在与直接口服抗凝剂相关的ICH中,前素复合缩与保守管理相比,直接口服抗凝剂
Bonaventure Ip1,2, Sangqi Pan1, Zhong Yuan3
1Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR.
JAMA network open
|February 6, 2024
概括
血复合缩剂 (PCC) 没有改善直接口服抗凝剂 (DOAC) 相关的脑内出血 (ICH) 患者的结局. 这项研究发现,与保守管理相比,功能恢复,死亡率或血液瘤扩张没有显著差异.
科学领域:
- 神经学 神经学
- 血液学 血液学 血液学
- 临床药理学 临床药理学
背景情况:
- 与直接口服抗凝剂 (DOAC) 相关的脑内出血 (ICH) 是一个重大的临床挑战,患病率和死亡率高.
- 血液静止疗法,如前列血复合物缩剂 (PCC) 的有效性,在管理DOAC相关的ICH方面仍然不确定.
研究的目的:
- 为了比较与PCC治疗的DOAC相关的ICH与保守管理的临床和放射性结果.
- 评估PCC在改善功能状态,降低死亡率和限制血瘤扩张方面的有效性.
主要方法:
- 进行了一项以人口为基础的,倾向分数加权的回顾性队列研究.
- 分析了2016年至2021年间在香港患有DOAC相关的ICH患者.
- 接受PCC (25-50 IU/kg) 的患者的结局与没有接受血静剂的患者进行了比较.
主要成果:
- 总共有232名患者被纳入;102人接受PCC,116人接受保守治疗.
- PCC与改善的神经恢复 (aOR,0.62;P=.14),90天死亡率 (aOR,1.03;P=.88),住院死亡率 (aOR,1.11;P=.66) 或减少血瘤扩张 (aOR,0.94;P=.90) 没有关联.
- 较高的基线血瘤体积,较低的格拉斯哥昏迷尺度和心室内出血与较差的神经结果有关.
结论:
- 在这组中国患者中,与DOAC相关的ICH的特征是大量的血瘤以及高死亡率和功能残疾.
- PCC治疗在改善功能结果,减少血瘤扩张或降低死亡率方面没有显著的益处.
- 对新型血液静止剂和先进的神经外科/医学疗法的进一步研究是有必要的,以优化与DOAC相关的ICH的管理.
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