达比加群酯对非瓣膜性房颤导管消融围术期抗凝疗效和安全性的 Meta 分析

目的：系统评价达比加群酯对非瓣膜性房颤导管消融围术期的抗凝疗效和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library（2016年第2期）、CMB、知网、万方和维普数据库，搜集有关房颤导管消融围术期使用达比加群酯和华法林抗凝治疗的随机对照及非随机对照的研究文献，由两位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后，采用 RevMan 5．3软件进行 Meta 分析。结果最终纳入23个研究、共7673例患者。Meta 分析结果显示：达比加群酯组脑卒中或短暂性脑缺血发生率与华法林组无明显区别[OR ＝1．0，95％CI：0．60～1．68，P ＝0．99]，大出血事件发生率无明显区别[OR ＝0．79，95％CI：0．52～1．19， P ＝0．25]，小出血事件发生率显著降低[OR ＝0．71，95％CI：0．57～0．87，P ＝0．001]。结论达比加群酯在房颤导管消融围术期抗凝疗效及大出血并发症的发生率上与华法林无明显区别，小出血并发症的发生率较华法林降低。

Efficacy and safety of dabigatran perioperative anticoagulation for patients undergoing catheter ablation of non-valvular atrial fibrillation:a Meta-analysis

Objective To systematically evaluate the efficacy and safety of dabigatran periopera-tive anticoagulation for patients undergoing catheter ablation of non-valvular atrial fibrillation.Meth-ods We collected research literature of randomized controlled trials (RCTs)or non-RCTs about perioperative anticoagulation for patients undergoing catheter ablation of non-valvular atrial fibrilla-tion from databases including PubMed,EMbase,The Cochrane Library (Issue 2,2016),CMB, CNKI,Wanfang and VIP with computer.Two evaluators independently screened literatures,extrac-ted data and assessed the bias risk of included studies,and then performed Meta-analysis by using software of RevMan 5.3.Results A total of 23 studies involving 7 673 patients were finally en-rolled in Meta-analysis.It showed no statistically significant difference in the incidence of cerebral apoplexy or transient cerebral ischemia between dabigatran and warfarin groups(OR =1.0,95%CI:0.60 -1.68,P =0.99),and so did the incidence of hemorrhoea event(OR =0.79,95%CI:0.52 -1.19,P =0.25).The incidence of minor hemorrhoea event in dabigatran group was signifi-cantly decreased than that in warfarin group(OR =0.71,95%CI:0.57 -0.87,P =0.001).Con-clusion There was no significant difference in the efficacy of perioperative anticoagulation for pa-tients undergoing catheter ablation of non-valvular atrial fibrillation and incidence of complication of hemorrhoea between dabigatran and warfarin.For patients taking dabigatran,the incidence of com-plication of minor hemorrhoea is reduced if compared with those taking warfarin.