目前非瓣膜性房颤患者口服华法林预防卒中的临床相关结局

摘要
背景

虽然一些新的抗血栓药物已经用于非瓣膜性心房颤动(AF)患者预防组卒中,但是在全球范围内仍有许多患者服用华法林治疗。我们通过研究当代大型随机对照试验(RCTs),对AF患者口服华法林预防卒中的安全性和疗效进行了荟萃分析。
方法:我们从MEDLINE,EMBASE和Cochrane数据库中检索相关文献。RCTs入选标准:试验比较了华法林和一种替代性的预防血栓形成的治疗方案,且华法林组至少有400例患者;患者卒中情况作为一个疗效判定结果。

结果

入选了55 789例患者的8个RCTs,这些患者给予华法林治疗后以年为单位进行随访。治疗总时间占整个过程的55%至68%。 服用华法林的AF患者卒中或系统性栓塞的年发病率约为1.66%(95%可信区间[CI],1.41%-1.91%)。在整个研究中,每年大出血发生率从1.40%到3.40%变化不等。老年患者(2.27%),女性患者(2.12%),有卒中病史患者(2.64%)以及先前未服用过维生素K拮抗剂的患者(1.96%)每年卒中的风险明显增加。随着CHADS2(充血性心力衰竭,高血压,年龄,糖尿病,和既往卒中)评分逐渐增加,患者卒中的年发病率也显著增高。

结论

目前华法林作为一种AF患者预防卒中的药物,其应用能降低卒中或系统性栓塞的发生率,每年约为1.66%。与先前一篇荟萃分析相比,抗凝治疗所需时间在整个过程中占的比例得到显著改善,同时典型卒中的发病率明显降低。
英文原文:

Background

Although several new antithrombotic agents have been developed for stroke prevention in patients with nonvalvular atrial fibrillation (AF), many patients will continue to be treated with warfarin worldwide. We performed a meta-analysis of safety and efficacy outcomes in patients with AF treated with warfarin for stroke prevention in large contemporary randomized controlled trials (RCTs).

Methods

We searched the MEDLINE, EMBASE, and Cochrane databases for relevant studies; RCTs comparing warfarin with an alternative thromboprophylaxis strategy with at least 400 patients in the warfarin arm and reporting stroke as an efficacy outcome were included.

Results

Eight RCTs with 55 789 patient-years of warfarin therapy follow-up were included. Overall time spent in the therapeutic range was 55% to 68%. The annual incidence of stroke or systemic embolism in patients with AF taking warfarin was estimated to be 1.66% (95% CI, 1.41%-1.91%). Major bleeding rates varied from 1.40% to 3.40% per year across the studies. The risk of stroke per year was significantly higher in elderly patients (2.27%), female patients (2.12%), patients with a history of stroke (2.64%), and patients reporting no previous exposure to vitamin K antagonists (1.96%). There was a significant increase in the annual incidence of stroke with progressively increasing CHADS2 (congestive heart failure, hypertension, age, diabetes, and prior stroke) scores.

Conclusions

Current use of warfarin as a stroke prevention agent in patients with AF is associated with a low rate of residual stroke or systemic embolism estimated to be 1.66% per year. Compared with a previous meta-analysis, there has been significant improvement in the proportion of time spent in therapeutic anticoagulation, with a resultant decline in observed stroke rates.



    2012/3/30 10:21:53     访问数:422
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