摘要
目的 评估心房颤动(atrial fibrillation,AF)相关的急性缺血性脑卒中(acute ischemic stroke,AIS)患者早期(≤3 d)应用新型口服抗凝药的有效性和安全性。方法对中国知网、万方、维普、PubMed、The Cochrane Library、Embase数据库进行系统检索,筛选AF相关的AIS患者早期抗凝治疗的临床研究,检索时间为建库至2022年11月4日,同时手动检索参考文献。由2名研究者独立筛选文献、资料提取与质量评价。采用RevMan 5.4软件进行Meta分析,合并二分类效应量采用相对危险度(relative risk,RR)以及95%置信区间(confidence interval,CI)表示。结果 纳入2篇随机对照试验和5篇非随机对照试验,共包括2 226例患者,Meta分析结果显示,早期抗凝治疗(≤3 d)与延迟抗凝(> 3 d)相比,在总缺血事件[RR=1.04,95%CI(0.67,1.61),P=0.88]、卒中复发或短暂性脑缺血发作[RR=0.88,95%CI(0.58,1.34),P=0.56]、大出血[RR=1.24,95%CI(0.59,2.62),P=0.56]、症状性脑出血[RR=0.98,95%CI(0.44,2.17),P=0.96]方面发生率相似,在全部脑出血方面,发生率低于延迟抗凝组[RR=0.59,95%CI(0.44,0.77),P=0.000 5]。结论 AF相关AIS发生后早期抗凝与延迟抗凝相比,在有效性方面相似,且不增加患者出血风险。
Objective To evaluate the efficacy and safety of early use of new oral anticoagulants(≤3 days) in patients with acute ischemic stroke(AIS) due to atrial fibrillation(AF).Method A?ter systematic retrieval of CNKI,WanFang Data,VIP,PubMed,The Cochrane Library and Embase database,clinical studies on early anticoagulation therapy for AF-related AIS patients were screened.The search was conducted from the time of database construction to November 4,2022,while the references were searched manually.Literature screening,data extraction and quality assessment were performed independently by 2 investigators.Meta-analysis was performed using RevMan 5.4 software,and the combined dichotomous effect sizes were expressed as relative risk(RR) and 95% confidence interval(CI).Result A total of 2 randomized controlled trials and 5 non-randomized controlled trials including 2 226 patients were included,and the analysis suggested that early anticoagulation treatment(≤3 days) was similar to delayed anticoagulation(> 3 days) in terms of total ischemic events [RR=1.04,95%CI(0.67,1.61),P=0.88],recurrent ischemic strokes or transient ischemic attack [RR=0.88,95%CI(0.58,1.34),P=0.56],major bleeding [RR=1.24,95%CI(0.59,2.62),P=0.56],and symptomatic intracerebral haemorrhage [RR=0.98,95%CI(0.44,2.17),P=0.96].In terms of total cerebral hemorrhages,the incidence was lower than in the delayed anticoagulation group.Conclusion Anticoagulation started early a?ter the occurrence of atrial fibrillation related ischemic stroke is similar to delayed anticoagulation in terms of effectiveness,and does not increase the risk of bleeding in patients.
作者
王运香
齐旭慧
蔡焕焕
鲁志兵
WANG Yunxiang;QI Xuhui;CAI Huanhuan;LU Zhibing(Department of Cardiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Institute of Myocardial Injury and Repair,Wuhan University,Wuhan 430071,China;Department of Gastroenterology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)
出处
《医学新知》
CAS
2024年第2期157-166,共10页
New Medicine
基金
湖北省自然科学基金创新群体项目(2021CFA051)。
作者简介
通信作者:鲁志兵,博士,教授,主任医师,博士研究生导师,Email:luzhibing222@163.com。
