CAJ | 학술논문

目的：系统性评价口服Xa抑制剂和华法林用于房颤患者抗凝治疗的有效性和安全性。方法按照Cochrane系统评价制作方法，计算机检索Pub Med数据库、Ovid数据库、EMBASE数据库、Medline光盘数据库、同方数据库检索相关文献，查找网络上有关的所有文章及未发表的病例对照实验，并用手工检索等方法收集相关文献，并对所有文献的参考文献进行进一步的检索。收集所有相关的病例对照试验，采用Cochrane协作网提供的RevMan5.0软件进行Meta分析，以获得口服Xa抑制剂和华法林相比对房颤患者抗凝效果的有效性和安全性的相关证据。结果 Xa抑制剂与华法林相比，能明显降低总死亡率【P=0.01，优势比（OR）0.89，95%可信区间（CI）（0.82，0.98）】、出血性脑卒中发生率【P＜0.00001，优势（OR）0.49，95%可信区间（CI）（0.39，0.60）】、主要部位出血发生率【P=0.07，优势比（OR）0.76，95%可信区间（CI）（0.57，1.02）】；然而缺血性脑卒中发生率【P=0.18，优势比（OR）1.08，95%可信区间（CI）（0.97，1.20）】、心肌梗死发生率【P=0.19，优势比（OR）0.94，95%可信区间（CI）（0.82，1.08）】、消化道出血发生率【P=0.65，优势比（OR）1.07，95%可信区间（CI）（0.78，1.47）】无差别。结论新型口服抗凝剂利伐沙班、阿哌沙班、依度沙班的最大优势在于出血风险减少和用药方便，但目前此类药物临床使用时间过短和上市后可能昂贵的价格，同时缺乏明确的解救药物，尚不足以将这些药物作为一线用药考虑。
목적：계통성평개구복Xa억제제화화법림용우방전환자항응치료적유효성화안전성。방법안조Cochrane계통평개제작방법，계산궤검색Pub Med수거고、Ovid수거고、EMBASE수거고、Medline광반수거고、동방수거고검색상관문헌，사조망락상유관적소유문장급미발표적병례대조실험，병용수공검색등방법수집상관문헌，병대소유문헌적삼고문헌진행진일보적검색。수집소유상관적병례대조시험，채용Cochrane협작망제공적RevMan5.0연건진행Meta분석，이획득구복Xa억제제화화법림상비대방전환자항응효과적유효성화안전성적상관증거。결과 Xa억제제여화법림상비，능명현강저총사망솔【P=0.01，우세비（OR）0.89，95%가신구간（CI）（0.82，0.98）】、출혈성뇌졸중발생솔【P＜0.00001，우세（OR）0.49，95%가신구간（CI）（0.39，0.60）】、주요부위출혈발생솔【P=0.07，우세비（OR）0.76，95%가신구간（CI）（0.57，1.02）】；연이결혈성뇌졸중발생솔【P=0.18，우세비（OR）1.08，95%가신구간（CI）（0.97，1.20）】、심기경사발생솔【P=0.19，우세비（OR）0.94，95%가신구간（CI）（0.82，1.08）】、소화도출혈발생솔【P=0.65，우세비（OR）1.07，95%가신구간（CI）（0.78，1.47）】무차별。결론신형구복항응제리벌사반、아고사반、의도사반적최대우세재우출혈풍험감소화용약방편，단목전차류약물림상사용시간과단화상시후가능앙귀적개격，동시결핍명학적해구약물，상불족이장저사약물작위일선용약고필。
Objective To evaluation system of oral factor Xa inhibitor and warfarin for the effectiveness and safety of anticoagulation in patients with atrial fibrillation treatment. Methods the method of making Cochrane system in accordance with the evaluation, Pub Med database, Ovid database, EMBASE data base, Medline CD ROM database, Tong fang database retrieval of relevant literature of computer retrieval, control experiments all articles related to search on the network and the case unpublished and manual search methods to collect relevant literature, and all references for further retrieval. Collect all relevant case-control trials were Meta analyzed using the Cochrane collaboration provided by RevMan 5.0 software;to obtain the oral factor Xa inhibitor and warfarin compared the relevant evidence on the efficacy and safety in patients with atrial fibrillation anticoagulation effect. Results factor Xa inhibitors compared with wafarlin can significantly reduce overall mortality [p=0.01, v odds ratio (OR)0.89, 95%confidence intercal (CI)(0.89,0.98),) hemor hemorrhagic stroke incidence [P<0.00001, OR 0.49, 95%CI(0.39,0.60) and the main parts of bleeding rate [P=0.07, OR 0.76,95%CI(0.57,1.02)];howener, ischemic stroke incidence [p=0.18, (OR) 1.08, 95%CI(0.97,1.20), and the incidence of myocardial infarction [P=0.19, (OR)0.94, 95%CI (0.82,1.08)], the incidence of gastrointestinal bleeding were [P=0.65, odds ratio (OR) 1.07, 95%confidence interval (CI) (0.78,1.47)]no difference. Conclusions The new oral anticoagulants Apixaban、Rivaroxaban、Edoxaban can reduce the bleeding risk and convenient medication, but at present the clinical drug use for too short a time and after the listing may be eapensive, and the lack of clear rescue drugs are insufficient to these drugs as first-line grugs considered.