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术前血小板功能测试对与管道流量转移相关的术外并发症率的影响:一项国际多中心研究
Justin E Vranic1, Adam A Dmytriw1,2, Inka K Berglar1
1Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA.
Neurosurgery
|April 18, 2024
概括
在管道栓塞装置 (PED) 治疗内动脉瘤之前进行血小板功能测试 (PFT) 并没有显著减少血栓栓塞并发症. 在接受双抗血小板治疗 (DAPT) 的患者中,常规PFT可能不需要.
科学领域:
- 神经内血管外科手术是一种神经内血管手术.
- 干预性神经放射学 干预性神经放射学
- 心血管医学 心血管医学
背景情况:
- 双抗血小板疗法 (DAPT) 对于在内动脉瘤管道栓塞装置 (PED) 程序期间最大限度地减少并发症至关重要.
- 血小板功能测试 (PFT) 用于指导DAPT疗法,但其对PED并发症的影响尚不清楚.
研究的目的:
- 评估手术前PFT在减少经过PED流转的患者周边手术血栓栓塞并发症的有效性.
- 为了比较接受PFT和不接受PFT的患者之间的并发症率.
主要方法:
- 来自13个中心的580名患者的回顾性分析,这些患者在未破裂的内动脉瘤中接受PED栓塞治疗.
- 在PFT组 (n=262) 和非PFT组 (n=318) 之间的血栓栓塞和出血并发症率的比较.
- 使用威尔科克森等级和,费舍尔精确或奇平方测试进行统计分析.
主要成果:
- 血栓塞栓并发症发生在PFT组的5%与非PFT组的1.6% (P=.019) 之间.
- 在PFT组的13.7%中发现了克洛皮多格雷尔无反应患者,需要改变DAPT治疗方案.
- 在PFT组患者中,患有并发症的永久神经障碍较少 (15.4%vs. 80%). 血并发症在各组之间是相似的.
结论:
- 在接受PED治疗的阿司匹林和克洛皮多格雷尔DAPT患者中,可能不需要程序前PFT来显著减少与程序相关的内并发症.
- 这项研究表明,目前的PFT协议可能对预防这种患者群体的并发症没有显著的益处.
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