针对非心脏性缺血性中风的个性化抗血小板治疗
Yifan Zhang1, Moli Wang2, Shengyuan Su3
1Department of Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China; Department of Critical Care Medicine, Shenzhen Baoan People's Hospital, Shenzhen, China.
概括
使用血小板映射 (TEG-PM) 进行血小板结晶学测试的个性化抗血小板治疗显著降低了缺血性中风事件. 这种个性化的方法改善了患者的治疗结果,但没有增加出血风险.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 临床医学 临床医学
背景情况:
- 抗血小板治疗对于预防非心脏性缺血性中风中复发性缺血性事件至关重要.
- 目前的抗血小板策略可能对所有患者来说都不是最佳的,导致治疗水平低于最佳水平或增加出血风险.
- 用血小板映射 (TEG-PM) 进行血小板结晶造影提供了一种评估血小板功能和指导个性化治疗的方法.
研究的目的:
- 评估TEG-PM指导的个性化抗血小板治疗在非心脏性缺血性中风患者的临床有效性.
- 为了比较接受个性化治疗和接受标准护理的患者之间缺血和出血事件的发生率.
- 确定影响个性化抗血小板治疗结果的风险因素.
主要方法:
- 分析了1264名患有非心脏性缺血性中风的患者队列,其中684人接受了TEG-PM测试.
- 患者被分为一个个性化组 (n=487) 根据TEG-PM结果 (HRPR,LRPR,阿司匹林/克洛皮多格雷尔耐药性) 进行调整的抗血小板疗法,以及一组控制组 (n=197) 接受标准药物治疗.
- 治疗调整包括增加,减少或切换抗血小板药物.
主要成果:
- 与对照组 (12.6%,P = 0.001) 相比,个性化治疗组的缺血事件发生率显著降低 (5.54%).
- 两组之间没有观察到出血事件的显著差异.
- 考克斯回归确定了晚年 (HR, 1.043) 和冠心病 (HR, 1.902) 作为不良事件的显著风险因素.
结论:
- 以TEG-PM为指导的个性化抗血小板治疗有效降低非心脏性缺血性中风患者的缺血事件风险.
- 这种个性化的方法不会增加出血或死亡的风险.
- 高龄和冠状动脉心脏病需要在治疗中风患者的抗血小板治疗时仔细考虑.
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