Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Significant Mitral Stenosis-a Preliminary Meta-Analysis.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2024-10-01 Epub Date: 2023-04-04 DOI:10.1007/s10557-023-07451-2

Yi Zhang, Mao Chen

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引用次数: 0

Abstract

Introduction: Patients with atrial fibrillation (AF) and concomitant moderate-to-severe mitral stenosis (MS) are listed as a contraindicated population to direct oral anticoagulant (DOAC) because of the traditional tenet of high stroke risk, despite scarce evidence. With accumulating data, we sought to conduct a systematic meta-analysis to preliminarily explore the efficacy and safety of DOAC versus warfarin in patients with AF and concomitant significant MS.

Methods: We searched the Medline, Embase databases, and the Cochrane Library (assessed October 10th, 2022) for eligible studies. Risk ratios (RRs) and 95% confidence intervals (CIs) were synthesized in Stata 16.1 (StataCorp).

Results: In random-effects meta-analyses, DOACs demonstrated a similar risk of stroke or systemic embolism (RR 0.51; 95% CI 0.09-2.96), all-cause death (RR 0.81; 95% CI 0.35-1.87), major or clinically relevant non-major bleeding (RR 0.57; 95% CI 0.24-1.39), and silent cerebral ischemia (RR 1.01; 95% CI 0.64-1.58) when compared with warfarin.

Conclusions: DOACs were similar to warfarin in the efficacy and safety profiles in patients with AF and concomitant significant MS. Future evidence is expected from other large trials.

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心房颤动和明显二尖瓣狭窄患者的直接口服抗凝药--初步的 Meta 分析。

简介：心房颤动（AF）合并中重度二尖瓣狭窄（MS）的患者被列为直接口服抗凝剂（DOAC）的禁忌人群，因为传统的原则是卒中风险高，尽管证据很少。随着数据的不断积累，我们试图进行一项系统性荟萃分析，初步探讨在房颤并伴有明显 MS 的患者中，DOAC 与华法林相比的疗效和安全性：我们检索了 Medline、Embase 数据库和 Cochrane 图书馆（评估日期为 2022 年 10 月 10 日）中符合条件的研究。用Stata 16.1 (StataCorp)对风险比（RRs）和95%置信区间（CIs）进行了综合分析：结果：在随机效应荟萃分析中，与华法林相比，DOACs发生中风或全身性栓塞（RR 0.51；95% CI 0.09-2.96）、全因死亡（RR 0.81；95% CI 0.35-1.87）、大出血或临床相关非大出血（RR 0.57；95% CI 0.24-1.39）以及无症状脑缺血（RR 1.01；95% CI 0.64-1.58）的风险相似：结论：对于房颤并伴有严重多发性硬化的患者，DOAC 在疗效和安全性方面与华法林相似。未来有望从其他大型试验中获得证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.