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直接口服抗凝剂与阿司匹林相比,用于未确定的来源的栓塞性中风:全面的元分析

Natalia Arturo¹, Aishwarya Koppanatham², Paweł Chochoł³

¹Universidad CES, Facultad de Medicina, Medellín, Colombia.

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

|February 8, 2025

概括

与阿司匹林相比,直接口服抗凝剂 (DOAC) 在未确定的来源 (ESUS) 栓塞性中风中预防中风复发方面没有显著的益处. 出血风险也没有显著增加,这表明需要进一步研究来确定合适的患者群体.

科学领域:

神经学神经学
心脏病学心脏病学
药理学药理学是指药理学的学科.

背景情况:

不确定源 (ESUS) 的栓塞性中风管理仍然具有挑战性.
在ESUS中,抗凝药被假设在中风预防方面优于抗血小板治疗.
之前的随机对照试验 (RCT) 已经产生了不确定的结果.

研究的目的:

进行一项元分析,评估直接口服抗凝剂 (DOAC) 与阿司匹林在ESUS患者的二次中风预防中的疗效和安全性.
评估DOACs对中风复发和重大出血事件的影响.

主要方法:

在PubMed,Scopus和Cochrane Central数据库中进行系统的文献搜索.
包括9项研究 (4项RCT),包括14582名ESUS患者.
随机效应模型对主要结果 (中风复发) 和安全结果 (严重出血) 的元分析.

主要成果:

DOACs 显示了减少中风复发的非统计学意义上的趋势 (OR 0.93; 95% CI 0.81-1.06; p=0.29).
在DOACs和阿司匹林之间没有观察到重大出血事件的显著差异 (HR 1.57;95% CI 0.86-2.86;p=0.15).
对心房心肌病的亚组分析没有显示DOACs的显著益处.

结论:

目前的证据不足以推在ESUS中预防中风的DOACs超过阿司匹林.
与阿司匹林相比,DOACs没有显示出主要出血风险的统计学上显著增加.
未来的研究应该专注于确定特定的栓塞源和患者亚组,这些患者可能会从口服抗凝疗 (OAC) 中受益.

关键词:

这是一种抗凝血药物.密码性电脑中风是什么意思在 DOAC 系统中使用 DOAC.这就是 ESUSUS.

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