Abstract：
Oral anticoagulation with vitamin K antagonists is currently advised for a period of 3 months after surgical mitral valve repair, regardless of the rhythm status. The evidence supporting this recommendation is weak and recent studies have challenged the safety and efficacy of this recommendation. A systematic review of literature was conducted by searching PubMed, Embase, Web of Science, Emcare, and Cochrane Library databases for original publications comparing the efficacy and safety of oral anticoagulation with vitamin K antagonists to antiplatelet treatment early after mitral valve surgery in patients with no atrial fibrillation. Study end points included thromboembolic complications, bleeding complications and survival. A total of 5 studies, including 5,093 patients, met the inclusion criteria; 2,824 patients were included in the oral anticoagulation and 2,269 in the antiplatelet treatment group. Pooled analyses demonstrated no beneficial effect of oral anticoagulation on the incidence of thromboembolic complications (risk ratio 1.14, 95% confidence interval 0.76 to 1.70, p = 0.53, I2 = 8%). Moreover, oral anticoagulation did not result in a significantly increased risk of bleeding complications (risk ratio 0.89, 95% confidence interval 0.32 to 2.44, p = 0.81, I2 = 87%). When combining the efficacy and safety end points, no difference was observed between groups (risk ratio 1.01, 95% confidence interval 0.51 to 1.97, p = 0.99 I2 = 85%). Likewise, mortality did not differ between groups (risk ratio 0.89, 95% confidence interval 0.15 to 5.23, p = 0.90 I2 = 71%). Our results confirmed the safety but failed to confirm the efficacy of oral anticoagulation in patients who underwent mitral valve surgery. A randomized controlled trial would provide the evidence needed to support treatment recommendations.
摘要：
背景：目前建议在手术二尖瓣修复后三个月内口服维生素K拮抗剂（VKA）抗凝治疗，无论节奏如何。支持该建议的证据薄弱，最近的研究对该建议的安全性和有效性提出了挑战。通过搜索PubMed，Embase,WebofScience,Emcare和Cochrane图书馆的原始出版物数据库，比较了无心房颤动患者二尖瓣手术后早期口服抗凝药和维生素K拮抗剂与抗血小板治疗的疗效和安全性。研究终点包括血栓栓塞并发症，出血并发症和生存率。总共有五项研究，包括5093名患者,符合纳入标准;2824例患者纳入口服抗凝治疗组,2269例纳入抗血小板治疗组.汇总分析显示，口服抗凝对血栓栓塞并发症的发生率没有有益的影响（风险比1.14，95％置信区间0.76-1.70，P=0.53，I2=8％）。此外，口服抗凝治疗并未显著增加出血并发症的风险(风险比0.89,95%置信区间0.32~2.44,P=0.81,I2=87%).当结合疗效和安全性终点时，组间无差异(风险比1.01,95%置信区间0.51-1.97,P=0.99I2=85%).同样，死亡率在组间无差异(风险比0.89,95%置信区间0.15-5.23,P=0.90I2=71%).我们的结果证实了二尖瓣手术患者的安全性，但未能证实口服抗凝治疗的有效性。随机对照试验将提供支持治疗建议所需的证据。
