■这篇综述旨在评估阿哌沙班与阿哌沙班的安全性和有效性。透析患者的维生素K拮抗剂(VKAs)。
■在PubMed上发表的所有类型的研究,Embase,中部,和截至2023年9月10日的WebofScience,并比较阿哌沙班与透析患者的VKA符合资格。
■纳入2项随机对照试验(RCT)和6项回顾性研究。与VKA相比,阿哌沙班治疗与大出血风险(RR:0.61;95%CI:0.48,0.77;I2=50%)和临床相关非大出血风险(RR:0.82,95%CI:0.68,0.98,I2=9%)显着降低。Meta分析还显示,阿哌沙班可显著降低消化道出血风险(RR:0.74,95%CI:0.64,0.85,I2=16%)和颅内出血风险(RR:0.64,95%CI:0.49,0.84,I2=0%)。Meta分析显示缺血性卒中风险无差异(RR:0.40,95%CI:0.06,2.69,I2=0%),两组间的死亡率(RR:1.26,95%CI:0.74,2.16,I2=94%)和静脉血栓栓塞复发(RR:1.02,95%CI:0.87,1.21,I2=0%).RCT亚组分析显示出血结局无差异。
■来自随机对照试验和回顾性研究的低质量证据表明,与VKA相比,阿哌沙班在透析患者中可能具有更好的安全性和同等疗效。在观察性研究中,阿哌沙班治疗与显著降低大出血和临床相关的非大出血风险相关,但在RCTs中不相关。回顾性数据的优势在解释结果时值得谨慎。
UNASSIGNED: This review aims to evaluate the safety and efficacy of apixaban vs. vitamin K antagonists (VKAs) in patients on dialysis.
UNASSIGNED: All types of studies published on PubMed, Embase, CENTRAL, and Web of Science up to 10 September 2023 and comparing outcomes of apixaban vs. VKA in dialysis patients were eligible.
UNASSIGNED: Two randomized controlled trials (RCTs) and six retrospective studies were included. Apixaban treatment was associated with significantly lower risk of major bleeding (RR: 0.61; 95% CI: 0.48, 0.77; I2 = 50%) and clinically relevant non-major bleeding (RR: 0.82, 95% CI: 0.68, 0.98, I2 = 9%) compared to VKA. Meta-analysis also showed that the risk of gastrointestinal bleeding (RR: 0.74, 95% CI: 0.64, 0.85, I2 = 16%) and intracranial bleeding (RR: 0.64, 95% CI: 0.49, 0.84, I2 = 0%) was significantly reduced with apixaban. Meta-analysis showed no difference in the risk of ischemic stroke (RR: 0.40, 95% CI: 0.06, 2.69, I2 = 0%), mortality (RR: 1.26, 95% CI: 0.74, 2.16, I2 = 94%) and recurrent venous thromboembolism (RR: 1.02, 95% CI: 0.87, 1.21, I2 = 0%) between the two groups. Subgroup analysis of RCTs showed no difference in bleeding outcomes.
UNASSIGNED: Low-quality evidence from a mix of RCTs and retrospective studies shows that apixaban may have better safety and equivalent efficacy as compared to VKA in dialysis patients. Apixaban treatment correlated with significantly reduced risk of major bleeding and clinically relevant nonmajor bleeding in observational studies but not in RCTs. The predominance of retrospective data warrants caution in the interpretation of results.