PDF(Pubmed)
Abstract：
UNASSIGNED: Several studies have summarized the clinical performance of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with mitral stenosis or aortic stenosis. The significance of this review was to provide clinicians the latest update of the clinical application of DOACs in managing this specific population.
UNASSIGNED: Literatures from the PubMed database up to July 2022 were screened for inclusion. Studies on the effect of DOACs in patients suffering from AF with mitral or aortic stenosis were assessed for further selection.
UNASSIGNED: Results from four studies were gathered: the RISE MS trial, the DAVID-MS study, and two observational studies. In the Korean observational study with a 27-month follow-up duration and a sample population consisted of patients with mitral stenosis and AF, the thromboembolic events happened at a rate of 2.22%/ year in the DOAC group and 4.19%/year in the warfarin group (adjusted hazard ratio: 0.28; 95% CI: 0.18-0.45). Intracranial hemorrhage occurred at rates of 0.49% and 0.93% in the DOAC and the warfarin groups, respectively (adjusted hazard ratio: 0.53; 95% CI: 0.22-1.26). In the Danish observational study, which had a sample pool with AF patients with aortic stenosis, reported that the adjusted hazard ratios for thromboembolism and major bleeding were 1.62 (95% CI, 1.08-2.45) and 0.73 (95% CI, 0.59-0.91) for DOACs compared with warfarin during 3 years of follow-up. In the RISE-MS trial involving AF patients with mitral stenosis, there were no differences in ischemic stroke, systemic embolic events, or major bleeding between the rivaroxaban vs. warfarin groups during a 1-year follow-up as well as equal rate of increased thrombogenicity in the left atrial appendage at 6 months. The rate of silent cerebral ischemia at 12 months was higher in the warfarin group (17.6%) than that in the rivaroxaban group (13.3%).
UNASSIGNED: Current published studies supported DOACs\' effectiveness in preventing thromboembolism in patients of AF with mitral or aortic stenosis. Further clinical trials could confirm these findings.
UNASSIGNED: Literatures from the PubMed database up to July 2022 were screened for inclusion. Studies on the effect of DOACs in patients suffering from AF with mitral or aortic stenosis were assessed for further selection.
UNASSIGNED: Results from four studies were gathered: the RISE MS trial, the DAVID-MS study, and two observational studies. In the Korean observational study with a 27-month follow-up duration and a sample population consisted of patients with mitral stenosis and AF, the thromboembolic events happened at a rate of 2.22%/ year in the DOAC group and 4.19%/year in the warfarin group (adjusted hazard ratio: 0.28; 95% CI: 0.18-0.45). Intracranial hemorrhage occurred at rates of 0.49% and 0.93% in the DOAC and the warfarin groups, respectively (adjusted hazard ratio: 0.53; 95% CI: 0.22-1.26). In the Danish observational study, which had a sample pool with AF patients with aortic stenosis, reported that the adjusted hazard ratios for thromboembolism and major bleeding were 1.62 (95% CI, 1.08-2.45) and 0.73 (95% CI, 0.59-0.91) for DOACs compared with warfarin during 3 years of follow-up. In the RISE-MS trial involving AF patients with mitral stenosis, there were no differences in ischemic stroke, systemic embolic events, or major bleeding between the rivaroxaban vs. warfarin groups during a 1-year follow-up as well as equal rate of increased thrombogenicity in the left atrial appendage at 6 months. The rate of silent cerebral ischemia at 12 months was higher in the warfarin group (17.6%) than that in the rivaroxaban group (13.3%).
UNASSIGNED: Current published studies supported DOACs\' effectiveness in preventing thromboembolism in patients of AF with mitral or aortic stenosis. Further clinical trials could confirm these findings.
摘要：
UNASSIGNED：多项研究总结了直接口服抗凝药（DOAC）在二尖瓣狭窄或主动脉瓣狭窄的房颤（AF）患者中的临床表现。这篇综述的意义是为临床医生提供DOAC在管理这一特定人群中的临床应用的最新更新。
UNASSIGNED：筛选了截至2022年7月的PubMed数据库中的文献。评估了DOAC对患有二尖瓣或主动脉瓣狭窄的AF患者的影响的研究，以进行进一步选择。
未经评估：收集了四项研究的结果：RISEMS试验，DAVID-MS研究,和两项观察性研究。在韩国观察性研究中，随访时间为27个月，样本人群包括二尖瓣狭窄和房颤患者，DOAC组和华法林组的血栓栓塞事件发生率分别为2.22%/年和4.19%/年(调整后风险比:0.28;95%CI:0.18~0.45).DOAC和华法林组的颅内出血发生率分别为0.49%和0.93%，分别（调整后的风险比：0.53；95%CI：0.22-1.26）。在丹麦的观察研究中，其中有一个主动脉瓣狭窄的房颤患者的样本库，据报道,在3年随访期间,与华法林相比,DOACs的血栓栓塞和大出血的校正风险比分别为1.62(95%CI,1.08~2.45)和0.73(95%CI,0.59~0.91).在涉及二尖瓣狭窄的房颤患者的RISE-MS试验中，缺血性卒中没有差异,全身栓塞事件,或利伐沙班与之间的大出血华法林组在1年的随访期间，以及在6个月时左心耳的血栓形成增加率相等。华法林组12个月时无症状脑缺血发生率(17.6%)高于利伐沙班组(13.3%)。
UNASSIGNED：目前已发表的研究支持DOACs在预防房颤伴二尖瓣或主动脉瓣狭窄患者血栓栓塞方面的有效性。进一步的临床试验可以证实这些发现。
UNASSIGNED：筛选了截至2022年7月的PubMed数据库中的文献。评估了DOAC对患有二尖瓣或主动脉瓣狭窄的AF患者的影响的研究，以进行进一步选择。
未经评估：收集了四项研究的结果：RISEMS试验，DAVID-MS研究,和两项观察性研究。在韩国观察性研究中，随访时间为27个月，样本人群包括二尖瓣狭窄和房颤患者，DOAC组和华法林组的血栓栓塞事件发生率分别为2.22%/年和4.19%/年(调整后风险比:0.28;95%CI:0.18~0.45).DOAC和华法林组的颅内出血发生率分别为0.49%和0.93%，分别（调整后的风险比：0.53；95%CI：0.22-1.26）。在丹麦的观察研究中，其中有一个主动脉瓣狭窄的房颤患者的样本库，据报道,在3年随访期间,与华法林相比,DOACs的血栓栓塞和大出血的校正风险比分别为1.62(95%CI,1.08~2.45)和0.73(95%CI,0.59~0.91).在涉及二尖瓣狭窄的房颤患者的RISE-MS试验中，缺血性卒中没有差异,全身栓塞事件,或利伐沙班与之间的大出血华法林组在1年的随访期间，以及在6个月时左心耳的血栓形成增加率相等。华法林组12个月时无症状脑缺血发生率(17.6%)高于利伐沙班组(13.3%)。
UNASSIGNED：目前已发表的研究支持DOACs在预防房颤伴二尖瓣或主动脉瓣狭窄患者血栓栓塞方面的有效性。进一步的临床试验可以证实这些发现。
