用于动脉剖析的抗血栓药物:更新的系统性审查
Nikolaos S Avramiotis1,2, Fabian Schaub3, Sebastian Thilemann1,2
1Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland.
European stroke journal
|October 26, 2024
概括
与抗血小板药物相比,抗血小板药物可以减少额外内动脉剖析 (eICAD) 患者的死亡和残疾. 这份科克伦评论的更新表明,由于抗血小板药物的证据较弱,建议个性化治疗决策.
科学领域:
- 神经学 神经学
- 血管医学 血管医学
- 基于证据的医学基于证据的医学.
背景情况:
- 额外内动脉剖析 (eICAD) 是中风的重要原因,特别是在年轻人中.
- 目前eICAD的治疗策略主要涉及抗血小板或抗凝药物.
- 对这些治疗方法的比较益处和危害进行全面的审查对于优化患者的治疗结果至关重要.
研究的目的:
- 在被诊断患有eICAD的患者中,比较抗血小板治疗与抗凝剂治疗的益处和危害.
- 更新有关eICAD治疗有效性和安全性的现有科克伦评论证据.
- 通过合成来自随机对照试验 (RCT) 和非随机研究的数据,为临床决策提供信息.
主要方法:
- 在多个数据库 (Cochrane Stroke Group Trials Register,CENTRAL,MEDLINE,EMBASE) 和个人搜索中进行了系统的文献搜索,截至2023年12月.
- 包括的研究是随机对照试验 (RCT) 和非随机研究,比较eICAD患者的抗凝血剂与抗血小板药物.
- 进行了元分析以计算几率比率 (ORs) 以95%的置信区间 (CI) 计算共同主要结果 (死亡,死亡或残疾) 和次要结果 (缺血性中风,内出血,外出血).
主要成果:
- 对42项研究 (2624名患者) 的分析表明,与抗凝血剂相比,用抗血小板药物治疗的患者死亡和死亡或残疾的几率更高.
- 抗血小板治疗与RCT中缺血性中风的概率显著增加有关 (OR 4.60).
- 接受抗血小板药物治疗的患者出现的症状明显较少的内出血 (OR 0.25),并趋向于较少严重的外出血.
结论:
- 目前支持抗血小板作为eICAD治疗标准的证据被认为很弱.
- 在eICAD患者中,抗凝固药治疗似乎与死亡和残疾的更好结果有关.
- 个人治疗决策,仔细平衡每个治疗方法的风险和危害,是eICAD管理的建议.
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