| Objective:It is well known that stroke have become one of the largest causes of the most main reason of middle-aged and old people to death and disability in today's society,of which two-thirds are ischemic,a quarter of the ischemic stroke types are cardiogenic,back to the cardiac cerebral infarction etiology and nonvalvular atrial fibrillation?NVAF?occupy the important position.NVAF not only increases the risk of ischemic stroke by as much as five times,but also causes systemic vascular system embolization,leading to increased morbidity and mortality,which leads to increased medical costs[1].Therefore,the use of assessment tool system to assess stroke risk in patients with NVAF and appropriate intervention based on the assessment results are effective measures for stroke prevention.At present,the methods to prevent stroke recurrence in patients with NVAF mainly include oral anticoagulation?OAC?,electrocoagulation and surgical treatment.Oral anticoagulant drugs including classic vitamin K antagonists warfarin and not a vitamin K antagonist anticoagulants?non-vitamin K antagonist oral anticoagulant NOAC?,and oral anticoagulant drugs has been shown to reduce 64%of the risk of stroke patients with nonvalvular atrial fibrillation[2].Warfarin as a standard of oral anticoagulant therapy has dozens of years of history,the current specification confirmed that most patients using China forests to achieve significant curative effect,because of its existence and the interaction between a variety of food and drugs,in the narrow therapeutic window and require constant monitoring and dose adjustment,which can lead to poor patient compliance,and even increase the risk of bleeding in patients with poor and anticoagulation risk;NOAC does not need to monitor clotting routine and has better compliance.In recent years,it has gradually replaced warfarin in stroke prevention in NVAF patients.Some patients have long-term anticoagulant contraindications or potential interference,and even refuse to follow the long-term anticoagulant treatment regimen,making surgical treatment an option.Common surgical methods for atrial fibrillation patients include radiofrequency ablation and left atrial age occlusion?LAAO?.The high recurrence rate after radiofrequency ablation makes left atrial appendage closure an option for stroke prevention in patients with NVAF[3].This study investigated the efficacy and safety of LAAO and OACs in stroke prevention in patients with NVAF through meta-analysis,in order to provide a better basis for the selection of individualized stroke prevention measures in NVAF patients.Methods:An electronic database by computer retrieval in English and Chinese,English database including the Cochrane,Pubmed,Medline,Embase,Web of Science,a limited search word for"left atrial appendage occlusion","oral anticoagulation","Nonvalvular atrial fibrillation"and"stroke"and its synonym,including VIP Chinese database,ten thousand party,CNKI,Limited search word for"left auricle closure","oral anticoagulation","nonvalvular atrial fibrillation"and"stroke"and its synonym,according to the limit of retrieval word retrieval from built libraries to December 2019 in both English and Chinese published about left on closure and oral anticoagulants therapy in patients with nonvalvular case-control studies,formulate strict and exclusion criteria,for screening out,will be completed screening according to the clinical research of literature types,respectively the Cochrane scale and NOS scale was used to evaluate the quality of the screened literatures according to the types of clinical studies.Relevant data of the literature were presented in tables and analyzed by ReMan5.3 statistical software.In order to quantify the heterogeneity among included studies,the value of I2was used to reflect it.When the heterogeneity is less than 50%,it is considered that the heterogeneity among studies is small;otherwise,it represents the heterogeneity among studies.When the heterogeneity was small,the fixed effect model?FE?was used for the meta-analysis of LAAO and OAC.When there was significant heterogeneity,a random effect model?RE?was used in the meta-analysis between LAAO and OAC,allowing variation between studies.When heterogeneity exists,potential sources of heterogeneity should be examined by subgroup analysis and sensitivity analysis.The sensitivity analysis method is by excluding literature contrast one by one if I2and P values change,the impact on the overall risk to test single study,statistical values are expressed in the OR?95%CI?,P<0.05 is considered to have statistical significance,and then evaluate left auricle closure and the oral anticoagulant drugs for NVAF the efficacy and safety of prevention of stroke patients,at the same time,application of funnel figure to assess whether there is publication bias.Results:A total of 7 literatures were included in this paper,with a sample size of 1874patients,including 1114 patients with left atrial appendage occlusion and 760patients with oral anticoagulant.In terms of effectiveness,statistical analysis was performed in three aspects:ischemic stroke,peripheral vascular embolism and cardiovascular events.The comparison of the results of ischemic stroke events showed that:I=0%,OR=1.22,95%CI?0.71,2.11?,P=0.47.The results showed that there was no significant difference between LAAO and OAC in the incidence of ischemic stroke events in NVAF.The results of peripheral vascular embolism events showed that:I=0%,OR=1.21,95%CI?0.63,2.29?,P=0.57.The results showed that there was no significant difference between LAAO and OAC in the occurrence of peripheral vascular embolism events in NVAF patients.The results of cardiovascular events showed that:I=35%,OR=0.52,95%CI?0.30,0.89?,P=0.02<0.05.The results showed that there was a difference in cardiovascular events between LAAO and OAC in NVAF patients,and the OR value was less than 1,indicating that the OAC group was more likely to have cardiovascular events.In terms of safety,the results of intracranial heterogeneity events showed that:I=53%>50%,OR=0.75,95%CI?0.20,2.80?,P=0.67.The results showed that there was no significant difference in intracranial heterogeneity events between LAAO and OAC.The results of the comparison of total bleeding events showed that:I=0%,OR=0.46,95%CI?0.32,0.66?,P<0.0001.The results showed that there was a statistical difference in total bleeding events between LAAO and OAC treated NVAF patients,and the incidence of total bleeding events in OAC group was higher than that in LAAO group.Conclusion:1.LAAO and OAC are equally effective in preventing ischemic stroke and peripheral vascular embolism in NVAF patients;2.Compared with OAC group,LAAO can reduce the occurrence of cardiovascular events in NVAF patients.3.LAAO and OAC did not increase the occurrence of intracranial hemorrhage in the preventive treatment of embolization events in NVAF patients,and the safety was similar.4.In the preventive treatment of embolization events in NVAF patients,the overall incidence of bleeding events in the LAAO group was lower than that in the OAC group,and the safety was better. |
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