本网络荟萃分析的目的是评估阿哌沙班的疗效和安全性,达比加群,利伐沙班,诊断为房颤和心脏瓣膜病的患者中的依度沙班。对各种电子数据库进行了全面检索,包括PubMed,Embase,和WebofScience,从成立到2024年2月15日。搜索策略结合了医学主题词(MeSH)术语和与瓣膜性心脏病相关的相关关键词,心房颤动,抗凝治疗,和研究设计,如随机对照试验和观察性研究。本分析评估的结果包括中风或全身性栓塞(SE)的发生率,以及大出血事件的发生。共有10项研究被纳入这项荟萃分析,包括40,662名参与者。其中,12,385收到阿哌沙班,2,829收到达比加群,13,662收到利伐沙班,2582人收到edoxaban,9202人接受了华法林。纳入研究的随访时间为3至54个月。在研究的四种直接口服抗凝剂(DOACs)中,与其他DOAC和华法林相比,阿哌沙班可显著降低卒中或SE的风险,强调其在房颤和心脏瓣膜病患者中的疗效。此外,阿哌沙班出现严重出血事件的风险较低,进一步强调与其他评估药物相比,其良好的安全性。总之,我们的研究结果表明,在该患者人群中,阿哌沙班可能比其他DOAC和华法林更有效,更安全.然而,需要更多的研究比较本队列中的各种DOAC,以确定预防不良结局的最佳治疗策略.
The objective of this network meta-analysis was to assess the efficacy and safety of apixaban, dabigatran, rivaroxaban, and edoxaban in patients diagnosed with atrial fibrillation and valvular heart disease. A comprehensive search was conducted across various electronic databases, including PubMed, Embase, and Web of Science, from inception to February 15, 2024. The search strategy utilized a combination of medical subject headings (MeSH) terms and relevant keywords related to valvular heart disease, atrial fibrillation, anticoagulant therapy, and study design, such as randomized controlled trials and observational studies. The outcomes evaluated in this analysis comprised the incidence of stroke or systemic embolism (SE), as well as the occurrences of major bleeding events. A total of 10 studies were incorporated into this meta-analysis, encompassing 40,662 participants. Of these, 12,385 received apixaban, 2,829 received dabigatran, 13,662 received rivaroxaban, 2,582 received edoxaban, and 9,202 received warfarin. The duration of follow-up in the included studies ranged from 3 to 54 months. Among the four direct oral anticoagulants (DOACs) studied, apixaban demonstrated a significant reduction in the risk of stroke or SE when compared to other DOACs and warfarin, highlighting its efficacy in patients with atrial fibrillation and valvular heart disease. Additionally, apixaban exhibited a lower risk of major bleeding events, further emphasizing its favorable safety profile compared to the other agents assessed. In conclusion, our findings suggest that apixaban may be more effective and safer than other DOACs and warfarin in this patient population. However, additional studies are warranted to compare the various DOACs in this cohort to identify the optimal treatment strategy for preventing adverse outcomes.