左心房阑尾闭塞器与直接口服抗凝药治疗心房颤动：最新系统回顾和 Meta 分析。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2024-10-10 DOI:10.1016/j.cpcardiol.2024.102880

Julia M. Fernandes , Rafael P.S. Pinheiro , Frans Serpa M.D. , Naieli M. de Andrade , Vinicius Pereira , Ângelo E.E. Sbardelotto , Wilton F. Gomes M.D.

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引用次数: 0

摘要

背景：直接口服抗凝药（DOACs）是非瓣膜性心房颤动（NVAF）患者的一线抗凝药物。经皮左心房阑尾封堵术（LAAO）已成为一种新疗法，与 DOACs 相比，其安全性和有效性仍存在争议：方法：对随机对照试验和观察性研究进行了系统回顾，重点关注 NVAF 患者。分析的结果包括(1)全因死亡率；(2)心血管（CV）死亡率；(3)血栓栓塞事件；(4)中风或短暂性脑缺血发作（TIA）；(5)出血事件；(6)死亡、出血和血栓栓塞事件的复合。我们根据（1）出血学术研究联盟（BARC）；（2）国际血栓与止血学会（ISTH）；（3）其他定义的不同定义对大出血进行了亚组分析：共纳入 10 项研究，涉及 18,507 名患者，其中 42.35% 的患者接受了 LAAO。在汇总分析中，LAAO 与较低的全因死亡率（HR 0.63；95% CI 0.50-0.80）、心血管死亡率（HR 0.56；95% CI 0.45-0.70）和综合结果（HR 0.73；95% CI 0.58-0.92）相关。中风/TIA事件呈下降趋势，但无统计学意义。采用ISTH定义，LAAO组的出血事件发生率明显降低（HR 0.63；95% CI 0.43-0.91）。在血栓栓塞事件方面没有发现明显差异：与 DOACs 相比，LAAO 可显著降低全因死亡率和心血管死亡率，以及死亡、出血或血栓栓塞事件的复合死亡率。

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Left atrial appendage occlusion devices vs direct oral anticoagulants for atrial fibrillation: An updated systematic review and meta-analysis

Background

Direct Oral Anticoagulants (DOACs) are the first line anticoagulation for patients with non-valvular atrial fibrillation (NVAF). Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a new therapy and its safety and effectiveness compared with DOACs are still controversial.

Methods

A systematic review of randomized controlled trials and observational studies was conducted, focusing on patients with NVAF. Outcomes analyzed included: (1) all-cause mortality; (2) cardiovascular (CV) mortality; (3) thromboembolic events; (4) stroke or transient ischemic attack (TIA); (5) bleeding events; and a (6) composite of death, hemorrhagic, and thromboembolic events. We performed a subgroup analysis of major bleeding according to different definitions: (1) Bleeding Academic Research Consortium (BARC); (2) International Society on Thrombosis and Haemostasis (ISTH); and (3) other definitions.

Results

Ten studies involving 18,507 patients were included, with 42.35 % undergoing LAAO. In pooled analysis, LAAO was associated with lower rates of all-cause mortality (HR 0.63; 95 % CI 0.50-0.80), cardiovascular mortality (HR 0.56; 95 % CI 0.45-0.70), and of the composite outcome (HR 0.73; 95 % CI 0.58-0.92). A trend towards lower stroke/TIA events was observed but not statistically significant. Overall bleeding events did not significantly differ between groups; using the ISTH definition, LAAO showed significantly lower incidence of bleeding events (HR 0.63; 95 % CI 0.43-0.91). No difference was found in thromboembolic events.

Conclusion

LAAO was associated with a significantly lower all-cause mortality and cardiovascular mortality, as well as the composite of death, hemorrhagic or thromboembolic events, as compared with DOACs.

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.