Efficacy And Safety Of New Oral Anticoagulants In Patients With Coronary Heart Disease And Atrial Fibrillation After PCI:A Meta Analysis

Background Coronary atherosclerotic heart disease(CHD)patients undergoing stent implantation need oral antiplatelet drugs antithrombotic treatment.Patients with atrial fibrillation(AF)need to use anticoagulant therapy of anticoagulant drugs when stroke risk factors for 1 or more.Coronary heart disease with atrial fibrillation patients after undergoing stent implantation,need a combination of antiplatelet and anticoagulant drugs.Warfarin(WF)as a line of anticoagulant drugs are widely used in clinical.With the clinical application of long time,its defects also gradually exposed.With the development of medicine,the new oral anticoagulant drugs(NOAC)has been gradually applied in clinical,but there is no definite evidence on its effectiveness and safety,need further clinical study to confirm.Objective To evaluate the efficacy and safety of new oral anticoagulants for patients with coronary heart disease and atrial fibrillation after percutaneous coronary intervention and to explore the different effects between the new oral anticoagulants and warfarin.Methods PubMed,Embase,Cochrane were systemically searched to collect related studies about efficacy and safety of NOAC in patients with coronary heart disease complicated with atrial fibrillation after PCI compared with warfarin.Meta-analysis was performed by RevMan5.2 software.Results There were 6 studies selected for Meta-analysis,including 3553 in the experimental group and 2170 in the control group.There was no significant difference in the risk of Stent thrombosis(OR=1.39,95%CI:0.80-2.41,P=0.24,I~2=0%),Myocardial infarction (OR=1.07,95%CI:0.78-1.46,P=0.69,I~2=28.1%),Stroke(OR=1.11,95%CI:0.70-1.76,P=0.66,I~2=0%),Death(OR=1.02,95%CI:0.76-1.36,P=0.91,I~2=0%);and there was significant difference in the risk of Major bleeding(OR=0.57,95%CI:0.45-0.71,P<0.00001,I~2=0%)between the experimental group and the control group.ConclusionIn patients with coronary heart disease and atrial fibrillation after PCI,NOAC had obvious advantage on reducing the risk of major bleeding in the combined use of anticoagulant and antiplatelet treatment when compared to WF.At the same time,not to increase the risk of Stent thrombosis,Myocardial infarction,Stroke,Death.Thus it can be seen,new oral anticoagulant drugs as warfarin in clinical curative effect,and have obvious advantages in security.