抗凝治疗对心房颤动患者痴呆风险的网状Meta分析-现代医学

抗凝治疗对心房颤动患者痴呆风险的网状Meta分析

单位：1. 同济大学医学院, 上海 200092;
2. 同济大学附属同济医院护理部, 上海 200065

分类号：R473.5

出版年·卷·期（页码）：2024·52·第六期（866-874）

摘要：

目的： 对比评价新型口服抗凝药物(NOACs)与维生素K抗凝剂(VKA)对心房颤动患者痴呆发生的疗效。方法： 计算机检索Web of Science、PubMed、Scopus、Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献数据库、维普中文科技期刊全文数据库，基于PICOS原则纳入口服抗凝药物治疗影响心房颤动患者痴呆的相关文献，检索时间截至2023年9月，使用RevMan 5.4软件和R 4.2.3软件进行Meta分析。结果： 最终纳入13篇文献，共2 187 211例心房颤动患者。结果显示，NOACs和VKA造成痴呆风险比较存在差异(HR=0.88,95%CI 0.82~0.95)；对血管性痴呆和阿尔茨海默病比较不存在显著差异；新型口服抗凝药物之间不存在显著差异，依度沙班和华法林对比存在显著差异(HR=0.36,95%CI 0.11~0.93)。结论： NOACs在预防心房颤动患者痴呆发生方面优于VKA，未来还需要更多临床试验证实该结论。

Objective: To compare and evaluate the efficacy of new oral anticoagulants(NOACs) versus vitamin K antagonists(VKA) on the development of dementia in patients with artrial fibrillation(AF). Methods: A computerized search of Web of Science, PubMed, Scopus, Cochrane Library, China Biomedical Medical Literature Database(CBM), China Knowledge Network, WanFang, and VIP databases was performed to include relevant study on oral anticoagulant therapy affecting dementia in patients with atrial fibrillation based on the PICOS principle. The search time was up to September 2023, and Meta-analysis was performed using RevMan 5.4 software and R 4.2.3 software. Results: Thirteen papers with a total of 2 187 211 patients with AF were finally included. The results showed that there was a difference in the comparison of the risk of dementia caused by NOACs and VKA(HR=0.88, 95%CI 0.82-0.95); there was no significant difference when comparing vascular dementia and Alzheimer's disease; there was no significant difference between the NOACs, and there was a significant difference in the comparison of edoxaban and warfarin(HR=0.36, 95%CI 0.11-0.93). Conclusion: NOACs is superior to VKA in preventing the development of dementia in patients with AF, and more clinical trials are needed to confirm this conclusion in the future.

