| background: Atrial fibrillation(AF)is the most common persistent arrhythmia associated with significant morbidity and high risk of ischemic stroke.Warfarin is the most widely used anticoction of atrial fibrillation,but its pharmacokinetic characteristics and the complexity of clinical medication,seriously affect its use,and also reduces the patient’s compliance.new oral anticoagulants(NOACs)such as direct thrombin inhibitors(dabigatran etexilate,DE),direct Xa factor inhibitors(rivaroxaban,apixaban and edarabine)have the features of stable efficacy,high safety and easy to use.However,new anticoagulants are only evaluated in limitednonvalvular atrial fibrillationpatients,some clinical issues are not yet clear,clinical evidence is insufficient,and its expensive,lack of effective antagonists.Studies have shown that aspirin combined with[ traditional Chinese medicine(Xin Xin Tong,Tong Xinluo),clopidogrel or dipyridamole ]can also be used for atrial fibrillation antithrombotic therapy,but the prevention effectof atrial fibrillation thrombosis and bleeding risk is not yet clear.Objective: In this paper,the efficacy and safety of aspirin combination therapy and new oral anticoagulants versus warfarin in atrial fibrillation were Systematic reviewed meta-analyzed to guide atrial fibrillation patients Different needs to choose the optimal antithrombotic regimen.method: Randomized controlled trials of the new oral anticoagulants for atrial fibrillation was performed by retrieving Wanfang,Vip,CNKI,PUBMED,OVID and COCHRANE libraries,as well as aspirin combined with traditional Chinese medicine(Naoxintong,Tongxinluo),clopidogrel or dipyridamole treatment for atrial fibrillation in randomized controlled trials and non-randomized controlled trials,with the control group of adjusted-dose warfarin(INR 2.0~3.0).The Heterogeneity analysis,RR as a combined effect,the funnel map evaluating published bias assessment and sensitivity analysis were carried on.Results: A total of 15 articles were included in the study,including 7 studies on new oral anticoagulants,3 studies on aspirin combined with traditional Chinese medicine,3 studies on aspirin and clopidogrel,2 studies on aspirin combined with dipyridamole.Results of the Meta-analysis and Systematic review: NOACs compared with warfarin,significantly reduced the incidence of stroke and all-cause mortality in NVAF patients,the difference was statistically significant [(RR = 0.86,95% CI(RR = 0.90,95% CI(0.86,0.94),p <0.00001)],different NOAC and treatment dose plays particular advantages and disadvantages;and also reduce their severe bleeding,micro bleeding,intracranial hemorrhage events[(RR=0.83,95%CI(0.72,0.97),p=0.02);(RR=0.83,95%CI(0.77,0.89),p<0.00001);(RR=0.41,95%CI(0.33,0.52),p<0.00001)].Aspirin plus traditional Chinese medicines were inferior to warfarin in the prevention of ischemic stroke in NVAF patients(RR=2.19,95%CI(1.26,3.80),p=0.005),but with better safety,significantly reduced the incidence of bleeding in NVAF patients(RR = 0.30,95% CI(011,0.78),p = 0.01).Aspirin plus clopidogrel was inferior to warfarin both in the prevention of ischemic strokethe and systemic embolization[(RR=2.25,95%CI(1.60,3.16),p<0.00001);(RR=4.36,95%CI(1.80,10.60),p=0.001)],and with higher incidence of bleeding events(RR=1.15,95%CI(1.04,1.28),p=0.006),but the safety was still controversial betweet studies home and abroad.Aspirin plus dipyridamole compared with warfarin,was superior in safaty and inferior in efficacy,but both the difference were not statistically significant,and the studies included were all domestic small sample test.Conclusion: In nonvalvular atrial fibrillation anticoagulant therapy 1.The effectiveness and safety of new oral anticoagulant therapy are superior to warfarin;2.Aspirin combined with traditional Chinese medicine treatment is not as effective as warfarin,but the safety is better.3.Aspirin combined with dipyridamole is similar to warfarin;4.Aspirin combined with clopidogrel treatment efficacy and safety are not as good as warfarin. |
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