作者：姚自鹏，尹琼，吴安爽，刘曼华，夏旭辉

单位：

431700 湖北省天门市第一人民医院心内科

Units：

Department of Cardiology, the First People's Hospital of Tianmen in Hubei Province, Tianmen 431700, China

关键词：

血栓栓塞；心室血栓；新型口服抗凝剂；维生素K 拮抗剂；Meta 分析

Keywords：

Thromboembolism; Ventricular thrombosis; New oral anticoagulants; Vitamin K antagonist; Meta-analysis

CLC：

R 619.2

DOI：

10.12114/j.issn.1008-5971.2021.00.152

Funds：

摘要：

背景　心室血栓（VT）可增加血栓栓塞事件发生风险，华法林药效不稳定且患者依从性差，而新型 口服抗凝剂（NOACs）为VT 的治疗提供可能，但目前相关文献研究较少，且尚无统一定论。目的　本研究采用Meta 分析法，对NOACs 治疗VT 的有效性和安全性进行系统评价，旨在为VT 的临床治疗提供可靠的参考依据。方法　计 算机检索Web of Science、Cochrane Library、PubMed、Embase 及中国知网（CNKI）、万方数据知识服务平台、中国生 物医学文献服务系统（CBM），检索时间从建库至2020 年11 月，获取已公开发表的VT 患者治疗效果的队列研究， 试验组为采用NOACs 治疗的患者；对照组为口服VKA（华法林）抗凝治疗的患者。比较两组患者治疗后血栓栓塞事 件、出血事件发生率及血栓溶解有效率、全因死亡率、主要不良心脑血管事件，并采用RevMan 5.3 软件进行Meta 分析。 结果　最终纳入13 篇文献，共包含2 167 例患者，其中试验组645 例，对照组1 522 例。Meta 分析结果显示，两组患 者血栓栓塞事件发生率〔RR=1.04，95%CI（0.85，1.29），P=0.68〕、出血事件发生率〔RR=0.81，95%CI（0.60，1.10）， P=0.18〕、全因死亡率〔RR=0.86，95%CI（0.52，1.42），P=0.55〕比较，差异无统计学意义。试验组患者治疗后血 栓溶解有效率高于对照组，差异有统计学意义〔RR=1.16，95%CI（1.06，1.27），P=0.002〕。仅1 篇文献比较了两 组患者主要不良心脑血管事件，由于研究太少，并未做进一步分析。对评价指标为血栓栓塞事件发生率的文献绘制漏 斗图显示，数据点分布不对称，提示评价指标为血栓栓塞事件发生率的文献存在发表偏倚的可能性大。结论　NOACs 可更有效地提高VT 患者血栓溶解有效率，且不会增加患者血栓栓塞事件、出血、死亡事件发生风险。

Abstract：

　Background　Ventricular thrombosis (VT) can increase the risk of thromboembolism, efficacy of warfarin is unstable and clinical compliance is poor, and new oral anticoagulants (NOACs) provides the possible for the treatment of VT, but there are few related literatures at present, and there is no unified conclusion. Objective　To systematically evaluate the efficacy and safety of NOACs in the treatment of VT, in order to provide reliable reference for clinical treatment of VT. Methods　Databases of Web of Science, Cochrane Library, PubMed, Embase, CNKI, Wanfang Data and CBM were searched for published cohort studies about efficacy and safety of NOACs in the treatment of VT from the establishment of database to November 2020. Patients in the experimental group were treated with NOACs, while patients in the control group were treated with vitamin K antagonist (VKA) (warfarin) . Incidence of thromboembolism events and bleed events, effective rate of thrombolysis, all cause mortality, major adverse cardiovascular events were compared between the two groups. Meta-analysis was conducted by using RevMan 5.3 software. Results　Finally, 13 articles were included, including 2 167 patients, among them, 645 patients in the experimental group and 1 522 patients in the control group. Meta-analysis results showed that, there was no significant difference in the incidence of thromboembolism events [RR=1.04, 95%CI (0.85, 1.29) , P=0.68] , incidence of bleed events [RR=0.81, 95%CI (0.60, 1.10) , P=0.18] , all cause mortality [RR=0.86, 95%CI (0.52, 1.42) , P=0.55] between the two groups. Incidence of effective rate of thrombolysis in the experimental group was higher than that in the control group [RR=1.16, 95%CI (1.06, 1.27) , P=0.002] . Only one article compared the major adverse cardiovascular events between the two groups, and no further analysis had been made due to the lack of research. The funnel chart of the literature whose evaluation index was the incidence of thromboembolism events showed that, the distribution of data points was asymmetric, which suggested that there was a great possibility of publication bias according to the literature of thromboembolism events incidence. Conclusion　NOACs can effectively promote effective rate of thrombolysis of VT patients, and without increasing the risk of thromboembolism, bleed and death events.

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