在使用直接抗凝剂时突破性缺血性中风后的抗凝策略:元分析
Michele Romoli1, Maurizio Paciaroni2, Nicola Marrone3,4
1Department of Neurosciences, Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy.
Neurology
|August 4, 2025
概括
在中风后从直接口服抗凝剂 (DOAC) 转换为华法林,会增加复发性中风和内出血 (ICH) 的风险. 基于DOAC的策略更安全,更有效地防止这些结果.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在接受直接口服抗凝剂 (DOACs) 的患者中,缺血性中风后抗凝剂的管理是一个临床挑战.
- 现有的指导方针为DOAC用户提供了最佳的抗凝策略的有限证据.
- 关于转换为华法林,改变DOAC或在中风后调整剂量存在争议.
研究的目的:
- 为了比较不同抗凝策略的有效性和安全性,在DOAC患者的缺血性中风后.
- 评估转换为华法林,转换为另一种DOAC,改变DOAC剂量和添加抗血小板药物的影响.
- 评估包括复发性缺血性中风,内出血 (ICH),任何中风和死亡率在内的结果.
主要方法:
- 进行了汇总数据的元分析,系统地搜索MEDLINE,Scopus和Cochrane图书馆,直到2025年1月31日.
- 包括的研究是随机对照试验和成年缺血性中风患者在DOACs上的队列研究 (n ≥ 50).
- 使用随机效应建模,将风险比率 (RR) 和95%置信区间 (CI) 用于比较结果.
主要成果:
- 与保持相同的DOAC (RR 1.80) 或改变DOAC剂量 (RR 1.72) 相比,切换为华法林显著增加了复发性缺血性中风的风险.
- 华法林切换与较高的ICH率有关,而不是继续使用相同的DOAC (RR 2.90) 或切换到另一个DOAC (RR 3.25).
- 继续使用相同的DOAC或切换到不同的DOAC显示了主要和次要结果的相似率.
结论:
- 在DOAC使用者中缺血性中风后切换为华法林似乎在预防中风复发和ICH方面不那么有效和安全.
- 基于DOAC的策略,包括维持当前的DOAC或切换到另一个DOAC,与更好的结果有关.
- 这些发现表明,在这个患者群体中,偏好基于DOAC的治疗,而不是华法林过渡.
相关概念视频
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.3K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.3K
Venous Thrombosis III: Interprofessional Care
22
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
22
Anticoagulant Drugs: Low-Molecular-Weight Heparins
909
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
909
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
645
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
645
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
44
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
44
Acute Coronary Syndrome IV: Interprofessional Care
28
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
28


