METHODS: We retrieved all relevant randomized controlled studies and observational cohort studies, which critically assessed the efficacy and safety of DOACs versus VKAs among patients with left-sided BHV and AF in databases of PubMed, Cochrane, ISI Web of Sciences, and Embase. The efficacy outcomes of this meta-analysis were stroke events and all-cause death when the safety outcomes included major and any bleeding.
RESULTS: The analysis integrated 13 studies while enrolling 27,793 patients with AF and left-sided BHV. DOACs reduced the rate of stroke by 33% compared with VKAs (risk ratio [RR] 0.67; 95% CI 0.50-0.91), with no increased incidence of all-cause death (RR 0.96; 95% CI 0.82-1.12). For safety outcomes, major bleeding was reduced by 28% using DOACs rather than VKAs (RR 0.72; 95% CI 0.52-0.99), while there was no difference in the events of any bleeding (RR 0.84; 95% CI 0.68-1.03). In addition, in patients younger than 75 years old, the stroke rate was reduced by 45% in the population using DOACs (RR 0.55; 95% CI 0.37-0.84).
CONCLUSIONS: Our meta-analysis demonstrated that in patients with AF and BHV, compared with VKAs, using DOACs was associated with reduced stroke and major bleeding events without an increase of all-cause mortality and any bleeding. In the population younger than 75 years old, DOAC might be more effective in preventing cardiogenic stroke.
方法:我们检索了所有相关的随机对照研究和观察性队列研究,在PubMed数据库中,对左侧BHV和AF患者中DOAC与VKAs的疗效和安全性进行了严格评估,科克伦,ISIWebofSciences,和Embase。该荟萃分析的疗效结果是卒中事件和全因死亡,而安全性结果包括严重出血和任何出血。
结果:该分析整合了13项研究,同时招募了27,793例房颤和左侧BHV患者。与VKAs相比,DOAC将卒中发生率降低了33%(风险比[RR]0.67;95%CI0.50-0.91),全因死亡发生率没有增加(RR0.96;95%CI0.82-1.12)。对于安全结果,使用DOAC而不是VKAs,主要出血减少了28%(RR0.72;95%CI0.52-0.99),而任何出血事件没有差异(RR0.84;95%CI0.68-1.03)。此外,在75岁以下的患者中,使用DOAC的人群卒中发生率降低了45%(RR0.55;95%CI0.37~0.84).
结论:我们的荟萃分析表明,在房颤和BHV患者中,与VKAs相比,使用DOAC与卒中和大出血事件减少相关,而全因死亡率和出血没有增加.在75岁以下的人群中,DOAC可能更有效地预防心源性卒中。