【摘要】 目的：对于经皮左心耳封堵术后的患者，指南推荐进行短期口服抗凝治疗，但许多患者由于有抗凝禁忌而接受抗血小板治疗。本研究旨在比较经皮左心耳封堵术后短期口服抗凝治疗与抗血小板治疗的有效性和安全性。方法：检索PubMed、Embase、Cochrane Library、中国知网数据库中2002年1月至2021年11月以经皮左心耳封堵术后接受短期口服抗凝治疗或抗血小板治疗的患者为研究对象及以器械相关血栓、脑卒中、大出血为研究终点的研究。分别采用Jadad评分量表和纽卡斯尔-渥太华量表（NOS）对纳入的随机对照研究和观察性研究进行质量评价。采用RevMan 5.3软件进行Meta分析。结果：最终纳入15项研究，其中随机对照研究1项，观察性研究14项（包括10项前瞻性队列研究和4项回顾性研究）；共纳入5 500例患者，其中3 215例接受抗血小板治疗，2 285例接受口服抗凝治疗。Meta分析结果显示：经皮左心耳封堵术后短期抗血小板治疗和口服抗凝治疗在器械相关血栓（OR=1.34,95%CI:0.91～1.97,P=0.14）、脑卒中（OR=1.27,95%CI:0.75～2.16,P=0.36）、大出血（OR=1.26,95%CI:0.92～1.74,P=0.15）发生风险方面的差异均无统计学意义。排除接受单联抗血小板治疗的患者后，双联抗血小板治疗与口服抗凝治疗在上述终点事件发生风险方面的差异也均无统计学意义（P均>0.05）。结论：在经皮左心耳封堵术后接受短期口服抗凝治疗和抗血小板治疗的患者中，器械相关血栓、脑卒中、大出血发生风险均相似。更多还原

【Abstract】 Objectives: Short-term oral anticoagulation(OAC) is recommended for patients following left atrial appendage closure(LAAC). However, many patients received antiplatelet therapy(APT) rather than OAC because of excessive bleeding risk. This meta-analysis was conducted to evaluate the efficacy and safety in patients treated with short-term OAC or APT following LAAC.Methods: The related literature was searched from PubMed, Embase, Cochrane Library and CNKI for studies comparing OAC with APT following LAAC published between January 2002 to November 2021. The outcomes of interest were devicerelated thrombosis(DRT), all-cause stroke and major bleeding. The quality of the included studies was evaluated with Newcastle-Ottawa Scale(NOS) or Jadad scale. RevMan 5.3 software was used for the meta-analysis.Results: A total of 15 studies including 1 randomized controlled trial and 14 observational studies(10 prospective cohort and 4 retrospective comparative designs) with 5 500 patients(APT, n=3 215; OAC, n=2 285) were included. There were no significant differences between the APT and OAC groups with regard to DRT(OR=1.34, 95% CI: 0.91-1.97, P=0.14), stroke(OR=1.27, 95% CI: 0.75-2.16, P=0.36)and major bleeding(OR=1.26, 95% CI: 0.92-1.74, P=0.15). These findings persisted in secondary analysis excluding patients who were treated with single APT(all P>0.05).Conclusions: There are no differences in the incidence of DRT, stroke and major bleeding in patients treated with shortterm APT compared with those who received short-term OAC following LAAC.更多还原