抗血小板治疗对重组组织型纤溶酶原激活剂静脉溶栓所致出血性转化的影响  

Antiplatelet therapy on hemorrhagic transformation after recombinant tissue plasminogen activator in intravenous thrombolytic therapy

作　　者：江选飞[1] 张正春[1] 

机构地区：[1]苏州大学附属第一人民医院神经内科,江苏苏州215006

出　　处：《临床荟萃》2012年第7期571-573,共3页Clinical Focus

摘　　要：目的评价抗血小板聚集治疗对急性缺血性脑卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后出血性转化(HT)的影响。方法将我院的111例急性缺血性脑血管病溶栓患者,根据溶栓前是否使用抗血小板聚集药物,分为对照组(未使用抗血小板聚集药物)30例、阿司匹林(ASA)组28例、氯吡格雷(CLP)组28例、阿司匹林加氯吡格雷(ASA+CLP)组25例,统计各组溶栓后HT的发生率及90天后改良的Rankin评分,并进行统计学比较。结果对照组、ASA组、CLP组、ASA+CLP组HT发生率分别为10.0%、21.4%、17.9%、48.0%。ASA+CLP组HT的发生率与对照组差异有统计学意义,其余各组间差异无统计学意义;ASA组和CLP组与ASA+CLP组比较Rankin评分差异有统计学意义。结论急性缺血性脑血管病溶栓前单用ASA或CLP未增加rt-PA溶栓后HT的发生率,溶栓前联合使用阿司匹林及氯吡格雷显著增加rt-PA溶栓后HT的发生率,各组HT的发生未增加90天后溶栓患者的残疾率。Objective To evaluate the effect of antiplatelet therapy on hemorrhagic transformation（HT） as of post-intravenous thrombolytic therapy with recombinant tissue plasminogen activator （rt-PA） for acute ischemic stroke. Methods All 111 patients with thrombolytic therapy were divided into four groups：control group 30 patients, aspirin（ASA） group 28 patients, clopidogre （CLP） group 28 patients, aspirin and clopidogrel （ ASA＋ CLP） group 25patients. The control group did not receive antiplatelet therapy. The incidence of HT and the modified Rankin score after 90 days in each group were compared. Results The incidence of HT in control group, ASA group, CLP group, ASA＋CLP group was 10.0% ,21.4%, 17.9% ,48.0% respectively. There was statistical difference between control group and ASA＋CLP group in HT incidence, but the rest group showed no difference. The comparison of modified Rankin score after 90 days between ASA group, CLP group vs ASA＋CLP group showed statistical difference. Conclusion The use of antiplatelet therapy drug alone did not increase the incidence of HT after rt-PA intravenous thrombolytic therapy for acute ischemic stroke,but combined use of aspirin and clopidogrel significantly increased the incidence of HT. The disability rate after 90 days did not increase by the reason of HT.

关 键 词：脑血管意外 血小板聚集抑制剂 重组组织型纤溶酶原激活剂 出血 

分 类 号：R743[医药卫生—神经病学与精神病学]