直接口服抗凝剂和华法林与心房颤动患者痴呆症发病率的关系:系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

目的 评价直接口服抗凝药(DOACs)和华法林与房颤(AF)患者痴呆症发病率的关系。方法 在Embase、PubMed、Cochrane、Web of Knowledge和ClinicalTrials.gov等数据库中检索相关研究。结果共纳入 9 项研究,涉及 447644 名房颤患者。结果表明,与接受华法林治疗的房颤患者相比,接受 DOACs 治疗的房颤患者痴呆发生率较低(RR:0.692,95 % CI:0.603-0.793,P = 0.000),这一趋势在两个年龄组均可观察到,<75 岁(RR:0.770,95 % CI:0.639-0.929,P = 0.006)和≥75 岁(RR:0.858,95 % CI:0.756-0.973,P = 0.017),尤其是在阿尔茨海默病(RR:0.798,95 % CI:0.684-0.932,P = 0.004)而非血管性痴呆(RR:0.841,95 % CI:0.61-0.143,P = 0.269)病例中。此外,与服用华法林的患者相比,服用利伐沙班(RR:0.680,95 % CI:0.624-0.741,P = 0.000)和阿哌沙班(RR:0.598,95 % CI:0.528-0.676,P = 0.000)而非达比加群(RR:0.941,95 % CI:0.862-1.027,P = 0.17)的患者痴呆发生率更低。值得注意的是,服用利伐沙班(RR:0.75,95 % CI:0.67-0.84,P = 0.000)和阿哌沙班(RR:0.758,95 % CI:0.647-0.889,P = 0.001)的房颤患者的痴呆发生率低于服用达比加群者,但曲伐沙班和阿哌沙班之间的差异无统计学意义(RR:1.161,95 % CI:0.934-1.443,P = 0.018)。结论与接受华法林治疗的患者相比,接受 DOACs(尤其是利伐沙班和阿哌沙班)治疗的 AF 患者的痴呆发生率较低,与达比加群相比较,观察到明显的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of direct oral anticoagulants and warfarin with incidence of dementia in atrial fibrillation patients: A systematic review and meta-analysis

Objects

To evaluate the association of direct oral anticoagulants (DOACs) and warfarin with dementia incidence in atrial fibrillation (AF) patients.

Methods

Relevant studies were retrieved in databases including Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Meta-analysis was then conducted using Stata 12.0 software.

Results

A total of 9 studies involving 447,644 AF patients were included. The results indicated that AF patients treated with DOACs had a lower incidence of dementia compared to those treated with warfarin (RR: 0.692, 95 % CI: 0.603–0.793, P = 0.000), This trend was observed in both age groups, <75 years old (RR: 0.770, 95 % CI: 0.639–0.929, P = 0.006) and ≥75 years old (RR: 0.858, 95 % CI: 0.756–0.973, P = 0.017), particularly in cases of Alzheimer's disease (RR: 0.798, 95 % CI: 0.684–0.932, P = 0.004) rather than vascular dementia (RR: 0.841, 95 % CI: 0.61–0.143, P = 0.269). Furthermore, patients taking rivaroxaban (RR: 0.680, 95 % CI: 0.624–0.741, P = 0.000) and apixaban (RR: 0.598, 95 % CI: 0.528–0.676, P = 0.000) instead of dabigatran (RR: 0.941, 95 % CI: 0.862–1.027, p = 0.17) exhibited a lower incidence of dementia than those took warfarin. Notably, AF patients taking rivaroxaban (RR: 0.75, 95 % CI: 0.67–0.84, P = 0.000) and apixaban (RR: 0.758, 95 % CI: 0.647–0.889, P = 0.001) had a lower incidence of dementia than those taking dabigatran, although the difference between trivaroxaban and apixaban was not statistically significant (RR:1.161, 95 % CI: 0.934–1.443, P = 0.018).

Conclusions

AF patients treated with DOACs, particularly rivaroxaban and apixaban, showed a lower incidence of dementia compared to those treated with warfarin, with a notable disparity observed when compared to dabigatran.

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来源期刊
IJC Heart and Vasculature
IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
10.30%
发文量
216
审稿时长
56 days
期刊介绍: IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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