Neurology:心房颤动和抗血栓形成药物相互作用对脑出血预后的影响

2019-10-11 xing.T MedSci原创

由此可见,AF和ICH患者的病死率增加。然而,调整抗栓治疗后,AF对死亡率没有单独的影响。相反,抗血栓预处理对无房颤的ICH患者结局具有有害影响,但对有房颤的ICH患者则无效应。

近日,神经病学领域权威取杂志Neurology上发表了一篇研究文章,研究人员旨在分析伴有和不伴房颤(AF)的原发性脑出血(ICH)患者之间临床差异,并评估房颤的存在是否可改善抗血栓预处理对结局的影响。

在这项前瞻性观察研究中,来自两家大学医院的研究人员招募了1106名连续就诊的ICH患者。研究人员对临床特征进行了描述,并根据有无房颤进行分层。考虑抗血栓预处理(无、抗血小板或口服抗凝剂)和房颤(是/否),研究人员分析了受试者住院和3个月的死亡率以及3个月的残疾情况。

在21.9%的原发性ICH病例中存在AF。AF-ICH患者年龄较大,血管危险因素更多,抗血栓形成预处理更多,临床严重程度更高,血肿量更大,住院和3个月死亡率更高。在AF-ICH患者中,不进行复诊的医嘱更为频繁。经过2种不同的调整模型后,AF-ICH患者的死亡率仍显著较高。但是,在模型中采用先前的抗血栓治疗后,与非AF病例相比,AF-ICH患者的3个月死亡率调整后的比值比为1.45(95%置信区间为0.74-2.85,p=0.284)。AF可改善抗血栓预处理对住院(P=0.077)和3个月死亡率(P=0.008)的影响。在无AF的患者中,抗血栓预处理可增加死亡率,但在AF-ICH患者中,未观察到此效应。

由此可见,AF和ICH患者的病死率增加。然而,调整抗栓治疗后,AF对死亡率没有单独的影响。相反,抗血栓预处理对无房颤的ICH患者结局具有有害影响,但对有房颤的ICH患者则无效应。 

原始出处:

Jaume Roquer,et al.Interaction of atrial fibrillation and antithrombotics on outcome in intracerebral hemorrhage.Neurology.2019.https://doi.org/10.1212/WNL.0000000000008462

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    2020-05-08 yinhl1978
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    2019-10-13 ylz8405
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    2019-10-13 gwc388
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    2019-10-13 sodoo

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