Thrombolysis Rate And Safety Evaluation Of Left Atrial/left Atrial Appendage Thrombosis Anticoagulation Therapy In Patients With Nonvalvular Atrial Fibrillation

Objective:Non-valvular atrial fibrillation(NVAF),which causes the formation of atrial thrombus,especially in the left atrium/left atrial appendage,is currently treated mostly with anticoagulant drugs,however,the efficacy and safety of these drugs need to be verified by further studies.To investigate the efficacy and safety of left atrial appendage thrombotic anticoagulants in cases of valvular atrial fibrillation,and to evaluate them using systematic reviews and meta-analyses.Methods:We used computers to search Pub Med,Clinical Trials database,CNKI,Wan Fang Data,and VIP databases from January 2000 to January 2023,the literature on anticoagulation therapy in patients with nonvalvular atrial fibrillation and left atrioventricular/left atrial appendage thrombosis was recorded,and the thrombolysis rate of antithrombotic therapy in patients with nonvalvular atrial fibrillation combined with left atrioventricular/left atrial appendage thrombosis was calculated,and subgroup analysis was carried out to evaluate its safety.Results:According to the inclusion criteria,16 studies were included,and 1123 patients with nonvalvular atrial fibrillation with LAT/LAAT were included in the study,with a thrombolysis rate of 66.4%(95% CI: 60% to 73%)after anticoagulation;Subgroup analysis according to the type of oral anticoagulant showed that the thrombolytic rate was 64.3%(95% CI: 60.9% to 67.7%)with warfarin,70.2%(95% CI: 60.9% to 79.5%)with newer oral anticoagulants,70.3%(95% CI: 59.8% to 80.8%)with rivaroxaban and69.0%(95% CI)with dabigatran cilexetil CI:50.4%-87.7%);Subgroup analysis according to follow-up time showed a thrombolysis rate of 57.0%(95% CI: 44.2% to69.9%)at 2 months,65.6%(95% CI: 48.2% to 82.9%)at 3 months,72.8%(95% CI:70.1% to 75.6%)at 4 months,and 73.2%(95% CI: 68.0%-78.3%);For the analysis of different types of atrial fibrillation,the thrombolysis rate of patients with paroxysmal atrial fibrillation and LAT/LAAT was 60.6%(95% CI: 32.4%-88.9%),and the thrombolysis rate of patients with persistent atrial fibrillation combined with LAT/LAAT was 57.8%(95% CI: 41.2%-74.3%).Subgroup analysis according to patient sex showed thrombolysis rates of 57.8%(95% CI: 37.5% to 78.1%)in men and 51.4%(95% CI:39.5% to 63.3%)in women.For the safety of anticoagulation in patients with atrial fibrillation and LAT/LAAT,the results of the analysis were as follows: the incidence of stroke and systemic embolic events caused by anticoagulation was 2.5%(95% CI: 2.5%to 2.5%);The incidence of bleeding events was 5%(95% CI: 5% to 5%),and no major embolism,bleeding events,or deaths were reported in the included literature.Conclusion:Anticoagulation is effective in patients with nonvalvular atrial fibrillation and left atrioventricular/left atrial appendage thrombosis,and newer oral anticoagulants have advantages over warfarin in antithrombotic therapy,but the occurrence and evaluation of stroke,systemic embolic events,and bleeding events cannot be ignored in the process of treatment.