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首页> 外文期刊>Heart >Current and new oral antithrombotics in non- valvular atrial fibrillation: a network meta-analysis of 79 808 patients
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Current and new oral antithrombotics in non- valvular atrial fibrillation: a network meta-analysis of 79 808 patients

机译：非瓣膜性心房颤动的现行和新型口服抗血栓药：79 808例患者的网络荟萃分析

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Background Antithrombotic therapy reduces stroke, embolism and mortality in patients with atrial fibrillation (AF); however, meta-analyses have focused on pairwise comparisons of treatments. Objective To synthesise the evidence from trials using a multiple treatment comparison methods thereby permitting a broader comparison across multiple therapies. Design, setting, patients Randomised controlled trials in patients with AF of antithrombotics were identified from MEDLINE, Embase, and Cochrane Central Register of Controlled Trials through May 2012. We performed a random-effects model within a Bayesian framework using Markov Chain Monte Carlo simulation to calculate pooled OR and 95% credibility intervals (Crl). We also ranked therapies by their likelihood of leading to the best results for the outcomes. Main outcome measure Multiple endpoints including stroke, embolism, death and bleeding. Results We identified 20 studies with 79 808 patients allocated to 8 treatments: ASA, ASA plus clopidogrel, vitamin K antagonists (VKAs), dabigatran 110 mg, dabigatran 150 mg, rivaroxaban, apixaban or placebo/ control. Compared with placebo/control, dabigatran 150 mg was associated with the lowest risk of stroke (OR=0.25, 0.15-0.43), the composite of ischaemic stroke or systemic embolism (OR=0.26, 0.12-0.54) and mortality (OR=0.53, 0.28-0.88). ASA plus clopidogrel was associated with the highest risk of major bleeding (OR=3.65, 1.22-13.56). In simulated comparisons, the novel oral anticoagulants ranked better than VKA or antiplatelet therapies for prevention of stroke, ischaemic stroke or systemic embolism and mortality. Conclusions In this network meta-analysis, novel oral anticoagulants were the most promising treatments to reduce stroke, stroke or systemic embolism, and all-cause mortality in patients with AF.
机译：背景抗血栓治疗可降低房颤（AF）患者的卒中，栓塞和死亡率。然而，荟萃分析集中于治疗的成对比较。目的使用多种治疗比较方法从试验中综合证据，从而可以对多种治疗方法进行更广泛的比较。设计，背景，患者从MEDLINE，Embase和Cochrane对照试验中央注册中筛选出抗栓剂AF患者的随机对照试验，直至2012年5月。我们使用Markov Chain Monte Carlo模拟方法在贝叶斯框架内进行了随机效应模型计算合并OR或95％可信区间（Crl）。我们还根据可能导致最佳结果的治疗效果对治疗方法进行了排名。主要结果指标多个终点，包括中风，栓塞，死亡和出血。结果我们确定了20项研究，将79 808例患者分配给8种治疗方法：ASA，ASA加氯吡格雷，维生素K拮抗剂（VKA），达比加群110 mg，达比加群150 mg，利伐沙班，阿哌沙班或安慰剂/对照。与安慰剂/对照相比，达比加群150 mg与发生中风的风险最低（OR = 0.25，0.15-0.43），缺血性中风或全身性栓塞的综合风险最低（OR = 0.26，0.12-0.54）和死亡率（OR = 0.53）相关。 ，0.28-0.88）。 ASA加氯吡格雷与大出血风险最高相关（OR = 3.65，1.22-13.56）。在模拟比较中，在预防中风，缺血性中风或全身性栓塞和死亡率方面，新型口服抗凝药的疗效优于VKA或抗血小板疗法。结论在该网络荟萃分析中，新型口服抗凝剂是减少房颤患者中风，中风或全身栓塞和全因死亡率的最有前途的治疗方法。

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  • 来源
    《Heart》 |2014年第5期|396-405|共10页
  • 作者

    Ariel Dogliotti; Ernesto Paolasso; Robert P Giugliano;

  • 作者单位

    Unidad de Epidemiologia Clinica y Estadistica, Grupo Orono, Rosario, Argentina,Instituto Cardiovascular de Rosario, Rosario, Argentina;

    Instituto Cardiovascular de Rosario, Rosario, Argentina,Instituto de Investigaciones Clinicas, Rosario, Argentina;

    Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, TIMI Study Group, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA;

  • 收录信息 美国《科学引文索引》(SCI);美国《化学文摘》(CA);
  • 原文格式 PDF
  • 正文语种 eng
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