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在接受口服抗凝药的患者中,急性缺血性中风的IV血栓溶解与未知发病
Kosmas Macha, Jochen A Sembill1, Iris Muehlen2
1Department of Neurology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Cerebrovascular diseases (Basel, Switzerland)
|August 25, 2024
概括
内静脉血栓溶解 (IVT) 对于缺血性中风,在接受口服抗凝药的选定患者中是安全的,包括直接口服抗凝药 (DOAC) 和维生素K对抗剂 (VKA),即使发病时间不明.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
背景情况:
- 内静脉血栓溶解 (IVT) 是急性缺血性中风的标准治疗方法,特别是在延长或未知的时间窗口中,通常由多式成像指导.
- 证据支持IVT在服用口服抗凝剂的患者,包括直接口服抗凝剂 (DOACs).
- 然而,对于服用口服抗凝固药并未知发病时间的缺血性中风患者的IVT数据有限.
研究的目的:
- 为了评估IVT在缺血性中风患者的安全性和有效性,这些患者接受口服抗凝药,中风发病时间不明.
- 为了比较口服抗凝剂患者与不服用抗凝剂患者的内出血 (ICH) 发生率.
主要方法:
- 一项纵向队列研究 (STAMINA) 包括在未知或延长的时间窗口 (2015年1月至2019年12月) 中接受IVT治疗的急性缺血性中风患者.
- 患者的选择是基于多模式CT或MRI.
- 如果INR或血水平符合机构标准,接受口服抗凝药 (VKA或DOAC在48小时内) 的患者有资格. 主要结局是任何和有症状的内出血 (ICH).
主要成果:
- 在未知/扩展窗口内接受IVT的170名患者中,有19名患者接受口服抗凝剂 (6VKA,13DOAC).
- 在服用口服抗凝剂和不服用口服抗凝剂的患者之间,症状性ICH的风险相似 (5.3%对2.7%,p=0.453).
- 在调整混因子后,口服抗凝药与症状性ICH没有显著的关联 (aOR 1.02 [0.09-11.02],p=0.988).
结论:
- 对于不知发病时间的缺血性中风,IVT在接受口服抗凝药的精心挑选的患者中似乎是安全的.
- 这包括接受DOAC和VKA治疗的患者.
- 进一步的研究可能会在更大的队列中证实这些发现.
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