不同剂量的新型口服抗凝药对高龄患者有效性及安全性的Meta分析

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中图分类号：R5 文献标志码：A 文章编号：1674-490X（2025）04-0018-11

Efficacy and safety of different doses of new oral anticoagulants in elderly patients： a Meta-analysis

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 O610oO，China）

Abstract： Objective To investigate the eficacy and safety of noval oral anticoagulants （NOACs） with reduced dose and standard dose in the elderly aged 8O 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 2O25，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， gastrointestinal hemorhage and severe bleeding in other places，etc.）and al-cause death. Results A total of 10 cohort studies were included in the meta-analysis，involving a total of 45 574 patients. In terms of efficacy，there was no significant diffrence 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 ）. Conclusion This study shows that for the elderly aged 8O 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 diference in the risk of bleeding. After excluding renal insuffciency，low body weight and combined use of antiplatelet drugs， standard dose of NOACs can be considered.

Key words： elderly people； noval oral anticoagulants；dose；non-valvular atrial fibrillation；cohorstudy ； Meta-analysis

心房颤动是临床上最常见的心律失常之一，年龄是心房颤动患者缺血性脑卒中最重要的预测危险因素之一。（剩余9038字）