摘要
目的探讨≥80岁高龄老年人服用新型口服抗凝药(noval oral anticoagulants,NOACs)减少剂量与标准剂量的有效性及安全性。方法通过计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普期刊数据库,检索范围为建库至2025年2月,筛选出符合标准的研究。结局指标包括缺血性卒中/全身栓塞(急性心肌梗死、肺栓塞、下肢深静脉血栓等)、出血事件(颅内出血、消化道出血和其他部位严重出血等)、全因死亡。结果共10篇队列研究纳入Meta分析,研究对象共45574例。在有效性方面,减少剂量组相比标准剂量组在栓塞风险方面差异无统计学意义(RR=1.40,95%CI=0.99~1.99,P=0.06),但敏感性分析剔除异质性高的研究后,减少剂量与栓塞风险增加有关,差异有统计学意义(RR=1.67,95%CI=1.42~1.97,P<0.05);在安全性方面,减少剂量组相比标准剂量组在出血风险方面差异无统计学意义(RR=0.90,95%CI=0.73~1.11,P=0.33),但存在较高的全因死亡风险,差异有统计学意义(RR=1.49,95%CI=1.18~1.89,P<0.05)。结论≥80岁高龄老年人服用减少剂量的NOACs可能与较高的栓塞风险、全因死亡风险相关,出血风险方面无差异;在排除肾功能不全、低体质量及联合应用抗血小板药物等因素后,可考虑给以标准剂量的NOACs。
Objective To investigate the efficacy and safety of noval oral anticoagulants(NOACs)with reduced dose and standard dose in the elderly aged 80 years and over.Methods PubMed,Cochrane Library,Embase,CNKI,Wanfang Database,and VIP Journal database were applied to research from the establishment of the database to February 2025,and the studies that met the criteria were screened.The outcomes included stroke/systemic embolism(acute myocardial infarction,pulmonary embolism,deep venous thrombosis of lower limbs,etc.),bleeding events(intracranial hemorrhage,gastrointesti-nal hemorrhage and severe bleeding in other places,etc.)and all-cause death.Results A total of 10 cohort studies were included in the meta-analysis,involving a total of 45574 patients.In terms of efficacy,there was no significant difference in the risk of embolism between the reduced dose group and the standard dose group(RR=1.40,95%CI=0.99-1.99,P=0.06).However,sensitivity analysis showed that the reduced dose group was associated with an increased risk of embolism after excluding studies with high heterogeneity.The difference was statistically significant(RR=1.67,95%CI=1.42-1.97,P<0.05).In terms of safety,there was no significant difference in the risk of bleeding between the reduced dose group and the standard dose group(RR=0.90,95%CI=0.73-1.11,P=0.33),but there was a higher risk of all-cause death(RR=1.49,95%CI=1.18-1.89,P<0.05).Conclu-sion This study shows that for the elderly aged 80 years and over,the use of reduced doses of NOACs may be associated with higher risks of embolism and all-cause death,but there is no significant difference in the risk of bleeding.After excluding renal insufficiency,low body weight and combined use of antiplatelet drugs,standard dose of NOACs can be considered.
作者
宋朕
吴婷婷
陈蕊肖
焦圣军
姚天宇
田野
路陆
SONG Zhen;WU Tingting;CHEN Ruixiao;JIAO Shengjun;YAO Tianyu;TIAN Ye;LU Lu(The Third Department of Cardiology,Cangzhou Hospital of Integrated Traditional Chinese and West-ern Medicine,Cangzhou 061000,China)
出处
《医学研究与教育》
2025年第4期18-28,共11页
Medical Research and Education