参考文献：

[1] BOIVIN-PROULX L A,BROUILLETTE J,DORAIS M,et al.Association between cardiovascular diseases and dementia among various age groups:a population-based cohort study in older adults[J].Sci Rep,2023,13(1):14881.
[2] The WCOTROCHADIC.Report on cardiovascular health and diseases in China 2022:an updated summary[J].Biomed Environ Sci,2023,36(8):669-701.
[3] STAERK L,SHERER J A,KO D,et al.Atrial fibrillation:epidemiology,pathophysiology,and clinical outcomes[J].Circ Res,2017,120(9):1501-1517.
[4] HEALEY J S,OLDGREN J,EZEKOWITZ M,et al.Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation:a cohort study[J].Lancet,2016,388(10050):1161-1169.
[5] JACOBS V,GRAVES K G,BUNCH T J.Anticoagulant use in atrial fibrillation and risk of dementia:review of contemporary knowledge[J].Expert Rev Cardiovasc Ther,2017,15(12):897-903.
[6] PAPANASTASIOU C A,THEOCHARI C A,ZAREIFOPOULOS N,et al.Atrial fibrillation is associated with cognitive impairment,all-cause dementia,vascular dementia,and alzheimer's disease:a systematic review and Meta-analysis[J].J Gen Intern Med,2021,36(10):3122-3135.
[7] LAU W C Y,TORRE C O,MAN K K C,et al.Comparative effectiveness and safety between apixaban,dabigatran,edoxaban,and rivaroxaban among patients with atrial fibrillation:a multinational population-based cohort study[J].Ann Intern Med,2022,175(11):1515-1524.
[8] STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in Meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.
[9] KUNDNANI N R,ROSCA C I,SHARMA A,et al.Selecting the right anticoagulant for stroke prevention in atrial fibrillation[J].Eur Rev Med Pharmacol Sci,2021,25(13):4499-4505.
[10] BEZABHE W M,BEREZNICKI L R,RADFORD J,et al.Oral anticoagulant treatment and the risk of dementia in patients with atrial fibrillation:a population-based cohort study[J].J Am Heart Assoc,2022,11(7):e023098.
[11] CADOGAN S L,POWELL E,WING K,et al.Anticoagulant prescribing for atrial fibrillation and risk of incident dementia[J].Heart,2021,107(23):1898-1904.
[12] CHEN N,LUTSEY P L,MACLEHOSE R F,et al.Association of oral anticoagulant type with risk of dementia among patients with nonvalvular atrial fibrillation[J].J Am Heart Assoc,2018,7(21):e009561.
[13] FRIBERG L,ROSENQVIST M.Less dementia with oral anticoagulation in atrial fibrillation[J].Eur Heart J,2018,39(6):453-460.
[14] GRYMONPREZ M,PETROVIC M,DE BACKER T L,et al.Comparing the risk of dementia in subjects with atrial fibrillation using non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists:a Belgian nationwide cohort study[J].Age Ageing,2023,52(3) afad038.
[15] HARRISON S L,BUCKLEY B J R,RITCHIE L A,et al.Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation:a global federated health network analysis[J].J Am Geriatr Soc,2022,70(8):2386-2392.
[16] HSU J Y,LIU P P,LIU A B,et al.Lower risk of dementia in patients with atrial fibrillation taking non-vitamin K antagonist oral anticoagulants:a nationwide population-based cohort study[J].J Am Heart Assoc,2021,10(5):e016437.
[17] JACOBS V,MAY H T,BAIR T L,et al.Long-term population-based cerebral ischemic event and cognitive outcomes of direct oral anticoagulants compared with warfarin among long-term anticoagulated patients for atrial fibrillation[J].Am J Cardiol,2016,118(2):210-214.
[18] KIM D,YANG P S,JANG E,et al.Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation[J].Europace,2021,23(2):184-195.
[19] LEE S R,CHOI E K,PARK S H,et al.Comparing warfarin and 4 direct oral anticoagulants for the risk of dementia in patients with atrial fibrillation[J].Stroke,2021,52(11):3459-3468.
[20] MONGKHON P,FANNING L,LAU W C Y,et al.Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation:a population-based cohort study[J].Heart Rhythm,2020,17(5 Pt A):706-713.
[21] SØGAARD M,SKJØTH F,JENSEN M,et al.Nonvitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients and risk of dementia:a nationwide propensity-weighted cohort study[J].J Am Heart Assoc,2019,8(11):e011358.
[22] CHOPARD R,PIAZZA G,GALE S A,et al.Dementia and atrial fibrillation:pathophysiological mechanisms and therapeutic implications[J].Am J Med,2018,131(12):1408-1417.
[23] LIN M,HAN W,ZHONG J,et al.A systematic review and Meta-analysis to determine the effect of oral anticoagulants on incidence of dementia in patients with atrial fibrillation[J].Int J Clin Pract,2021,75(10):e14269.
[24] DING M,FRATIGLIONI L,JOHNELL K,et al.Atrial fibrillation,antithrombotic treatment,and cognitive aging:a population-based study[J].Neurology,2018,91(19):e1732-e1740.
[25] MONGKHON P,NASER A Y,FANNING L,et al.Oral anticoagulants and risk of dementia:a systematic review and Meta-analysis of observational studies and randomized controlled trials[J].Neurosci Biobehav Rev,2019,96:1-9.
[26] YATES P A,VILLEMAGNE V L,ELLIS K A,et al.Cerebral microbleeds:a review of clinical,genetic,and neuroimaging associations[J].Front Neurol,2014,4:205.
[27] CHENG W, LIU W, LI B, et al. Relationship of anticoagulant therapy with cognitive impairment among patients with atrial fibrillation: a Meta-analysis and systematic review[J]. J Cardiovasc Pharmacol,2018,71(6):380-387.
[28] BRANCO D R, ALVES M, E SOUSA C S E, et al. Direct oral anticoagulants vs vitamin K antagonist on dementia risk in atrial fibrillation: systematic review with Meta-analysis[J]. J Thromb Thrombolysis, 2023,56(3):474-484.
[29] HOSPODAR A R,SMITH K J,ZHANG Y,et al.Comparing the cost effectiveness of non-vitamin K antagonist oral anticoagulants with well-managed warfarin for stroke prevention in atrial fibrillation patients at high risk of bleeding[J].Am J Cardiovasc Drugs,2018,18(4):317-325.
[30] WANG X,WANG T,CHEN X,et al.Efficacy and safety of oral anticoagulants in older adult patients with atrial fibrillation:pairwise and network Meta-analyses[J].J Am Med Dir Assoc,2023,24(8):1233-1239.e1226.
[31] STEFFEL J,COLLINS R,ANTZ M,et al.2021 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation[J].Europace,2021,23(10):1612-1676.
[32] PROIETTI R,RIVERA-CARAVACA J M,LÓPEZ-GÁLVEZ R,et al.Clinical implications of different types of dementia in patients with atrial fibrillation:insights from a global federated health network analysis[J].Clin Cardiol,2023,46(6):656-662.
[33] KIM D,YANG P S,YU H T,et al.Risk of dementia in stroke-free patients diagnosed with atrial fibrillation:data from a population-based cohort[J].Eur Heart J,2019,40(28):2313-2323.
[34] LEE Z X,ANG E,LIM X T,et al.Association of risk of dementia with direct oral anticoagulants versus warfarin use in patients with non-valvular atrial fibrillation:a systematic review and Meta-analysis[J].J Cardiovasc Pharmacol,2021,77(1):22-31.
[35] 杨歆，朱长才.基于openFDA对新型口服抗凝药依度沙班的不良反应分析[J].中国医院药学杂志，2022，42(22)：2397-2401.
[36] KOMATSU Y,YOKOYAMA S,HOSOMI K,et al.Impact of medication adherence on the association between oral anticoagulant use and risk of dementia:a retrospective cohort study using the Japanese claims database[J].Drugs Real World Outcomes,2022,9(3):437-449.

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