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。
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.
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.