基线抗血栓治疗和感染性内心炎的内出血风险:一个多中心前性队列研究
Javier T Solera1, Eduardo Aparicio-Minguijón1, Laura Domínguez-Pérez2
1Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12, Madrid, Spain.
概括
抗血栓治疗,特别是抗凝药,增加了感染性内心炎 (IE) 中内出血的风险. 基线抗血栓使用有助于IE患者早期神经学风险分层.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
背景情况:
- 传染性内心炎 (IE) 带来重大风险,主要是由于神经复杂症.
- 慢性抗血栓治疗在患有神经并发症的IE患者中的作用尚不清楚.
研究的目的:
- 调查基线抗血栓治疗与内出血 (ICH) 和左侧IE患者的死亡率之间的关联.
主要方法:
- 一项前性多中心队列研究分析了从2008年到2018年,3,236名确定的左侧IE患者.
- 患者被分为没有治疗 (NT),抗血小板治疗 (APT),抗凝血 (AC) 或联合治疗 (CAT) 组.
- 结局包括30天的ICH,缺血性中风,栓塞性事件,严重出血和全因死亡率,使用多变量回归模型进行分析.
主要成果:
- ICH发生在5.6%的患者中,与NT相比,CAT (9.5%) 和AC (6.8%) 组的发病率更高.
- 基线AC独立增加了ICH风险 (aRR1.83),CAT显示最高风险 (aRR2.45).
- 组合疗法 (CAT) 预测了更高的1年死亡率 (aHR 1.21),而APT与ICH没有关联.
结论:
- 基线抗血栓治疗,特别是抗凝药,是预测IEICH的重要因素.
- 微生物病因,先前的脑血管疾病和抗血栓使用对于IE早期神经风险分层至关重要.
- 调查结果支持基于神经成像的决策和IE患者的多学科护理.
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