| 【Background】Atrial fibrillation(AF)is a clinically common,age-related supraventricular arrhythmia.With the progress of population aging and the increase of average life expectancy,the incidence of elderly nonvalvular atrial fibrillation(NVAF)has increased significantly.Thromboembolism is a serious complication of AF that causes disability and death,especially ischemic stroke.According to CHA2DS2-VASC score and HAS-BLED score,age is a risk factor for embolic events and bleeding events.Warfarin is one of the main drugs for AF anticoagulation therapy.Most of the existing large-scale clinical studies did not include the aged,especially the elderly.Therefore,the major guidelines set different target values for the INR for warfarin anticoagulation therapy in elderly NVAF patients.【Objective】Meta-analysis is used to evaluate the effects of warfarin anticoagulant therapy of different intensities on the bleeding and embolism of elderly NVAF,and provide evidence-based medical evidence for the target value control of warfarin anticoagulant therapy in elderly NVAF patients.【Methods】Through Pub Med,Embase,Cochrane library,Web of science,Chinese Journal Full-text Database(CNKI),Wanfang Database to search for relevant research on warfarin anticoagulation therapy in elderly NVAF patients,the search deadline is August 2020.Two researchers independently screened the literature,extracted data,and evaluated the quality of the included studies.Rev Man 5.3 software was used for data analysis to compare the incidence of ischemic stroke,systemic embolism,bleeding events and all-cause death between low-intensity warfarin anticoagulation and standard-intensity anticoagulation in elderly NVAF patients,and to evaluate the two anticoagulation Effectiveness and safety of strength.【Results】A total of 8 clinical studies were included in this meta-analysis,with a total of 4767 patients.All patients were treated with oral warfarin anticoagulation,including 2445 in the low-intensity group(INR 1.5-2.0)and 2322 in the standard-intensity group(INR 2.0-3.0).The results of the meta-analysis showed that the total embolic events,cerebral embolism,fatal hemorrhage incidence,cardiovascular-related mortality,and all-cause mortality between the two groups were not statistically different(total embolic events: OR=1.29,95%CI 0.94 ~1.77,P=0.11;Cerebral embolism: OR=1.06,95%CI 0.64~1.74,P=0.83;Fatal bleeding: OR=0.42,95%CI 0.17~1.04,P=0.06;Cardiovascular related mortality: OR=1.32,95%CI 0.85 ~ 2.04,P=0.22;all-cause mortality: OR=1.32,95%CI 0.95~1.82,P=0.10);but the incidence of major bleeding events in the low-intensity group was significantly lower Standard intensity group(OR=0.48,95%CI0.33~0.70,P=0.0002).Subgroup analysis showed that in the population ≥75 years old,there was no significant difference in the incidence of total embolic events and cerebral embolism between the two groups(total embolic events: OR=0.95,95%CI 0.59~1.54,P=0.85;Cerebral embolism OR=0.94,95%CI 0.51~1.72,P=0.84);Similarly,the incidence of major bleeding events in the low-intensity group was significantly lower than that in the standard-intensity group(OR=0.36,95%CI 0.19~0.65,P=0.0009).Among Chinese,there was no significant difference in the incidence of cerebral embolism between the two groups(OR=1.36,95%CI 0.72~2.56,P=0.34);the total incidence of embolism in the low-intensity group was significantly higher than that in the standard-intensity group(OR=1.77,95%CI 1.07~2.93,P=0.03);the incidence of major bleeding events in the low-intensity group was also significantly lower than that in the standard-intensity group(OR=0.18,95%CI 0.06~0.49,P=0.0009).【Conclusions】In the anticoagulation treatment of the elderly NVAF warfarin,the low-intensity group is comparable to the standard-intensity group in preventing ischemic stroke and systemic embolism,and the bleeding risk is significantly reduced.However,as far as the Chinese population is concerned,the total risk of embolism in the low-intensity group is higher than that in the standard anticoagulation intensity group,the risk of cerebral embolism events is equivalent,and the risk of low-intensity bleeding is lower than the standard anticoagulation intensity group.It is recommended that the INR of elderly patients with NVAF should be controlled at 1.5-2.0during warfarin anticoagulation. |
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