The Effectiveness And Safety Of Low-dose Rivaroxaban In Elderly Patients With Non-valvular Atrial Fibrillation In Asia:A Meta-analysis

Background:The incidence of atrial fibrillation increases with age.For patients with atrial fibrillation,age is an independent risk factor for thromboembolic events.Anticoagulation therapy is the main method to prevent thromboembolism in patients with atrial fibrillation.Therefore,the correct selection and rational use of anticoagulant drugs for older patients with atrial fibrillation is particularly important.As a new type of oral anticoagulant drug,rivaroxaban has more stable pharmacokinetic characteristics than the classic oral anticoagulant warfarin,does not require frequent monitoring of coagulation function,is convenient to use,and has high safety.At present,European and American guidelines recommend appropriate reductions in the use of rivaroxaban for some elderly patients with high bleeding risk.Whether the reduction standards are applicable to elderly people with non-valvular atrial fibrillation in Asia still needs more in-depth exploration and research.Objective:Using the method of systematic review and Meta analysis,low-dose(10mg)rivaroxaban was used for Asian elderly people with nonvalvular atrial fibrillation,and its effectiveness and safety were comprehensively evaluated,in order to provide evidence-based medical evidence for clinical decision-making.Methods:(1)Computer search of Chinese and English databases to obtain documents:Pub Med,Embase,Wanfang Knowledge Data Platform,VIP Database(VIP),CNKI,etc.The time limit for retrieval is from the establishment of the database to November 2020,and the collection of published documents at home and abroad A randomized controlled study on the safety and effectiveness of low-dose rivaroxaban used in anticoagulant therapy in Asian elderly people with non-valvular atrial fibrillation.(2)Two independent researchers conduct data extraction,and then conduct a bias risk assessment on the included studies after mutual verification.(3)Use Review Manager 5.3 software for statistical analysis.Results:The computer was retrieved with 937 references,final screening on 11literature into the study,they were all randomized controlled trials.The studies were conducted with a total of 759 patients aged over 60 with NVAF in Asia.The studies set low-dose oral rivaroxaban(10mg)as the intervention and oral warfarin as the control group,and regularly monitor INR values to adjust the dosage.I~2value was used to evaluate the statistical heterogeneity of the study.There was no statistical heterogeneity for embolization events and bleeding events.The fixed-effect model was used for analysis,and Meta-analysis results showed that:The incidence of embolic events in elderly patients with NVAF in Asia treated with low dose rivaroxaban was lower than that with warfarin(OR=0.36,95%CI(0.22,0.59),P<0.0001),and the incidence of bleeding events in elderly patients with NVAF treated with low dose rivaroxaban was lower than that with warfarin(OR=0.23,95%CI(0.15,0.36),P<0.00001).Conclusions:(1)Compared with traditional warfarin treatment,the use of low-dose rivaroxaban in elderly people with non-valvular atrial fibrillation in Asia can reduce the occurrence of thromboembolic events and reduce the occurrence of bleeding events,which has advantages in safety and effectiveness;(2)However,due to the limited number of inductive studies,more high-quality clinical studies and real-world applications are needed to verify this result.