在急性心血管血栓性缺血性中风中出血性转变后的抗凝药
Hyunsoo Kim1, Ye-Eun An1, Beom-Seok Seo1
1Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Translational stroke research
|December 25, 2025
概括
血流转变的心血管栓塞性中风患者的抗凝治疗显示出更好的功能结果和更少的放射性恶化. 这表明抗凝剂可能是安全和有益的,尽管出血转化.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
背景情况:
- 心血管栓塞性中风 (CES) 患者有患出血转化 (HT) 的风险.
- 对抗凝血 (AC) 在患有HT的CES患者中的作用进行了辩论.
- 有HT的CES最佳管理策略需要进一步研究.
研究的目的:
- 评估抗凝治疗与神经成像和功能结果的关联性,在发生出血转化 (HT) 的CES患者中.
- 为了比较抗凝治疗 (AC),抗血小板治疗 (APT) 和药物停用 (DD) 对HT恶化和功能恢复的影响.
- 评估这种患者群体中AC的安全性,特别是症状性脑内出血 (sICH) 的风险.
主要方法:
- 在2011年1月至2023年8月期间入院的763名CES和HT患者的回顾性研究.
- 包括患有出血性心脏病发作或1型囊性血液瘤的患者,并在一周内进行后续成像.
- 通过调整的分析,在AC,APT和DD组中比较结果 (HT恶化,3个月的mRS,sICH).
主要成果:
- 与抗血小板治疗相比,抗凝血与HT恶化发生率较低相关 (调整后OR为0.48).
- 与APT (调整的OR0.63) 和药物停用 (调整的OR0.38) 相比,AC与更好的3个月功能结果 (mRS) 有关.
- 症状性脑内出血发生在5%的患者中,与停药 (11.7%) 相比,AC (1.5%) 和APT (2.1%) 组的发病率较低.
结论:
- 在患有HT的CES患者中,抗凝血治疗与改善功能结果和减少放射性恶化有关.
- 在这种情况下,抗凝剂似乎不会显著增加症状性脑内出血的风险.
- 这些发现表明,出血转化不应该自动排除ESE患者的抗凝治疗,这需要进一步的前性调查.
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