在急性脑性缺血症中,在强化治疗与指导方针抗血小板治疗期间出现出血
Lisa J Woodhouse1, Jason P Appleton1,2, Hanne Christensen3
1Stroke Trials Unit, Mental Health and Clinical Neuroscience, School of Medicine, South Block D Floor, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
Scientific reports
|July 20, 2023
概括
强化抗血小板治疗增加了缺血性中风后的出血风险,但没有减少复发事件. 出血的严重程度与更糟糕的结果相关,强调需要仔细选择和监测患者.
科学领域:
- 神经学 神经学
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 强化抗血小板治疗 (阿司匹林,克洛皮多格雷尔,二皮里达摩尔) 与二次中风预防的指导疗法进行了比较.
- 在缺血性中风后减少依赖的三重抗血小板药物 (TARDIS) 试验中研究了疗效和安全性.
- 出血风险及其与结果的关联是关键问题.
研究的目的:
- 确定在中风后接受强化治疗与指导方针抗血小板治疗的患者中出血的预测因素.
- 评估出血严重程度与临床结果之间的关联.
- 分析与治疗组相关的出血事件时间.
主要方法:
- 国际前性随机开放标签盲目的终点试验 (TARDIS).
- 3,096名参与者在48小时内患有缺血性中风或TIA,随机分为30天的密集或指导性抗血小板治疗.
- 使用ISTH尺度评估出血 (致命,主要,中度,轻微,没有).
主要成果:
- 与指导治疗相比,强化治疗显著增加了重大/致命出血 (aHR 2.21; p=0.007).
- 血流事件在中风后8-35天达到顶峰.
- 增加出血的预测因素包括年龄较大,女性性别,病前依赖,延迟随机化,先前出血/治疗和密集治疗.
结论:
- 密集的抗血小板治疗增加了出血风险,但没有改善TARDIS试验中的复发性中风/TIA预防.
- 更严重的出血事件与更糟糕的身体,情绪和生活质量结果有关.
- 患者因素和治疗强度影响出血风险,需要个性化治疗方法.
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