Comparison of Efficacy and Safety of Direct Oral Anticoagulants and Warfarin between Patients in Asian and non-Asian Regions: A Systematic Review and Meta-Regression Analysis
Comparison of Efficacy and Safety of Direct Oral Anticoagulants and Warfarin between Patients in Asian and non-Asian Regions: A Systematic Review and Meta-Regression Analysis
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亚洲和非亚洲地区患者直接口服抗凝药和华法林的疗效和安全性比较：系统评价和荟萃回归分析
DOI：
10.1002/cpt.2881
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Tohkin M.
中科院分区：
文献类型：
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作者：
Ambe K.;Akita A.;Wei J.;Yoshii Y.;Onishi M.;Tohkin M.
直接口服抗凝剂（DOACs）越来越多地取代华法林治疗非瓣膜性心房颤动（NVAF）患者。doac已被证明比华法林更有用，这一点在疗效和安全性方面的种族差异中得到了强调；然而，doac的地区差异仍不清楚。我们进行了一项系统回顾、荟萃分析和荟萃回归，以评估DOACs在亚洲和非亚洲地区非瓣瓣性房颤患者中的疗效和安全性。我们系统地检索了2019年8月之前发表的随机对照试验。我们定义了11项研究，包括7118名亚洲患者和53,282名非亚洲患者，共计60,400名非瓣瓣性房颤患者。以华法林为对照，计算DOACs的风险比（rr）。DOACs在亚洲地区对卒中/全身性栓塞事件的疗效显著更高(亚洲地区RR: 0.62, 95%可信区间（CI）： 0.49-0.78；非亚洲地区的RR: 0.83, 95% CI: 0.75-0.92；p交互作用：0.02)，与华法林比较。与华法林相比，DOACs在亚洲地区对于大出血的安全性显著更高（亚洲地区RR: 0.62, 95% CI: 0.51-0.75；非亚洲地区RR: 0.90, 95% CI: 0.76-1.05；相互作用p: 0.004）。此外，我们进行了meta回归分析，以讨论DOACs与华法林的真正地区差异。meta -回归分析调整了每项研究中个体背景的影响，表明在疗效方面存在区域差异，但在药物安全性方面没有。这些结果表明，在亚洲地区，doac治疗可能比常规华法林更有效。
Direct oral anticoagulants (DOACs) have increasingly replaced warfarin for treating patients with non‐valvular atrial fibrillation (NVAF). DOACs have been demonstrated to be more useful than warfarin, which was highlighted at its ethnic differences in efficacy and safety; however, the regional differences of DOACs remain unclear. We conducted a systematic review, meta‐analysis, and meta‐regression to evaluate the efficacy and safety of DOACs in patients from Asian and non‐Asian regions with NVAF. We systematically searched randomized control trials published before August 2019. We defined 11 studies comprising 7,118 Asian and 53,282 non‐Asian patients, totaling 60,400 patients with NVAF. The risk ratios (RRs) of DOACs were calculated against warfarin. The efficacy of DOACs was significantly higher in Asian regions regarding stroke/systemic embolism events (RR: 0.62 and 95% confidence interval (CI): 0.49–0.78 for the Asian region; RR: 0.83 and 95% CI: 0.75–0.92 for non‐Asian regions;Pinteraction: 0.02), when compared with warfarin. The safety of DOACs was significantly higher in Asian regions regarding major bleeding (RR: 0.62 and 95% CI: 0.51–0.75 for Asian regions; RR: 0.90 and 95% CI: 0.76–1.05 for non‐Asian regions;Pinteraction: 0.004), compared with warfarin. In addition, we conducted meta‐regression analysis to discuss the true regional differences of DOACs to warfarin. The meta‐regression analysis, which adjusts the effect of individual backgrounds in each study, indicated that the regional differences were observed in the efficacy but not in drug safety. These results suggest that treatment with DOACs may be more effective than the conventional warfarin in the Asian region.