JAHA:卵圆孔未闭所致隐源性卒中的封堵、抗凝或抗血小板治疗

2018-06-21 xiangting MedSci原创

PFO封堵在预防隐源性卒中后卒中复发方面优于抗血栓治疗。

研究人员进行了一项系统回顾和meta分析,纳入比较PFO封堵、抗凝和抗血小板疗法预防卵圆孔未闭(PFO)相关隐源性卒中患者卒中复发的随机对照试验(RCT)。

研究人员检索了Medline、Cochrane图书馆和EMBASE在2018年3月前发表的研究。主要结局是卒中复发。在随机效应meta分析中计算汇总发病率、危险比和风险比(RRs)。

与抗血栓治疗(抗血小板治疗或抗凝治疗:6项RCTs共3560例患者; RR=0.36,95%CI:0.17-0.79; I2=59%)相比,PFO封堵与卒中复发的风险降低相关。与没有下述这些解剖特征的患者相比(RR=0.80,95%CI 0.43-1.47; I2=12%),PFO封堵对卒中复发的影响在房间隔动脉瘤或大分流患者中更为明显(RR=0.27,95%CI,0.11-0.70;I2=42%),主要并发症发生率为2.40%(95%CI,1.03-4.25; I2=77%)。随机接受PFO封堵的患者比抗血栓治疗患者的新发心房颤动更频繁(RR = 4.33,95%CI,2.37-7.89; I2=14%)。1项RCTs比较了PFO封堵与抗凝治疗(353例患者,危险比=0.14,95%CI,0.00-1.45),2项RCTs比较了PFO封堵与抗血小板治疗(1137例患者;危险比=0.18,95%CI,0.05-0.63;I2=12%)。3项RCTs比较了抗凝治疗和抗血小板治疗,均没有显著差异。

PFO封堵在预防隐源性卒中后卒中复发方面优于抗血栓治疗。年度卒中的绝对风险减低较少,但在年轻和中年患者中有相当长的时间对风险进行调整(至少5年)。PFO封堵与房颤风险升高相关。

原始出处:

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    2021-10-24 452946589

    卒中的研究采纳的因素是取决于医生的,患者的依从性研究的纳入值得考虑

    0

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    2018-06-23 zhaohui6731
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    2018-06-21 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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    2018-06-21 大爰

    学习了谢谢分享!!

    0

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    2018-06-21 龙胆草

    学习谢谢分享

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