Lancet:血管内卒中治疗期间用阿司匹林和/普通肝素就是一场灾难!

2022-03-04 Nebula MedSci原创

血管内卒中治疗期间予以围手术期静脉用阿司匹林和普通肝素均会增加症状性颅内出血风险,而且对患者的功能性预后也毫无益处

目前临床上常采用阿司匹林和普通肝素进行血管内卒中治疗以改善再灌注和患者预后。但是,抗血栓药物对该适应症的影响和风险尚不清楚。因此,本研究旨在评估在缺血性卒中患者血管内治疗期间静脉注射阿司匹林和(或)普通肝素的安全性和有效性。

这是一项开放标签、多中心、随机对照的临床试验,采用2X3设计,招募了年满18岁的缺血性卒中患者,1:1随机分成两组,接受或不接受围手术期静滴阿司匹林(300 mg),然后再1:1:1随机分成三组,接受中等剂量普通肝素、低剂量普通肝素或不接受肝素治疗。主要终点是第90天时改良Rankin量表分数的变化。

研究流程

2018年1月22日至2021年1月27日,共有663位患者参与随机分组,其中628位 (95%) 被纳入改良意向治疗人群。2021年2月4日,在对数据进行揭盲和分析后,试验指导委员会永久停止了患者招募,并且出于安全考虑停止了试验。

安全性预后

接受阿司匹林干预的患者出现症状性颅内出血的风险高于未接受阿司匹林的患者(14% vs 7%;校正优势比[OR] 1.95),接受普通肝素干预的患者出现症状性颅内出血的风险也高于未接受普通肝素的患者(13% vs 7%;OR 1.98)。阿司匹林和普通肝素干预都会使改良Rankin量表分数向更差的方向变化,虽然无显著性。

90天时Rankin量表分数分布

综上所述,血管内卒中治疗期间予以围手术期静脉用阿司匹林和普通肝素均会增加症状性颅内出血风险,而且对患者的功能性预后也毫无益处

 

原始出处:

Wouter van der Steen, et al. Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial. The Lancet. February 28, 2022. https://doi.org/10.1016/S0140-6736(22)00014-9.

评论区 (4)
#插入话题
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    2022-09-06 howi

    #Lancet#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1831478, encodeId=b28218314e8f9, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Sep 06 15:14:17 CST 2022, time=2022-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200050, encodeId=197a120005080, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Sun Mar 06 21:56:13 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199801, encodeId=421911998017b, content=血管内卒中治疗期间,予以围手术期静脉用阿司匹林和普通肝素均会增加症状性颅内出血,而且对患者的预后毫无益处, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:05:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199510, encodeId=6ea5119951074, content=小僧不太懂 这篇文章证明卒中血管内治疗围手术期不能静滴抗板药,那应该?常规口服双抗颅内6个月,颅外3个月吗?请指点,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220304/445bde15dcf1414ebad3dceed557ffdd/a7edca31f34e46c3a2ff3e3c64c5e64e.jpg, createdBy=57756536134, createdName=ms6000000076046775, createdTime=Fri Mar 04 23:17:37 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
    2022-03-06 坚定的心

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1831478, encodeId=b28218314e8f9, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Sep 06 15:14:17 CST 2022, time=2022-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200050, encodeId=197a120005080, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Sun Mar 06 21:56:13 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199801, encodeId=421911998017b, content=血管内卒中治疗期间,予以围手术期静脉用阿司匹林和普通肝素均会增加症状性颅内出血,而且对患者的预后毫无益处, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:05:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199510, encodeId=6ea5119951074, content=小僧不太懂 这篇文章证明卒中血管内治疗围手术期不能静滴抗板药,那应该?常规口服双抗颅内6个月,颅外3个月吗?请指点,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220304/445bde15dcf1414ebad3dceed557ffdd/a7edca31f34e46c3a2ff3e3c64c5e64e.jpg, createdBy=57756536134, createdName=ms6000000076046775, createdTime=Fri Mar 04 23:17:37 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
    2022-03-06 ms1000002136354097

    血管内卒中治疗期间,予以围手术期静脉用阿司匹林和普通肝素均会增加症状性颅内出血,而且对患者的预后毫无益处

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1831478, encodeId=b28218314e8f9, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Sep 06 15:14:17 CST 2022, time=2022-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1200050, encodeId=197a120005080, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210302/d7aef29f1c284560b978861e2a96fbb2/c495254e3ce54350a8a4f1eb91e884c8.jpg, createdBy=15e55464744, createdName=坚定的心, createdTime=Sun Mar 06 21:56:13 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199801, encodeId=421911998017b, content=血管内卒中治疗期间,予以围手术期静脉用阿司匹林和普通肝素均会增加症状性颅内出血,而且对患者的预后毫无益处, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Sun Mar 06 02:05:58 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199510, encodeId=6ea5119951074, content=小僧不太懂 这篇文章证明卒中血管内治疗围手术期不能静滴抗板药,那应该?常规口服双抗颅内6个月,颅外3个月吗?请指点,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220304/445bde15dcf1414ebad3dceed557ffdd/a7edca31f34e46c3a2ff3e3c64c5e64e.jpg, createdBy=57756536134, createdName=ms6000000076046775, createdTime=Fri Mar 04 23:17:37 CST 2022, time=2022-03-04, status=1, ipAttribution=)]
    2022-03-04 ms6000000076046775

    小僧不太懂 这篇文章证明卒中血管内治疗围手术期不能静滴抗板药,那应该?常规口服双抗颅内6个月,颅外3个月吗?请指点,谢谢

    0

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