在患有大核心中风的患者中使用抗凝剂和内血管血栓切除术:SELECT2试验的二次分析
Deep K Pujara1, M Shazam Hussain2, Michael G Abraham3
1Department of Neurology, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Annals of neurology
|July 23, 2024
概括
内血管血栓切除术 (EVT) 可能不会改善服用口服抗凝剂 (OAC) 的中风患者的结果. 然而,OAC使用不应该自动排除患者从EVT,基于并发症和中风严重程度的个性化决定是关键.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 脑卒中医学 脑卒中医学
背景情况:
- 口服抗凝剂 (OAC) 通常用于患有中风风险因素的患者,如心房动.
- 血管内血栓切除术 (EVT) 对正在服用OAC的大型心脏病发作患者的安全性和有效性尚不清楚.
- 之前的研究还没有充分解决OAC用户的大型缺血性中风的EVT结果.
研究的目的:
- 评估内血管血栓切除术 (EVT) 与医疗管理 (MM) 相比,在接受口服抗凝剂 (OAC) 的大核心前部循环缺血性中风患者中对内血管血栓切除术 (EVT) 的安全性和有效性.
- 确定OAC使用是否会影响该患者群体中EVT的结果.
- 确定影响OAC用户接受EVT治疗决策的因素.
主要方法:
- 从SELECT2试验 (NCT03876457) 的数据分析,比较EVT与MM在大型心脏病发作患者中.
- 基于基线OAC使用 (维生素K对抗剂或直接OAC) 的患者分层.
- 对临床结果的评估,包括修改的兰金度表得分和出血率,并对并发症进行调整.
主要成果:
- 与MM相比,EVT在OAC组中没有显示出改善的临床结果 (aOR 0.89 [0.53-1.50]).
- 在非OAC患者中,EVT显示出明显更好的结果 (aOR 1.87 [1.45-2.40],p=0.02).
- 虽然在接受EVT的OAC患者中,任何出血的发生率更高 (86%),但在OAC患者中,在EVT或MM手臂中没有发生膜或症状性内出血.
结论:
- 单独使用口服抗凝剂不应成为大型核心缺血性中风患者内血管血栓切除术的排除标准.
- 考虑基线并发症和缺血性损伤程度的个性化治疗决策对于优化EVT结果至关重要.
- 可能需要进一步的研究来完善接受EVT的OAC用户的患者选择和管理策略.
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