重新评估肝素在急性缺血性中风机械血栓切除过程中的作用:增加风险而没有功能益处
Seyed Behnam Jazayeri1, Sherief Ghozy2, Ram Saha3
1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Clinical neurology and neurosurgery
|September 26, 2024
概括
在急性缺血性中风的机械血栓切除术期间服用肝素与更糟糕的结果和增加栓塞有关. 由于这些风险,在此过程中应重新考虑常规使用肝素.
科学领域:
- 神经学 神经学
- 干预性神经放射学 干预性神经放射学
- 临床试验 临床试验
背景情况:
- 机械血栓切除术 (MT) 是由于大血管封闭 (AIS-LVO) 的急性缺血性中风的关键治疗方法.
- 由于风险/收益平衡不确定,在MT期间肝素的作用仍然存在争议.
- 这项研究系统地审查了肝素在AIS-LVO MT中的安全性和有效性.
研究的目的:
- 为了评估在AIS-LVO的MT中对肝素的施用的影响.
- 评估肝素对功能结果,再注血和并发症率的影响.
- 在AIS-LVO MT中提供基于证据的关于肝素使用的建议.
主要方法:
- 对AIS-LVO在MT期间使用肝素的研究进行系统审查和元分析.
- 在PubMed,Embase和Scopus数据库中进行了搜索.
- 用于元分析的随机效应模型,并对异质性的子组分析.
主要成果:
- 肝素使用与较低的有利功能结果率 (mRS 0-2) 有关.
- 在接受肝素治疗的患者中观察到远端栓塞的风险增加.
- 亚组分析显示,在接受IVT和肝素治疗的患者中,症状性内出血 (symptomatic intracranial hemorrhage,简称SICH) 较高,结果更差.
结论:
- 在AIS-LVO的MT期间服用肝素与较差的临床结果和增加的远端栓塞相关.
- 在接受静脉输血栓溶解 (IVT) 的患者中,肝素使用会增加SICH的风险.
- 在AIS-LVO的MT期间常规使用肝素需要重新考虑.
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