心房颤动合并肿瘤患者应用新型口服抗凝剂的有效性及安全性的Meta分析

目的:评估新型口服抗凝剂(NOAC)相比华法林应用于心房颤动合并肿瘤患者中的有效性及安全性。方法:计算机检索Pubmed、EMBASE、Cochrane等数据库,并追踪以获文献的参考文献,检索时间范围为各数据库建库至2020年1月。按照纳入及排除标准筛选文献,并进行质量评价。应用Revman5.3软件对数据进行Meta分析。结果:共纳入6篇文献,总计200546例研究对象。Meta分析结果显示:相比于华法林,心房颤动合并肿瘤患者应用新型口服抗凝剂脑卒中/系统性栓塞发生率显著降低(OR=0.63,95%CI:0.40~0.98,P=0.04),静脉血栓栓塞发生风险差异无统计学意义(OR=0.91,95%CI:0.33~2.52,P=0.86),全因死亡率差异无统计学意义(OR=0.68,95%CI:0.41~1.14,P=0.15),大出血发生率降低,差异有统计学意义(OR=0.61,95%CI:0.39~0.94,P=0.02)。结论:心房颤动合并肿瘤患者抗凝治疗方面,新型口服抗凝剂相比于华法林,有更低的栓塞、出血风险。

Meta-analysis on Efficacy and Safety of Novel Oral Anticoagulants in Atrial Fibrillation Patients Complicating With Cancer

Objectives:To evaluate the efficacy and safety of novel oral anticoagulants(NOAC)versus warfarin in atrial fibrillation patients complicating with cancer.Methods:The related literatures were obtained from Pubmed,EMBASE,Cochrane Library beginning from the establishment of the database to January 2020.The literatures were screened according to inclusion and exclusion criteria and evaluated for quality.The RevMan 5.3 software was used for meta-analysis of the data.Results:Six literatures were included with a total of 200546 patients.Compared with warfarin,the incidence of stroke/systemic embolism was significantly lower in NOAC group than in warfarin group(OR=0.63,95%CI:0.40-0.98,P=0.04).Incidence of VTE(OR=0.91,95%CI:0.33-2.52,P=0.86)and all-cause death(OR=0.68,95%CI:0.41-1.14,P=0.15)was similar between two groups.The incidence of major bleeding was significantly lower in NOAC group than in warfarin group(OR=0.61,95%CI:0.39-0.94,P=0.02).Conclusions:In patients with atrial fibrillation and cancer,novel oral anticoagulants(NOAC)use is associated with a lower incidence of stroke/systemic embolism and major bleeding compared to warfarin.