JAMA:意外!近期使用NOACs与rt-PA治疗的急性缺血性中风患者的颅内出血无关!

2022-03-03 MedSci原创 MedSci原创

在接受静脉阿替普酶治疗的急性缺血性卒中患者中,与不使用抗凝剂相比,在之前的7天内使用NOACs与颅内出血的风险明显增加无关。

目前的威廉亚洲博彩公司 建议对正在服用非维生素K拮抗剂的口服抗凝剂(NOACs)的急性缺血性卒中患者不使用静脉注射阿替普酶。

为了评价与未服用长期抗凝剂的患者相比,静脉注射阿替普酶在卒中前服用NOACs的患者中的安全性和功能结果。来自杜克大学医学中心神经病学的专家开展相关研究,结果发表在JAMA杂志上。

研究人员对163038名急性缺血性卒中患者进行回顾性队列研究,这些患者在2015年4月至2020年3月期间在1752家医院接受了静脉阿替普酶治疗,在卒中前服用NOACs或未服用抗凝剂。暴露因素为在阿替普酶治疗前7天内,用NOACs进行预中风治疗。主要结果是静脉注射阿替普酶后36小时内发生的有症状的颅内出血。有4个次要的安全结果,包括住院病人的死亡率,以及出院时评估的7个次要功能结果,包括出院回家病人的比例。

在163038名接受静脉阿替普酶治疗的患者中(中位年龄=70;49.1%为女性,2207人(1.4%)在中风前服用NOACs,160831人(98.6%)没有服用抗凝剂。服用NOACs的患者年龄较大(中位年龄,75[IQR,64-82]岁,而未服用抗凝剂的患者为70[IQR,58-81]岁),心血管合并症的发生率较高,且中风情况较严重(NIHSS=10[IQR,5-17] vs 7[IQR,4-14])。

总的来说,服用NOACs的患者未调整的症状性颅内出血率为3.7%(95%CI,2.9%-4.5%),而未服用抗凝剂的患者为3.2%(95%CI,3.1%-3.3%)。调整了基线临床因素后,各组之间的症状性颅内出血风险没有显著差异(OR=0.88[95%CI,0.70-1.10];风险差异[RD],-0.51%[95%CI,-1.36%至0.34%])。

同时,次要安全结果没有明显差异,包括住院病人死亡率(服用NOACs vs 未服药6.3%vs4.9%;OR=0.84[95%CI,0.69-1.01])。在次要功能结果中,7个中的4个在调整后显示出有利于NOAC组的显著差异,包括出院回家的患者比例(45.9% vs 53.6%;OR=1.17 [95% CI,1.06-1.29];RD=3.84% [95% CI,1.46%-6.22%])。

在接受静脉阿替普酶治疗的急性缺血性卒中患者中,与不使用抗凝剂相比,在之前的7天内使用NOACs与颅内出血的风险明显增加无关。

 

参考文献:

Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA. 2022;327(8):760–771. doi:10.1001/jama.2022.0948

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    2022-02-25 songbq
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createdName=songbq, createdTime=Fri Feb 25 19:25:11 CST 2022, time=2022-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1893487, encodeId=6540189348eac, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Tue May 10 09:25:11 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216901, encodeId=2c3a1216901da, content=很不错的研究发现,学习了,非常感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=311984902, createdName=maotouying, 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00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500621, encodeId=c8fc1500621e2, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507561, encodeId=bffa150e561c6, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=)]
    2022-05-04 maotouying

    很不错的研究发现,学习了,非常感谢

    0

  5. 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00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500621, encodeId=c8fc1500621e2, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507561, encodeId=bffa150e561c6, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], 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  6. 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00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500621, encodeId=c8fc1500621e2, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507561, encodeId=bffa150e561c6, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], 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    2022-03-04 ms9000001434185440

    学习

    0

  7. 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00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500621, encodeId=c8fc1500621e2, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507561, encodeId=bffa150e561c6, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], 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    2022-03-03 ms7000000457406546

    学到了

    0

  8. 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00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500621, encodeId=c8fc1500621e2, content=<a href='/topic/show?id=a1d3e93536b' target=_blank style='color:#2F92EE;'>#缺血性中风#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79353, encryptionId=a1d3e93536b, topicName=缺血性中风)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c54f9440276, createdName=hywen7329, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1507561, encodeId=bffa150e561c6, content=<a href='/topic/show?id=528b12904c3' target=_blank style='color:#2F92EE;'>#NOAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12904, encryptionId=528b12904c3, topicName=NOAC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=418f9911898, createdName=30397607, createdTime=Sat Feb 26 00:25:11 CST 2022, time=2022-02-26, status=1, ipAttribution=)]
    2022-02-26 yaanren
  9. 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  10. 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    2022-02-26 30397607

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