抗凝血与抗血小板在不确定来源的栓塞性中风的子组之间:随机对照试验的元分析
Malik Ghannam1, Abdullah M Al-Qudah1, Qasem N Alshaer1
1From the Department of Neurology (M.G., Q.N.A., A.A.), University of Iowa Hospitals & Clinics, Iowa City; Department of Neurology (A.M.A.-Q.), University of Pittsburgh Medical Center, PA; Departments of Biostatistics (R.K.), Neurology (W.T.L., D.T.) and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Hardin Library for the Health Sciences (C.A.C.), The University of Iowa, Iowa City; Department of Cardiology and Angiology (T.K., T.G.), and Institute for Clinical Epidemiology and Applied Biometry (L.M.S.-H.), Faculty of Medicine, Eberhard Karls University Tübingen, Germany; Department of Neurology (K.F., S.Y.), Brown University, Providence, RI; Department of Neurology (J.L.S.), University of California at Los Angeles (UCLA); Department of Neurology (S.E.K.), University of Pennsylvania, PA; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons; Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology & Stroke (S.P.), and Hertie Institute for Clinical Brain Research (S.P.), Eberhard Karls University Tübingen, Germany; and Department of Neurology (H.K.), Weill Cornell Medicine, New York, NY.
对于源不明的栓塞性中风 (ESUS),抗凝剂通常不对抗血小板治疗有益. 然而,抗凝药对状孔 (PFO) 患者来说是有前途的,需要个性化治疗策略.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 临床试验 临床试验
背景情况:
- 源不明的栓塞性中风 (ESUS) 是一种异质的疾病,需要个性化治疗.
- 确定最佳的二次预防策略对于ESUS患者至关重要.
研究的目的:
- 评估ESUS子组中抗凝治疗与抗血小板治疗对二次缺血性中风预防的有效性.
- 为了确定可能预测治疗反应的特定患者特征.
主要方法:
- 7项随机对照试验的研究水平元分析,涉及14804名ESUS患者.
- 抗凝血与抗血小板治疗对复发性缺血性中风,严重出血和死亡的比较.
- 基于年龄,性别,形孔 (PFO),左心房扩大 (LAE) 和心房心脏病的子组分析.
主要成果:
- 与整体抗血小板治疗相比,抗凝血治疗显示出类似的复发性缺血性中风率 (RR 0.91).
- 抗凝固药物显著降低了ESUS患者PFO的缺血性中风风险 (RR 0.59).
- 在LAE患者中,治疗的有效性因心脏监测方案而异;对于年龄,性别或心房心脏病小组没有观察到任何益处.
结论:
- 经验性抗凝药对ESUS一般人群没有好处.
- 个性化治疗策略至关重要,包括在LAE患者中长时间监测心脏动脉动.
- 抗凝药可能对PFO等特定亚组有益,但需要进一步进行大型前性研究.
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