| Objective:To evaluate the efficacy and safety of thrombolytic therapy among patients of acute cerebral infarction complicated with atrial fibrillation through a meta-analysis on clinical literatures,so as to reduce the risk relevant to drug use and improve the efficacy of drugs through standardization of medications,and thus support the formulation of safe and effective treatment regimens theoretically.Methods : Through the systematic retrieval of Google scholar search engine and databases such as CBM,WanFang Data,MEDLINE,EMbase and Cochrane Library,the clinical research on thrombolytic therapy in patients with acute cerebral infarction complicated with atrial fibrillation was searched by the combination of subject headings and free-text terms retrieval from the construction of the database to 2020.On the basis of inclusive criteria and exclusive criteria,literatures were screened and taken effective extraction of the data in the literature.Target patients with thrombolytic drugs or placebo were regarded as experimental group and control group,efficacy and safety of thrombolytic treatment were evaluated in these two groups.The quality assessment,heterogeneity analysis,sensitivity analysis and publication bias analysis of the included literature were carried out by Rev Man 5.3 and stata15.1.Result:According to the search terms,449 relevant literatures were initially detected.A total of 7 studies were finally included in this article after a series of screening.All included studies were clinical randomized controlled trials(RCTs).Though Cochrane bias risk assessment tool,quality evaluation results of the study showed that the included studies were highly comparable.In terms of clinical efficacy,the NIHSS score was used to evaluate of efficacy of the patients receiving thrombolytic treatment in seven RCTs.Total 645 patients were included,of which 330 patients in experimental group and 315 patients in control group.The NIHSS score of the experimental group was significantly lower than that of control group(MD=-2.96,95%CI[-3.74,-2.18],P<0.0001).The ADL scale was used to evaluate efficacy of the patients receiving thrombolytic treatment in three RCTs.Total 250 patients were included,of which 125 patients in experimental group and 125 patients in control group.The ADL score of the experimental group was significantly lower than that of control group(MD=18.68,95%CI[15.96,21.40],P<0.0001).In terms of safety evaluation,the symptomatic hemorrhage was used to evaluate of safety of patients receiving thrombolytic treatment in two RCTs.Total 126 patients were included,of which 66 patients in experimental group and 60 patients in matched group.Incidence of symptomatic hemorrhage in experimental group was higher than that in control group,but there was no significant difference between the two groups(RR=2.12,95%CI[0.87,5.16],P=0.10).The death rate was used to evaluate of safety of patients receiving thrombolytic treatment in four RCTs.Total 313 patients were included of which 162 in experimental group and 151 in matched group.The death rate in experimental group was lower than that in matched group,however,there was no significant difference between the two groups(RR=0.84,95%CI[0.40,1.77],P=0.64).Conclusion: Thrombolytic therapy has curative effect and high safety among patients of acute cerebral infarction complicated with atrial fibrillation.7 literatures completely satisfying the inclusion criteria were included in the present study,and were mainly domestic studies,which made this study limited to some extent.We hope that more RCT studies are published,so as to provide more evidence for evaluating the efficacy and safety of thrombolytic therapy among patients of acute cerebral infarction complicated with atrial fibrillation. |
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