静脉溶栓在正在使用直接口服抗凝药的急性缺血性卒中患者中的有效性和安全性  

Efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke on direct oral anticoagulants

作　　者：宋良[1] 付胜奇 朱利利 禹萌 刘海涛[1] 石宝洋 张洪涛 Song liang;Fu Shengqi;Zhu Lili;Yu Meng;Liu Haitao;Shi Baoyang;Zhang Hongtao(Department of Neurology,the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)神经内科,郑州450003

出　　处：《国际脑血管病杂志》2024年第11期801-806,共6页International Journal of Cerebrovascular Diseases

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20240880);河南省科技攻关项目(242102310048)。

摘　　要：目的:探讨静脉溶栓(intravenous thrombolysis,IVT)在正在使用直接口服抗凝药(direct oral anticoagulants,DOACs)的急性缺血性卒中(acute ischemic stroke,AIS)患者中的有效性和安全性。方法:回顾性纳入2021年1月至2024年12月在郑州人民医院卒中中心住院并且在发病前48 h内服用过DOACs的AIS患者。记录人口统计学特征、血管危险因素、实验室检查结果、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分以及其他临床资料。主要转归指标为在发病后90 d时采用改良Rankin量表评估的功能转归,0~2分定义为转归良好。次要转归指标为发病后36 h内发生的有症状颅内出血(symptomatic intracranial hemorrhage,sICH)及任何部位任何出血。采用多变量logistic回归模型确定转归的独立影响因素。结果:共纳入153例患者,男性87例(56.9%),平均年龄(71.261±6.983)岁。74例(48.4%)接受IVT,59例(38.6%)转归不良。IVT组患者转归良好率显著高于非IVT组(71.6%对51.9%;χ^(2)=6.274,P=0.012),但sICH以及任何部位任何出血发生率均无显著统计学差异。转归良好患者基线NIHSS评分显著低于转归不良组[(8.817±3.677)分对(11.203±5.060)分;t=-3.361,P<0.001],而IVT比例显著高于转归不良组(56.4%对35.6%;χ^(2)=6.274,P=0.012)。多变量logistic回归分析显示,既往卒中或短暂性脑缺血发作史[优势比(odds ratio,OR)3.964,95%置信区间(confidence interval,CI)1.611~9.753;P=0.003]和高基线NIHSS评分(OR 1.129,95%CI 1.034~1.233;P=0.007)是转归不良的独立危险因素,而IVT是转归良好的独立保护因素(OR 0.166,95%CI 0.068~0.410;P<0.001)。结论:对于在发病前48 h内服用过DOACs的AIS患者,IVT能够显著改善患者转归且不会增加sICH风险。Objective:To investigate the efficacy and safety of intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS)who are currently using direct oral anticoagulants(DOACs).Methods:Patients with AIS admitted to the Stroke Center of Zhengzhou People's Hospital from January 2021 to December 2024 and had taken DOACs within 48 hours prior to onset were included retrospectively.The demographic characteristics,vascular risk factors,laboratory test results,baseline National Institutes of Health Stroke Scale(NIHSS)scores,and other clinical data were collected.The main outcome measure was the functional outcome evaluated using the modified Rankin Scale at 90 days after onset,with a score of 0-2 defined as good outcome.The secondary outcome measures were symptomatic intracranial hemorrhage(sICH)and any bleeding in any location occurring within 36 hours after onset.Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcome.Results:A total of 153 patients were included,with 87 males(56.9%),aged(71.261±6.983)years.Seventy-four patients(48.4%)underwent IVT,and 59(38.6%)had poor outcome.The good outcome rate in the IVT group was significantly higher than that in the non-IVT group(71.6%vs.51.9%;χ^(2)=6.274,P=0.012),but there was no significant difference in the incidence of sICH and any bleeding in any location.The baseline NIHSS score of the good outcome group was significantly lower than that of the poor outcome group(8.817±3.677 vs.11.203±5.060;t=3.361,P<0.001),and the proportion of IVT was significantly higher than that of the poor outcome group(56.4%vs.35.6%;χ^(2)=6.274,P=0.012).Multivariate logistic regression analysis showed that previous history of stroke or transient ischemic attack(odds ratio[OR]3.964,95%confidence interval[CI]1.611-9.753;P=0.003)and high baseline NIHSS score(OR 1.129,95%CI 1.034-1.233;P=0.007)were independently associated with the poor outcome,while IVT was independently associated with the good outcome(OR 0.166,95%CI 0.068-0.410;P<

关 键 词：缺血性卒中 抗凝药 血栓溶解疗法 治疗结果 颅内出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]