利伐沙班与华法林用于房颤导管消融术后疗效及安全性的系统分析
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摘要
目的比较利伐沙班与华法林用于心房颤动导管消融术后的有效性和安全性。方法计算机检索Cochrane Library、Pub Med、Em Base、Web of Science、中国知网、中国生物医学文献数据库(CBM)、维普、万方数据库,入选标准为心房颤动导管消融术后采用利伐沙班或华法林抗栓治疗患者的前瞻随机与非随机对照试验。评价纳入研究质量并核对,用Rev Man 5. 3对研究结果进行Meta分析。结果共纳入14项研究、3958例患者,其中利伐沙班组2458例,华法林组1500例。Meta分析结果显示,总体分析显示利伐沙班组栓塞、大出血、小出血风险均小于华法林组(P <0. 05),5项随机对照研究分析显示,二者上述事件发生率差异无统计学意义。结论利伐沙班用于心房颤动导管消融术后可能存在一定的优势,但仍需要更多高质量的随机对照研究来验证其疗效与安全性。
Objective To evaluate the effectiveness and safety of rivaroxaban compared with warfarin in patients undergoing atrial fibrillation ablation. Methods We searched for prospective relevant studies of rivaroxaban and warfarin used in the periprocedural period of catheter ablation for atrial fibrillation through electronic databases including Cochrane Library,PubMed,EmBase,Web of Science,CNKI,CBM,VIP and Wangfang database. Data were extracted into a specially designed extraction form. Results A total of 14 studies including 3958 patients were eligible for final analysis,with 2458 cases in rivaroxaban group and 1500 cases in warfarin group. The overall analysis showed that the risk of embolization,hemorrhage and small bleeding of rivaroxaban was less than that of warfarin( P < 0. 05). But there wes no significant difference only included in 5 randomized controlled studies. Conclusion The patients treated with rivaroxaban during catheter ablation period had similar incidences of thromboembolic events and major hemorrhage compared with those treated with warfarin,but there need more high-quality random controlled trials to prove it.
Objective To evaluate the effectiveness and safety of rivaroxaban compared with warfarin in patients undergoing atrial fibrillation ablation. Methods We searched for prospective relevant studies of rivaroxaban and warfarin used in the periprocedural period of catheter ablation for atrial fibrillation through electronic databases including Cochrane Library,PubMed,EmBase,Web of Science,CNKI,CBM,VIP and Wangfang database. Data were extracted into a specially designed extraction form. Results A total of 14 studies including 3958 patients were eligible for final analysis,with 2458 cases in rivaroxaban group and 1500 cases in warfarin group. The overall analysis showed that the risk of embolization,hemorrhage and small bleeding of rivaroxaban was less than that of warfarin( P < 0. 05). But there wes no significant difference only included in 5 randomized controlled studies. Conclusion The patients treated with rivaroxaban during catheter ablation period had similar incidences of thromboembolic events and major hemorrhage compared with those treated with warfarin,but there need more high-quality random controlled trials to prove it.
引文
[1]JANUARY C T,WANNA L S,ALPERT J S,et al.2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society[J].JACC,2014,130(23):199-267.
[2]CAMM A J,LIP G Y,DE CATERINA R,et al.2012 focused update of the ESC Guidelines for the management of atrial fibrillation:an update of the 2010 ESC Guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association[J].Europace,2012,14(10):1385-1413.
[3]PATEL M R,MAHAFFEY K W,GARG J,et al.Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J].N Engl J Med,2011,365(10):883-891.
[4]BERNARD M,BRABHAM W,NETZLER P,et al.Comparison of atrial fibrillation ablation bleeding and thrombotic complications with dabigatran,rivaroxaban and warfarin[J].J Am Coll Cardiol,2013,61(10):276-281.
[5]LAKKIREDDY D,REDDY Y M,DI BIASE L,et al.Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation:results from a multicenter prospective registry[J].J Am Coll Cardiol,2014,63(10):982-988.
[6]PROVIDANCIA R,MARIJON E,ALBENQUE J P,et al.Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation[J].Europace,2014,16(8):1137-1144.
[7]CAPPATO R,MARCHLINSKI F E,HOHNLOSER S H,et al.Uninterrupted rivaroxaban vs.Uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation[J].Eur JHeart,2015,36(28):1805-1811.
[8]王汝朋,杨水祥.利伐沙班和达比加群酯及华法林在非瓣膜性心房颤动患者抗凝治疗的研究[J].中华老年心脑血管病杂志,2015,17(12):1246-1249.
[9]章玲,李军,麦爱欢,等.心房颤动射频消融术后利伐沙班和华法林抗凝治疗对比研究[J].中华临床医师杂志,2015,6(9):118-119.
[10]RILLIG A,LIN T,PLESMAN J,et al.Apixaban,rivaroxaban,and dabigatran in patients undergoing atrial fibrillation ablation[J].J Cardiovasc Electrophysiol,2016,27(2):147-153.
[11]YOSHIMURA A,IRIKI Y,ICHIKI H,et al.Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation[J].J Cardiol,2016,69(1):228-235.
[12]OKUMURA K,AONUMA K,KUMAGAI K,et al.Efficacy and safety of rivaroxaban and warfarin in the perioperative period of catheter ablation for atrial fibrillation-outcome analysis from a prospective multicenter registry study in Japan[J].Circ J,2016,80(11):2295-2301.
[13]TAO S,OTOMO K,ONO Y,et al.Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin[J].J Interv Card Electrophysiol,2017,48(2):167-175.
[14]唐艺加.心房颤动患者射频消融术后利伐沙班抗凝效果观察[J].血栓与止血,2016,22(2):144-146.
[15]王璇,王祖禄,梁明,等.利伐沙班用于心房颤动导管消融术后抗凝治疗的有效性及安全性研究[J].中国循环杂志,2014,14(z1):131.
