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时间到抗凝药逆转和脑内出血后的结果
Kevin N Sheth1, Nicole Solomon2, Brooke Alhanti2
1Yale Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut.
JAMA neurology
|February 9, 2024
概括
在脑内出血 (ICH) 患者的早期抗凝药逆转显著改善了生存率. 加快门到治疗 (DTT) 时间对于这种高死亡率中风亚型的更好的结果至关重要.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
背景情况:
- 脑内出血 (ICH) 是一种严重的中风类型,死亡率高,特别是在与抗凝血药物相关时.
- 与抗凝药相关的ICH由于出血风险和及时逆转策略的需要,提出了独特的挑战.
研究的目的:
- 为了确定门到治疗 (DTT) 时间是否会影响接受逆转治疗的抗凝血相关ICH患者的结果.
- 调查DTT与综合住院患者死亡率和住院出院之间的关联.
主要方法:
- 一个回顾性队列研究利用美国心脏协会获得与指南-中风注册 (2015-2021).
- 包括在465家美国医院出现症状后24小时内出现ICH的患者.
- 根据患者和医院的特征调整后勤回归建模来分析DTT和结果.
主要成果:
- 60分钟或更短的DTT与住院患者死亡率降低和退院相关 (aOR,0.82;95% CI,0.69-0.99).
- 在60分钟或更短的DTT (aOR,0.91;95% CI,0.67-1.24) 时,没有观察到功能性结果 (修改的兰金尺度得分0-3) 的显著差异.
- 与较短的DTT相关的因素包括白人种族,较高的缩血压和较低的中风严重程度.
结论:
- 在ICH患者中,较早的抗凝药逆转与改善的生存率有关.
- 这些发现强调了快速评估和治疗的重要性,以减少抗凝血相关的ICH中的死亡率.
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