抗凝药患者急性中风的内血管血栓切除术:系统性审查和元分析
Kaho Adachi1, Allison Raymundo1, Anthony Sanchez1
1University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA.
Journal of thrombosis and thrombolysis
|November 2, 2025
概括
与维生素K对抗剂 (VKA) 相比,直接口服抗凝剂 (DOAC) 对接受内血管血栓切除术 (EVT) 的急性缺血性中风 (AIS) 患者更安全. 与VKAs不同,DOAC显示出症状性内出血和死亡的风险类似.
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:
- 内血管血栓切除术 (EVT) 是急性缺血性中风 (AIS) 的关键治疗方法.
- 在接受EVT的前血栓患者中,使用口服抗凝剂预防中风需要仔细考虑,因为它可能对结果产生影响,特别是症状性内出血 (sICH).
- 不确定性存在于不同口服抗凝剂类别,特别是维生素K抗剂 (VKA) 和直接口服抗凝剂 (DOAC) 的相对安全性和有效性,在EVT的背景下.
研究的目的:
- 评估VKA和DOAC在接受EVT的AIS患者的安全性和有效性.
- 为了比较结果,包括症状性内出血 (sICH) 和死亡率,在接受EVT的抗凝血和非抗凝血AIS患者之间.
- 评估治疗剂量抗凝剂对EVT结果的影响.
主要方法:
- 从2015年到2024年8月,在PubMed,Cochrane和Embase数据库中进行了系统的文献搜索.
- 包括比较抗凝血 (VKA或DOAC) 与接受EVT的非抗凝血AIS患者的研究.
- 分析了安全结果 (sICH,90天死亡率) 和疗效结果 (再输血率,90天功能结果),并对治疗剂量抗凝剂进行了亚组分析.
主要成果:
- 分析了15项涉及62,328名AIS患者的研究;9,977名患者接受抗凝药 (6,879名VKA,3,098名DOAC).
- 与没有抗凝药相比,使用VKA与明显更高的SICH (OR=1.32) 和90天死亡率 (OR=1.61) 相关.
- DOACs在SICH风险 (OR=0.83) 或死亡率 (OR=1.20) 中没有显著差异. 两组抗凝血剂的功能结果都较差,但只有VKA患者在治疗剂量小组中表现出这种情况. 在不同组中,EVT的成功率相似.
结论:
- 与VKAs相比,DOAC在AIS患者中对EVT具有更安全的概况,其特点是患病和死亡风险较低.
- 这些发现表明,DOAC可能是这种患者群体中预防中风的首选抗凝剂选择.
- 进一步的研究是有必要的,以探索长期的结果,并区分手术相关的死亡率和其他原因.
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