[16]朱锦富,唐义虎,吴延虎.心房颤动射频消融术后多种药物抗凝治疗的临床对比研究[J].南京医科大学学报(自然科学版),2016,36(11):1356-1358.
[17]孙劼,冯力,冯涛,等.阵发性心房颤动射频消融术后利伐沙班和华法林抗凝治疗的临床效果分析[J].河南医学研究,2017,26(11):1979-1980.
[18]余香,肖骅.利伐沙班在心房颤动导管消融围手术期的应用进展[J].心血管病学进展,2015,36(4):451.
[19]CALKINS H,KUCK K H,CAPPATO R,et al.HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation:recommendations for patient selection,procedural techniques,patient management and follow-up,definitions,endponits and research trial design[J].Europace,2012,14(4):526-606.
[20]王茂敬,蔡尚郎,赵青.心房颤动导管消融术应用达比加群酯-华法林桥接治疗抗凝的安全性和有效性[J].中华心律失常学杂志,2017,21(2):135.
[21]利伐沙班临床应用中国专家组.利伐沙班临床应用中国专家建议-非瓣膜性心房颤动卒中预防分册[J].中华内科杂志,2013,52(10):897-902.
[22]ROCKET A F.Rivaroxaban-once daily,oral,direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation:rationale and design of the ROCKET AF study[J].Am Heart J,2010,159(31):340-347.
[2]CAMM A J,LIP G Y,DE CATERINA R,et al.2012 focused update of the ESC Guidelines for the management of atrial fibrillation:an update of the 2010 ESC Guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association[J].Europace,2012,14(10):1385-1413.
[3]PATEL M R,MAHAFFEY K W,GARG J,et al.Rivaroxaban versus warfarin in nonvalvular atrial fibrillation[J].N Engl J Med,2011,365(10):883-891.
[4]BERNARD M,BRABHAM W,NETZLER P,et al.Comparison of atrial fibrillation ablation bleeding and thrombotic complications with dabigatran,rivaroxaban and warfarin[J].J Am Coll Cardiol,2013,61(10):276-281.
[5]LAKKIREDDY D,REDDY Y M,DI BIASE L,et al.Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation:results from a multicenter prospective registry[J].J Am Coll Cardiol,2014,63(10):982-988.
[6]PROVIDANCIA R,MARIJON E,ALBENQUE J P,et al.Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation[J].Europace,2014,16(8):1137-1144.
[7]CAPPATO R,MARCHLINSKI F E,HOHNLOSER S H,et al.Uninterrupted rivaroxaban vs.Uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation[J].Eur JHeart,2015,36(28):1805-1811.
[8]王汝朋,杨水祥.利伐沙班和达比加群酯及华法林在非瓣膜性心房颤动患者抗凝治疗的研究[J].中华老年心脑血管病杂志,2015,17(12):1246-1249.
[9]章玲,李军,麦爱欢,等.心房颤动射频消融术后利伐沙班和华法林抗凝治疗对比研究[J].中华临床医师杂志,2015,6(9):118-119.
[10]RILLIG A,LIN T,PLESMAN J,et al.Apixaban,rivaroxaban,and dabigatran in patients undergoing atrial fibrillation ablation[J].J Cardiovasc Electrophysiol,2016,27(2):147-153.
[11]YOSHIMURA A,IRIKI Y,ICHIKI H,et al.Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation[J].J Cardiol,2016,69(1):228-235.
[12]OKUMURA K,AONUMA K,KUMAGAI K,et al.Efficacy and safety of rivaroxaban and warfarin in the perioperative period of catheter ablation for atrial fibrillation-outcome analysis from a prospective multicenter registry study in Japan[J].Circ J,2016,80(11):2295-2301.
[13]TAO S,OTOMO K,ONO Y,et al.Efficacy and safety of uninterrupted rivaroxaban taken preoperatively for radiofrequency catheter ablation of atrial fibrillation compared to uninterrupted warfarin[J].J Interv Card Electrophysiol,2017,48(2):167-175.
[14]唐艺加.心房颤动患者射频消融术后利伐沙班抗凝效果观察[J].血栓与止血,2016,22(2):144-146.
[15]王璇,王祖禄,梁明,等.利伐沙班用于心房颤动导管消融术后抗凝治疗的有效性及安全性研究[J].中国循环杂志,2014,14(z1):131.
[16]朱锦富,唐义虎,吴延虎.心房颤动射频消融术后多种药物抗凝治疗的临床对比研究[J].南京医科大学学报(自然科学版),2016,36(11):1356-1358.
[17]孙劼,冯力,冯涛,等.阵发性心房颤动射频消融术后利伐沙班和华法林抗凝治疗的临床效果分析[J].河南医学研究,2017,26(11):1979-1980.
[18]余香,肖骅.利伐沙班在心房颤动导管消融围手术期的应用进展[J].心血管病学进展,2015,36(4):451.
[19]CALKINS H,KUCK K H,CAPPATO R,et al.HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation:recommendations for patient selection,procedural techniques,patient management and follow-up,definitions,endponits and research trial design[J].Europace,2012,14(4):526-606.
[20]王茂敬,蔡尚郎,赵青.心房颤动导管消融术应用达比加群酯-华法林桥接治疗抗凝的安全性和有效性[J].中华心律失常学杂志,2017,21(2):135.
[21]利伐沙班临床应用中国专家组.利伐沙班临床应用中国专家建议-非瓣膜性心房颤动卒中预防分册[J].中华内科杂志,2013,52(10):897-902.
[22]ROCKET A F.Rivaroxaban-once daily,oral,direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation:rationale and design of the ROCKET AF study[J].Am Heart J,2010,159(31):340-347.