发病前口服抗栓药物对急性缺血性卒中患者静脉溶栓安全性的影响研究  

Safety of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Antithrombotic Therapy before Stroke Onset

作　　者：张心邈 王春娟 杨昕 谷鸿秋 姜英玉 王伊龙[1] 赵性泉[1] 李子孝[1,2] 王拥军 ZHANG Xin-Miao;WANG Chun-Juan;YANG Xin;GU Hong-Qiu;JIANG Ying-Yu;WANG Yi-Long;ZHAO Xing-Quan;LI Zi-Xiao;WANG Yong-Jun(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京100070 [2]国家神经系统疾病临床医学研究中心

出　　处：《中国卒中杂志》2021年第11期1110-1114,共5页Chinese Journal of Stroke

基　　金：“十三五”国家重点研发计划(2016YFC0901001,2017YFC1310901,2016YFC0901002,2017YFC1307905)北京市百千万人才工程(2018A13)。

摘　　要：目的探索发病前口服抗栓药物对急性缺血性卒中患者静脉溶栓安全性的影响。方法研究对象为2018年1-12月的全国、多中心、缺血性卒中住院患者登记研究中进行了rt-PA静脉溶栓的患者。根据患者发病前是否应用抗栓药物,将患者分为观察组(发病前口服抗栓药物)和对照组(发病前未口服抗栓药物)。比较两组的基线信息、溶栓后症状性颅内出血率和在院全因死亡率的差异,并采用多因素回归分析发病前应用抗栓药物对患者溶栓后住院期间安全性的影响。结果本研究共纳入了全国1374家医院的17587例rt-PA静脉溶栓的急性缺血性卒中住院患者。其中,有3313例(18.8%)发病前应用抗栓药物,纳入观察组,14274例(81.2%)发病前未应用口服抗栓药物,纳入对照组。与对照组相比,观察组患者年龄较高(67.7±11.1岁vs 64.8±12.2岁),男性比例较低(63.6%vs 65.7%),既往血管危险因素比例较高,入院NIHSS>15分的患者比例较高(16.1%vs 13.5%),差异均有统计学意义。观察组溶栓后症状性颅内出血的发生率(0.12%vs 0.07%,P=0.156)和在院全因死亡率(1.72%vs 1.16%,P=0.010)均高于对照组,但多因素校正后,两组溶栓后症状性颅内出血(HR 1.133,95%CI 0.220~5.822,P=0.881)和在院全因死亡(HR 0.912,95%CI 0.612~1.359,P=0.651)方面的差异均未达统计学意义。结论发病前应用抗栓药物对急性缺血性卒中患者静脉溶栓的短期安全性无显著影响,不增加症状性颅内出血的发生率和在院全因死亡率。Objective To investigate the effect of antithrombotic therapy before stroke onset on intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods The data of in-hospital AIS patients who received intravenous thrombolysis from a national,multi-center stroke registry of from January to December,2018 were collected and retrospectively analyzed.All the patients were divided into observation group(with antithrombotic therapy before stroke onset)and control group(without antithrombotic therapy before stroke onset).Baseline information and in-hospital safety outcomes(symptomatic intracranial hemorrhage and all-cause death)were compared between the two groups,and multivariate logistic regression was used to analyze the correlation between pre-antithrombotic therapy and in-hospital safety outcomes.Results A total of 17587 eligible patients in 1374 hospitals were included in this study,with 3313 patients(18.8%)in observation group and 14274 patients(81.2%)in control group.Compared to the control group,the observation group had higher age(67.7±11.1 years vs 64.8±12.2 years),less males(63.6%vs 65.7%)and a higher proportion of vascular risk factors,and NIHSS>15(16.1%vs 13.5%)on admission,with all statistical differences.The incidence of symptomatic intracranial hemorrhage(0.12%vs 0.07%,P=0.156)and all-cause death(1.72%vs 1.16%,P=0.010)in observation group were higher than those in control group.After multivariate adjustment,there was no statistical difference between the two groups in terms of symptomatic intracranial hemorrhage(HR 1.133,95%CI 0.220-5.822,P=0.881)and in-hospital all-cause death(HR 0.912,95%CI 0.612-1.359,P=0.651).Conclusions There were no significant effects of antithrombotic therapy before stroke onset on short-term safety of intravenous thrombolytic therapy in AIS patients,without increasing the risk of symptomatic intracranial hemorrhage and in-hospital all-cause death.

关 键 词：缺血性卒中 静脉溶栓 抗栓药物 症状性颅内出血 死亡率 

分 类 号：R743.3[医药卫生—神经病学与精神病学]