抗凝患者血管内卒中治疗与颅内出血的风险
2020年02月10日 【健康号】 刘建仁     阅读 7786

脑卒中,脑梗死,脑中风,血管内治疗,介入治疗,取栓,抗凝,华法林,DOACS, 新型口服抗凝药,口服的直接凝血酶抗凝剂,刘建仁,神经内科

Endovascular Stroke Treatment and Risk of Intracranial Hemorrhage in Anticoagulated Patients.

Meinel TR,et al  Stroke             2020  Jan 29MORE            


Abstract           翻译      


背景与目的-我们旨在确定接受维生素K拮抗剂(VKA)或直接口服抗凝剂(DOAC)的患者在机械血栓切除术后的安全性和死亡率。方法-在一项多中心观察性队列研究中,我们采用多因素Logistic回归分析评估了在进行血栓切除术前症状性颅内出血(sICH)与VKA或DOAC处方之间的相关性,而未进行抗凝治疗。主要结局是90天内sICH的发生率和全因死亡率,并纳入了有关已确认的治疗性抗凝药的敏感性分析。此外,我们对该主题的文献进行了系统的回顾和荟萃分析。结果-共纳入1932例患者(VKA,n = 222; DOAC,n = 98;无抗凝治疗,n = 1612);中位年龄为74岁(四分位间距为62-82);妇女占49.6%。与对照组相比,VKA处方与sICH和死亡率的机率增加有关(校正后的机率[aOR],2.55 [95%CI,1.35-4.84]和1.64 [95%CI,1.09-2.47]),而没有观察到与DOAC摄入量相关(aOR为0.98 [95%CI,0.29-3.35]和1.35 [95%CI,0.72-2.53])。仅考虑确诊抗凝治疗范围内的患者的敏感性分析并没有改变发现。研究水平的荟萃分析纳入了来自15个观察性队列的7462名患者(855个VKA,318个DOAC和6289个对照)的数据,证实了这些观察结果,从而使VKA患者的sICH发生率增加(aOR,1.62 [95%CI,1.22 -2.17]),但不适用于DOAC患者(aOR为1.03 [95%CI,0.60-1.80])。结论-接受VKA的患者在机械血栓切除术后有sICH风险和死亡率增加。在急性环境中,与DOAC相关的sICH的较低风险也很明显。在接受VKA治疗的患者中,建议改善选择。注册网址:https://www.clinicaltrials.gov。唯一标识符:NCT03496064。系统评价和荟萃分析:CRD42019127464。

以上为中文翻译

Background and Purpose- We aimed to determine the safety and mortality after mechanical thrombectomy in patients taking vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Methods- In a multicenter observational cohort study, we used multiple logistic regression analysis to evaluate associations of symptomatic intracranial hemorrhage (sICH) with VKA or DOAC prescription before thrombectomy as compared with no anticoagulation. The primary outcomes were the rate of sICH and all-cause mortality at 90 days, incorporating sensitivity analysis regarding confirmed therapeutic anticoagulation. Additionally, we performed a systematic review and meta-analysis of literature on this topic. Results- Altogether, 1932 patients were included (VKA, n=222; DOAC, n=98; no anticoagulation, n=1612); median age, 74 years (interquartile range, 62-82); 49.6% women. VKA prescription was associated with increased odds for sICH and mortality (adjusted odds ratio [aOR], 2.55 [95% CI, 1.35-4.84] and 1.64 [95% CI, 1.09-2.47]) as compared with the control group, whereas no association with DOAC intake was observed (aOR, 0.98 [95% CI, 0.29-3.35] and 1.35 [95% CI, 0.72-2.53]). Sensitivity analyses considering only patients within the confirmed therapeutic anticoagulation range did not alter the findings. A study-level meta-analysis incorporating data from 7462 patients (855 VKAs, 318 DOACs, and 6289 controls) from 15 observational cohorts corroborated these observations, yielding an increased rate of sICH in VKA patients (aOR, 1.62 [95% CI, 1.22-2.17]) but not in DOAC patients (aOR, 1.03 [95% CI, 0.60-1.80]). Conclusions- Patients taking VKA have an increased risk of sICH and mortality after mechanical thrombectomy. The lower risk of sICH associated with DOAC may also be noticeable in the acute setting. Improved selection might be advisable in VKA-treated patients. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064. Systematic Review and Meta-Analysis: CRD42019127464.


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