关键词: 心房颤动, Meta分析, 抗凝药, 随机对照试验, 华法林, 阿哌沙班

Abstract: Background　Atrial fibrillation （AF） is one of the most common arrhythmias encountered clinically.Thrombosis is a common complication of AF.For a long time，warfarin was a first choice for anticoagulation in patients with AF.But adverse reactions of warfarin have been troubled clinicians and patients.At present，with the new anticoagulants generated，and their efficacies have been verified by large-scale clinical trials，this problem has been solved.But there is still lack of direct comparative studies of such anticoagulants.Objective　To evaluate the therapeutic effect of novel oral anticoagulants in patients with AF by network meta-analysis.Methods　Databases of PubMed，EMBase，the Cochrane Library，Web of Science，CBM，Wanfang Data，CNKI were searched for randomized controlled trials （RCTs） concerning novel oral anticoagulants in patients with AF from inception to July，2018.Quality assessment and data extraction from the included RCTs were performed.Statistical analyses of the incidence of embolization，intracranial hemorrhage，ischemic stroke，myocardial infarction，and gastrointestinal bleeding，and all-cause mortality were conducted with R 3.4.3 and Stata 14 software.Surface under the cumulative ranking （SUCAR） was used to rank the value of the treatments.Results　A total of 28 RCTs were included，involving 261 272 patients.The results of network meta-analysis showed that the incidence of embolic events associated with warfarin was higher than that caused by dabigatran（150 mg），rivaroxaban （20 mg），apixaban （10 mg），and edoxaban （60 mg） （P<0.05）．The incidence of intracranial hemorrhage related with warfarin was higher than that caused by dabigatran （110 mg），dabigatran（150 mg），rivaroxaban （20 mg），apixaban （10 mg），edoxaban （30 mg）and edoxaban （60 mg）（P<0.05）．Warfarin was associated with a higher incidence of ischemic stroke compared with dabigatran （150 mg） （P<0.05）．Other treatments，except for ximelagatran （36 mg） and rivaroxaban （15 mg），were associated with lower all-cause mortality compared with warfarin （P<0.05）．Warfarin was associated with a higher incidence of myocardial infarction compared with ximelagatran （36 mg） （P<0.05）．But it was associated with a lower incidence of gastrointestinal bleeding compared with rivaroxaban （20 mg） （P<0.05）．SUCAR values of all the interventions demonstrated that，dabigatran （150 mg） was associated with lower incidence of embolization and all-cause mortality；edoxaban（30 mg） was related to lower incidence of intracranial hemorrhage and gastrointestinal bleeding；ximelagatran （36 mg） was associated with lower incidence of ischemic stroke and myocardial infarction.Conclusion　Available evidence shows that apixaban （10 mg） may be a promising treatment.The overall quality of the included studies is high，and the analysis results have certain guiding significance.However，considering the unsatisfied quality of the included domestic studies，our results need to be verified by more high-quality domestic studies.

Key words: Atrial fibrillation, Meta-analysis, Anticoagulants, Randomized controlled trial, Warfarin, Apixaban