a standard-dose(150 mg)of dabigatran reduced the risk of stroke/systemic embolism(SSE)in patients over 70 years with atrial fibrillation.A standard-dose of dabigatran did not decrease the risk of major bleeding,but a low dose was able to achieve it.A standard-dose(20 mg)of rivaroxaban could considerably reduce the risk of SSE in geriatric patients over 70 years with atrial fibrillation without increasing the risk of major bleeding.A standard-dose(5 mg)of apixaban could considerably decrease the risk of SSE and major bleeding in patients over 70 years with atrial fibrillation;A standard-dose(36 mg)of ximelagatran was as effective as warfarin in decreasing the incidence of SSE in patients over 70 years with atrial fibrillation,but could also considerably decrease the risk of major bleeding;A low-dose(15-30 mg)or a standard-dose(30-60 mg)of edoxaban decreased the incidence of SSE in patients over 70 years with atrial fibrillation,as did warfarin,but edoxaban considerably decreased the risk of major bleeding.Conclusions Compared with warfarin,most of new oral anticoagulants show good efficacy in patients over 70 years old with atrial fibrillation,NOACs given at standard doses increase the risk of major bleeding,but at low doses can realize both efficacy and safety.