JNNP:抗凝治疗缺血性卒中与急性心栓塞性卒中的早期复发:IAC研究

2021-05-06 MedSci原创 MedSci原创

心房颤动(AF)与缺血性中风风险增加相关,研究表明,口服抗凝治疗与缺血性中风风险降低相关。尽管抗凝治疗,AF患者的缺血性中风风险依然升高。据荟萃分析显示,华法林治疗缺血性中风的总风险为2%。重要的是,

心房颤动(AF)与缺血性中风风险增加相关,研究表明,口服抗凝治疗与缺血性中风风险降低相关。尽管抗凝治疗,AF患者的缺血性中风风险依然升高。据荟萃分析显示,华法林治疗缺血性中风的总风险为2%。重要的是,在既往中风或短暂性脑缺血发作的患者中,这种风险几乎增加了一倍。最近的研究比较了直接口服抗凝剂(DOAC)与华法林和阿司匹林,在接受DOAC治疗的患者中,缺血性中风/全身性栓塞的发生率每年高达1.5%。这项研究评估中风复发的短期风险,通过考虑心脏生物标志物以及竞争性大动脉粥样硬化中风机制。

抗凝治疗(IAC)研究的启动是一项多中心回顾性研究,汇集了2015年和2018年美国八个综合卒中中心治疗的房颤患者中连续出现急性缺血性卒中的缺血性卒中登记数据。为了本研究的目的,调研了所有在中风时有抗凝治疗状态信息的患者,以及在最初90天内存活并接受随访的患者。收集了家庭用药的数据,包括抗血小板、他汀类药物、华法林和DOAC的治疗。主要预测指标是卒中前抗凝(ACp)。

主要结果是复发性缺血事件和症状性颅内出血(sICH),所有结果由研究现场研究助理从病历中提取。临床变量包括:卒中危险因素(高血压史、糖尿病史、高脂血症史、既往卒中或短暂性脑缺血发作史、吸烟史)、CHA2DS2Vasc评分和NIHSS评分。超声心动图变量测量:超声心动图变量由缺血性中风后3个月内经胸超声心动图提取。在这项分析中,包括了左心室射血分数和左心房扩大由左心房直径或容积测量确定。院内治疗包括:静脉注射阿替普酶,机械性血栓切除术,肝素或低分子肝素(LMWH)桥接,开始或恢复抗凝治疗。将患者分为两组:中风指数前抗凝治疗组(ACp)和抗凝治疗组(ACn)。比较了两组患者的临床特征、住院治疗和90天的预后。为了确定ACp与再发性缺血事件之间的关系,在先前研究的基础上建立了一个预先确定的Cox回归模型。

Figure 1

Kaplan-Meier生存分析

2084例IAC患者中,1518例有抗凝史,患者随访90天。在校正Cox风险模型中,ACp仅在完全校正模型中与90天复发性缺血事件的高风险相关(95% CI 0.99至2.28,p=0.058),但不增加90天sICH的风险(95% 可信区间0.46至2.51,p=0.862)。此外,转换抗凝等级与减少再发性缺血事件的风险无关(95% CI 0.12至1.33,p=0.136)或sICH(95% 置信区间0.29至7.50,p=0.641)。

与抗凝治疗相比,抗凝治疗缺血性卒中的房颤患者复发卒中的风险更高,表明不同的潜在病理机制需要不同的中风预防措施,识别这些机制可能改善二级预防策略。

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  5. 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    2021-05-08 ms8000000228605912

    阅读

    0

  6. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20230630/45a9f4621df74074b590d70ac0520503/cb1d43f20bcc4383ad82ab451c44de67.jpg, createdBy=64465410190, createdName=linmougui, createdTime=Fri May 07 09:45:02 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963290, encodeId=73af9632903f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM73viaWoUZm0aibNfSHdP5mH9bkuna8vADwicUbqADOia9qTNNHoz601KrbUysAkJRKiaqJK7oge00Yang/0, createdBy=547d1604828, createdName=Breath jiang, createdTime=Fri May 07 06:44:23 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963281, encodeId=49a19632811f, content=好用, beContent=null, objectType=article, channel=null, level=null, 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    2021-05-07 linmougui

    学习了

    0

  7. 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createdAvatar=https://img.medsci.cn/20210224/ce0d4123440c4a7dbcb2e72458d6c283/7cc60f034a584c3dabbaa659278e106d.jpg, createdBy=82e45441201, createdName=ms7000001204488220, createdTime=Fri May 07 00:02:21 CST 2021, time=2021-05-07, status=1, ipAttribution=)]
    2021-05-07 Breath jiang

    学习啦

    0

  8. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20230630/45a9f4621df74074b590d70ac0520503/cb1d43f20bcc4383ad82ab451c44de67.jpg, createdBy=64465410190, createdName=linmougui, createdTime=Fri May 07 09:45:02 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963290, encodeId=73af9632903f, content=学习啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM73viaWoUZm0aibNfSHdP5mH9bkuna8vADwicUbqADOia9qTNNHoz601KrbUysAkJRKiaqJK7oge00Yang/0, createdBy=547d1604828, createdName=Breath jiang, createdTime=Fri May 07 06:44:23 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963281, encodeId=49a19632811f, content=好用, beContent=null, objectType=article, channel=null, level=null, 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    2021-05-07 ms9000001108301207

    好用

    0

  9. 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    2021-05-07 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

  10. 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createdAvatar=https://img.medsci.cn/20210224/ce0d4123440c4a7dbcb2e72458d6c283/7cc60f034a584c3dabbaa659278e106d.jpg, createdBy=82e45441201, createdName=ms7000001204488220, createdTime=Fri May 07 00:02:21 CST 2021, time=2021-05-07, status=1, ipAttribution=)]
    2021-05-07 ms7000001204488220

    学习了

    0

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