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源不明的栓塞性中风中的直接口服抗凝剂:更新的元分析

Gabriel Marinheiro¹, Beatriz Araújo², André Rivera²

¹School of Medicine, Federal University of Ceará, Sobral, Ceará, Brazil. gabrielmarinheirosb@gmail.com.

Journal of thrombosis and thrombolysis

|July 30, 2024

概括

直接口服抗凝剂 (DOACs) 没有降低源不明的栓塞性中风 (ESUS) 患者的复发性中风风险. 与阿司匹林相比,DOACs增加了非重大出血风险,主要出血率相似.

科学领域:

神经学神经学
心脏病学心脏病学
药理学药理学是指药理学的学科.

背景情况:

源不明的栓塞性中风 (ESUS) 是一个治疗挑战.
直接口服抗凝剂 (DOAC) 在ESUS管理中的作用尚未确立.
现有的指导方针为ESUS中的抗凝药提供了有限的建议.

研究的目的:

在ESUS患者中,系统地评估DOAC与阿司匹林相比的疗效和安全性.
确定DOACs对复发性中风,全身血栓塞和死亡率的影响.
在这个患者群体中评估与DOAC相关的出血事件的风险.

主要方法:

在PubMed,Embase和Cochrane图书馆的系统文献搜索随机对照试验 (RCT).
在被诊断患有ESUS的患者中,包括将DOAC与阿司匹林进行比较的RCT.
使用风险比率 (RR) 和95%置信区间 (CI) 的二进制终点的元分析.

主要成果:

分析了4个涉及13,970名患者的RCT.
与阿司匹林相比,DOACs没有显著降低复发性中风的风险 (RR 0.95;95% CI 0.84-1.09) 或所有原因的死亡率 (RR 1.11;95% CI 0.87-1.42).
DOACs显著增加了临床相关的非重大出血 (CRNB) 的风险 (RR 1.52;95% CI 1.20-1.93),而重大出血的风险是相似的 (RR 1.57;95% CI 0.87-2.83).

结论:

与阿司匹林相比,在ESUS患者中,DOACs在预防复发性中风或降低死亡率方面没有显著的好处.
在ESUS中使用DOAC与临床相关的非重大出血的风险增加有关.
目前的证据表明,阿司匹林可能是一种更安全的替代品,用于预防ESUS患者的复发事件,具有相似的重大出血风险.

关键词:

密码性电脑中风是什么意思在 DOAC 系统中使用 DOAC.直接的口服抗凝剂直接的口服抗凝剂这就是 ESUSUS.进行元分析分析.一次性中风,中风.

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