MedElevator
Войти в исследования Clinical therapeutics · 2025
Efficacy and Safety of Direct Oral Anticoagulants in Patients After Heart Valve Replacement or Repair: A Systematic Review and Network Meta-Analysis.
СтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Gao Weiqi, Zhang Zhijiao, Jia Pengyan, Dong Lingjun, Li Ruijuan, Xu Juan, Zhang Jingmin, Chen Weihong
Аннотация
PURPOSE: The optimal anticoagulation strategy following bioprosthetic heart valve replacement or valve repair remains controversial. Therefore, we conducted a meta-analysis to compare the efficacy and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with heart valve disease.
METHODS: We searched PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wanfang for clinical studies comparing DOACs and VKAs in patients following bioprosthetic heart valve replacement or repair, up to November 1, 2023. The meta-analysis was conducted using RevMan 5.3 and Stata 17.0.
FINDINGS: Thirty-three studies involving 59,660 individuals were included in the meta-analysis. Compared with VKAs, DOACs may reduce the risk of stroke or systemic embolism (risk ratios [RR] = 0.83, 95% confidence interval [CI] 0.75-0.93, P = 0.0007) and major bleeding (RR = 0.76, 95% CI 0.62-0.94, P = 0.009), while the risks of all-cause death and intracranial bleeding were similar. DOACs may increase the risk of gastrointestinal bleeding (RR = 1.42, 95% CI 1.04-1.95, P = 0.03). Twelve studies (4,789 patients) were included in a network meta-analysis. Indirect comparisons suggested rivaroxaban appears most favorable in reducing stroke or systemic embolism and major bleeding, though based on indirect evidence.
IMPLICATIONS: In patients following bioprosthetic heart valve replacement or repair, DOACs may reduce the risk of stroke or systemic embolism and major bleeding, but may increase gastrointestinal bleeding compared with VKAs. Among DOACs, rivaroxaban appears to be the optimal choice. These findings should be interpreted cautiously due to limited RCT evidence and incomplete drug-specific reporting.
METHODS: We searched PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wanfang for clinical studies comparing DOACs and VKAs in patients following bioprosthetic heart valve replacement or repair, up to November 1, 2023. The meta-analysis was conducted using RevMan 5.3 and Stata 17.0.
FINDINGS: Thirty-three studies involving 59,660 individuals were included in the meta-analysis. Compared with VKAs, DOACs may reduce the risk of stroke or systemic embolism (risk ratios [RR] = 0.83, 95% confidence interval [CI] 0.75-0.93, P = 0.0007) and major bleeding (RR = 0.76, 95% CI 0.62-0.94, P = 0.009), while the risks of all-cause death and intracranial bleeding were similar. DOACs may increase the risk of gastrointestinal bleeding (RR = 1.42, 95% CI 1.04-1.95, P = 0.03). Twelve studies (4,789 patients) were included in a network meta-analysis. Indirect comparisons suggested rivaroxaban appears most favorable in reducing stroke or systemic embolism and major bleeding, though based on indirect evidence.
IMPLICATIONS: In patients following bioprosthetic heart valve replacement or repair, DOACs may reduce the risk of stroke or systemic embolism and major bleeding, but may increase gastrointestinal bleeding compared with VKAs. Among DOACs, rivaroxaban appears to be the optimal choice. These findings should be interpreted cautiously due to limited RCT evidence and incomplete drug-specific reporting.