本文關(guān)鍵詞： 非瓣膜性心房顫動 達比加群 利伐沙班 療效 安全性　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討達比加群與利伐沙班在非瓣膜性心房顫動(NVAF)患者中抗凝治療的療效和安全性。方法:計算機檢索PubMed、Embase、The Cochrane Library及中文數(shù)據(jù)庫獲得有關(guān)NVAF患者接受達比加群與利伐沙班抗凝治療的研究。療效事件包括缺血性腦卒中或系統(tǒng)性栓塞、心肌梗死和全因死亡,安全性事件包括顱內(nèi)出血、胃腸道出血、嚴(yán)重出血和任何出血。采用STATA 12.0進行統(tǒng)計分析,計算相對危險度(RRs)及95%可信區(qū)間(CI)來表示匯總效應(yīng)。如合并后P㩳0.05,表示差異有統(tǒng)計學(xué)意義。結(jié)果:納入14篇隊列研究,1篇樣本量較小的RCT,抗凝時間在90天-2.5年。結(jié)果顯示,與達比加群比較利伐沙班有較低的缺血性腦卒中或系統(tǒng)性栓塞的風(fēng)險(RR:1.273;95%CI:1.154-1.416;P=0.000)。利伐沙班增加顱內(nèi)出血(RR:0.607;95%CI:0.508-0.725;P=0.000)及胃腸道出血的風(fēng)險(RR:0.789;95%CI:0.733-0.849;P=0.000)。全因死亡、心肌梗死、嚴(yán)重出血及任何出血事件的發(fā)生率無顯著差異。基于抗凝時間的亞組分析顯示,抗凝治療≥12個月時,利伐沙班有較低的缺血性腦卒中或系統(tǒng)性栓塞的風(fēng)險(RR:1.33;95%CI:1.18-1.50),但同時顱內(nèi)出血(RR:0.64;95%CI:0.47-0.85)及胃腸道出血風(fēng)險(RR:0.84;95%CI:0.73-0.96)增加。抗凝治療6個月時,利伐沙班有較高的顱內(nèi)出血(RR:0.53;95%CI:0.41-0.6)、胃腸道出血(RR:0.75;95%CI:0.68-0.83)及嚴(yán)重出血風(fēng)險(RR:0.63;95%CI:0.47-0.84)。結(jié)論:抗凝≥12個月時,在減少缺血性腦卒中或系統(tǒng)性栓塞風(fēng)險方面,利伐沙班優(yōu)于達比加群,但同時利伐沙班的顱內(nèi)出血及胃腸道出血風(fēng)險增加。抗凝6個月時,利伐沙班的顱內(nèi)出血、胃腸道出血及嚴(yán)重出血風(fēng)險多于達比加群。
[Abstract]:Objective: to investigate the efficacy and safety of dabigac and rivastaban in the treatment of patients with non-valvular atrial fibrillation (NV). Methods: to search the Cochrane Library and Chinese database of PubMedbase in patients with NVAF. A study of the anticoagulant therapy of rivastaban. Therapeutic events include ischemic stroke or systemic embolism. Myocardial infarction and all-cause death, safety events include intracranial hemorrhage, gastrointestinal bleeding, severe bleeding and any bleeding. Statistical analysis using STATA 12.0, calculate the relative risk of RRs and 95% CI) to indicate the aggregate effect. Results: in 14 cohort studies, RCTs with a small sample size ranged from 90 days to 2.5 years. The risk of ischemic stroke or systemic embolism is lower than that of Dapiga group. RR: 1.273c95CI1.154-1.416Ph 0.0000.0000.000%. Levasaban increases the risk of intracranial hemorrhage by RR: 0.60795 CIW 0.508-0.725P0.000) and gastrointestinal hemorrhage by RR: 0.789 95 CIW 0.733-0.849P0.0000.0000.000. There was no significant difference in the incidence of severe bleeding and any bleeding events. Subgroup analysis based on anticoagulant time showed that when anticoagulant therapy was more than 12 months, Rivasaban had a lower risk of ischemic stroke or systemic embolism (RR: 1.3395), but at the same time the risk of intracerebral hemorrhage was increased by R: 0.6495 (CI: 0.47-0.85) and gastrointestinal hemorrhage risk (RR0.84 + 95CIW 0.73-0.96). After 6 months of anticoagulant therapy, Rivasaban had higher risk of intracranial hemorrhage (RR: 0.53 ~ 95CI: 0.41-0.610, Gastrointestinal hemorrhage: 0.75 / 95CI: 0.68-0.83) and severe risk of hemorrhage. Conclusion: when anticoagulant 鈮，

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