在心房动中中风后抗凝血时间:从系统性审查和元分析中获得的证据
Mostafa Hossam El Din Moawad1,2, Suhel Batarseh3, Abdelaziz A Awad4
1Alexandria Main University Hospital, Alexandria, Egypt.
概括
在心房的患者中,在缺血性中风后早期开始口服抗凝药可以减少复发性中风. 这种方法在重大出血事件方面似乎是安全的,但需要更多的研究.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 临床药理学 临床药理学
背景情况:
- 在心房动 (AF) 患者中,在缺血性中风后开始口服抗凝剂 (OAC) 的最佳时间正在争论中.
- 早期的OAC可能会减少复发性中风,但会增加出血转变的风险;指南冲突.
- 这一元分析调查了早期与晚期OAC启动对AF相关的缺血性中风临床结果的影响.
研究的目的:
- 评估早期与晚期口服抗凝药的启动对复发性中风,内出血,出血,死亡率,TIA和血栓形成的影响.
- 综合现有研究的证据,以告知关于AF患者缺血性中风后OAC时间的临床决策.
主要方法:
- 按照PRISMA指南进行的系统审查和元分析.
- 包括观察性和实验性研究,比较早期和晚期的抗凝血启动.
- 十七项研究符合分析的纳入标准.
主要成果:
- 早期的抗凝治疗显著降低了复发性缺血性中风的风险 (OR = 0.72,P = .03).
- 在内出血 (OR = 1.13,P = .44),出血 (OR = 0.87,P = .27),死亡率 (OR = 0.94,P = .68),TIA (OR = 0.99,P = .98) 或血栓形成 (OR = 0.87,P = .47) 方面没有发现显著差异.
- 发现了显著的异质性,可能是由于研究设计,抗凝剂类型和中风严重程度.
结论:
- 早期启动OAC可能会减少缺血复发,但不会显著增加主要出血事件.
- 需要进一步的随机对照试验来确定最终的最佳OAC时间.
- 临床实践应考虑减少复发性中风和潜在出血风险之间的平衡.
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