血管内治疗前或期间服用抗血小板药物,在静脉静脉血栓溶解后用于动脉血性大血管封闭
Satoshi Miyamoto1, Mikito Hayakawa2, Wataro Tsuruta1
1Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan.
概括
在静脉输血栓溶解 (IVT) 和机械血栓切除 (MT) 后的早期抗血小板治疗 (APT) 对于急性大血管封闭性中风似乎是安全的. 这种方法可以帮助预防重新封闭和血栓形成,而不会增加出血风险.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 血管医学 血管医学
背景情况:
- 机械血栓切除术 (MT) 对于急性大血管封闭 (LVO) 中风至关重要.
- 在MT后的重新封闭和血栓形成可能会使结果恶化.
- 目前的指导方针限制了静脉输血栓溶解 (IVT) 后的早期抗血小板治疗 (APT),使动脉血性LVO (AT-LVO) 的管理复杂化.
研究的目的:
- 为了研究早期APT在IVT后接受MT的急性AT-LVO患者中给予APT的安全性.
- 为了比较早期和延迟/没有APT组之间的出血事件和死亡率.
主要方法:
- 一项日本注册研究 (770名AT-LVO患者,51家机构,2019年1月至12月) 的后期分析.
- 专注于164名前部循环AT-LVO患者,在IVT后接受MT治疗.
- 使用倾向性得分匹配,比较MT前/MT内APT组和MT后/没有APT组之间的结果.
主要成果:
- 在匹配的队列中 (37名患者/组),在所有出血事件的发生率 (14%对22%),任何内出血 (ICH) (8%对14%),症状性ICH (sICH) (3%对8%) 或90天死亡率 (3%对3%) 中没有显著差异.
- 这些发现表明,早期启动APT并没有引起安全问题.
结论:
- 针对急性AT-LVO,在IVT和MT之后早期使用APT可能是一个安全的策略.
- 这种方法需要进一步的研究,以通过预防术后并发症来潜在地改善临床结果.
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