标题：不同抗凝强度华法林对中国和日本非瓣膜性房颤患者出血与栓塞事件影响的Meta分析

      作者：董丽，刘婷，蒋文平，惠杰，汪小华    (苏州大学附属第一医院心内科，江苏 苏州 215006)

      卷次： 2017年28卷21期

      【摘要】 目的 探讨不同抗凝强度的华法林对中国和日本非瓣膜性房颤患者出血与栓塞事件的影响。方法 检索 Pubmed、EMbase、Cochrane Central Register of Controlled Trials (CENTRAL)、中国生物医学文献库)CBM)数据库，收集不同抗凝强度华法林治疗非瓣膜性心房颤动的观察性研究，用 RevMan 5.3软件统计分析。结果 共纳入5篇文章。Meta分析显示：与 INR(国际标准化比值)2.0~3.0相比，INR 1.5~2.5组的非瓣膜性心房颤动患者的栓塞事件没有增加[OR=1.26，95%CI=(0.96，1.66)，Z=1.66，P=0.10]；出血风险 [OR=0.81，95%CI=(0.63，1.05)，Z=1.61，P=0.11])、致命性出血 [OR=0.75，95%CI=(0.47，1.19)，Z=1.22，P=0.22]和死亡事件 [OR=1.22，95%CI=(0.86，1.73)，Z=1.12，P=0.26]发生的风险亦无统计学意义的变化。结论 中日非瓣膜性房颤接受华法林抗凝治疗患者，其 INR维持在1.5~2.5能达到治疗目的，且相对安全，临床可适当调整 INR的标准。
      【关键词】 华法林；非瓣膜性房颤；INR；抗凝治疗；Meta分析
      【中图分类号】 R541.7+5 【文献标识码】 A 【文章编号】 1003—6350（2017）21—3580—05

Effect of different intensity of warfarin therapy on the endpoints of Chinese and Japanese patients withnonvalvular atrial fibrillation: a meta-analysis.
DONG Li, LIU Ting, JIANG Wen-ping, HUI Jie, WANG Xiao-hua.Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, CHINA
【Abstract】 Objective To explore the effect of different intensity of warfarin therapy on the endpoints of Chi-nese and Japanese patients with nonvalvular atrial fibrillation (NVAF). Methods The cohort studies of different inten-sity of warfarin therapy on patients with NVAF were collected in the databases including Pubmed, EMbase, Cochrane,CBM. Data were analyzed by RevMan 5.3 version. Results Five cohort studies were enrolled into this research. The re-sults of meta-analysis indicated that a range of international normalized ratio (INR) 1.5-2.5 did not increase the inci-dence of the thromboembolic events in patients with nonvalvular atrial fibrillation (OR=1.26，95% CI=0.96 to 1.66, Z=1.66, P=0.10), compared with the range of INR 2.0-3.0. Meanwhile, there were no statistically differences on the inci-dences of bleeding events (OR=0.81, 95%CI=0.63 to 1.05, Z=1.81, P=0.11), fatal bleeding events (OR=0.75, 95%CI=0.47 to 1.19, Z=1.22, P=0.22) and death events (OR=1.22, 95%CI=0.86 to 1.73, Z=1.12, P=0.26) in patients with nonval-vular atrial fibrillation between the two groups. Conclusion The range of INR 1.5-2.5 also has effective anticoagulanteffect for Chinese and Japanese patients with nonvalvular atrial fibrillation. The INR range can be adjusted for Chineseand Japanese NVAF patients with warfarin therapy.
      【Key words】 Warfarin; Nonvalvular atrial fibrillation (NVAF); International normalized ratio (INR); Anticoagu-lant therapy; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2017.21.046