左心耳封堵术后抗凝与抗血小板治疗方案的比较:系统评价/Meta分析

Comparison of Anticoagulant and Antiplatelet Therapy Regimens after Left Atrial Appendage Occlusion:A Systematic Review/Meta Analysis

目的:该Meta分析比较了左心耳封堵术(LAAC)后不同抗栓方案治疗的有效性和安全性。方法:通过计算机检索PubMed、Embase、Medline、Cochrane Library、中国知网、维普网,检索时限从建库至2023年3月相关主题词和自由词。将抗栓方案分为口服抗凝(OAC)组和抗血小板(APT)组,采用Revman 5.4分析事件的发生率。结果:最终纳入了15项研究,共35107例患者。结果发现OAC组的装置相关血栓(DRT)发生率[RR=0.50,95%CI(0.37,0.68),P<0.001]、全因死亡率[RR 0.69,95%CI(0.55,0.87),P=0.001]显著低于APT组,但两组卒中/系统性栓塞、大出血、任何出血和任何严重不良反应发生率差异无统计学意义(P>0.05)。亚组分析发现,单用OAC的DRT发生率、全因死亡率、任何严重不良反应发生率均低于APT组(P<0.05),其他结局指标两组差异无统计学意义(P>0.05);其中,非维生素K口服抗凝药(NOAC)的DRT、全因死亡、任何严重不良反应和任何出血发生率均显著低于APT(P<0.05),而华法林仅DRT发生率低于APT(P<0.05),两组其他结局指标差异均无统计学意义(P>0.05)。而OAC联用一种抗血小板药物(SAPT)时,DRT发生率显著低于APT组(P<0.05),但大出血发生率更高(P<0.05),其余结局指标差异均无统计学意义(P>0.05)。结论:LAAC后抗凝治疗的临床获益可能优于抗血小板治疗;具体抗凝方案选择时,单用NOAC可能优于单用华法林或OAC联合一种抗血小板药物。

Objective:This meta-analysis compared the effectiveness and safety of different antithrom-botic regimens after left atrial appendage closure(LAAC).Methods:Databases PubMed,Embase,Medline and Cochrane Library were searched through a computer from the time they were created to March 2023.We divided the antithrombotic regimens into an oral anticoagulation(OAC)group and an antiplatelet thera-py(APT)group,and analyzed the incidence of events using the Revman 5.4.Results:Finally,15 studies were included,with a total of 35107 patients.The results showed that the incidence of device related thrombosis(DRT)[RR=0.50,95%CI(0.37,0.68),P<0.001]and all-cause mortality[RR=0.69,95%CI(0.55,0.87),P=0.001]in the OAC group were significantly lower than those in the APT group,but there was no significant difference in the incidence of ischemic stroke/systemic embolism,major bleeding,any bleeding and any major adverse event between the two groups(P>0.05).Subgroup analysis found that the incidence of DRT,all-cause mortality,and major adverse event in the OAC alone group were lower than those in the APT group(P<0.05),there was no significant difference in other outcome indicators between the two groups(P>0.05).Among them,the incidence of DRT,all-cause death,any major adverse event and any bleeding of non vitamin K oral anticoagulant(NOAC)was significantly higher than that of APT(P<0.05).While warfarin only had a higher incidence of DRT than APT(P<0.05),there was no significant difference in other outcome indicators between the two groups(P>0.05).When OAC was combined with a single antiplatelet therapy(SAPT),the incidence of DRT was significantly lower than that of APT group,however,the incidence of major bleeding was higher(P<0.05),and there was no significant difference in other outcome indicators(P>0.05).Conclusion:The clinical benefits of anticoagulation therapy after LAAC may be superior to antiplatelet therapy;when selecting specific anticoagulation schemes,NOAC alone may be superior to warfarin alone or OAC combined with SAPT.