用抗血小板药和抗凝剂进行二次中风预防的出血风险:倾向性得分匹配分析
Salia Farrokh1,2, Krishna Nalleballe3, Sanjeeva Onteddu3
1Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery Johns Hopkins University School of Medicine Baltimore MD USA.
Journal of the American Heart Association
|August 20, 2025
概括
结合抗血小板药物和抗凝剂治疗中风患者,会增加长期出血的风险,尤其是12个月以上的脑内出血. 这些组合疗法急性和长期增加胃肠道出血的风险.
科学领域:
- 心脏病学
- 神经学
- 药理学
背景情况:
- 在急性缺血性中风 (AIS) 中,针对二次性中风预防的抗血小板和抗凝药疗法的安全性存在有限的数据.
- 在同时患有心房动和急性心肌梗塞的患者中,与这些组合相关的出血风险尚未得到充分确立.
研究的目的:
- 检查与单一 (SAPT) 或双重抗血小板疗法 (DAPT) 与抗凝剂相结合的出血风险.
- 为了比较患有AIS,心房动和急性心肌梗塞的患者的风险.
主要方法:
- 使用来自76家美国医院的TrinetX数据进行的回顾性横截面队列研究.
- 对抗凝血剂单独,抗凝血剂加SAPT和抗凝血剂加DAPT分队进行的倾向性比分分析.
- 在3个月,12个月和随访期间评估急性自发脑内出血和胃肠道出血风险.
主要成果:
- 在144,434名患者中,有8772人仅服用抗凝剂,88,430人服用抗凝剂加SAPT,47232人服用抗凝剂加DAPT.
- 与单独使用抗凝剂相比,3个月和12个月内脑内出血风险没有显著增加.
- 长期脑内出血的风险增加 (SAPT的OR为1.26,DAPT的OR为1.34) 并在所有时间点增加胃肠道出血的风险.
结论:
- 在AIS后,结合抗血小板药物和抗凝剂可能会增加长期脑内出血的风险,特别是在12个月以后.
- 组合疗法与急性和长期胃肠道出血的风险增加有关.
- 需要进行更大规模的前性研究来证实这些发现.
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