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Neurology:不同抗凝方法的患者机械血栓切除术的结局比较

2020-01-21 xing.T MedSci原创

该研究强调了DOA相比于VKA的优势。在死亡率、优良结局和再通率方面,DOA似乎为AIS患者的MT治疗提供了有利条件。

机械血栓切除术(MT)是接受有效抗凝治疗的急性缺血性卒中(AIS)患者主要治疗方法之一。鉴于与维生素K拮抗剂(VKA)相比,它们的疗效和安全性,直接口服抗凝剂(DOA)的使用有所增加。近日,神经病学领域权威取杂志Neurology上发表了一篇研究文章,研究人员比较了卒中发作之前接受DOA和VKA治疗的患者MT的手术和临床结局。

研究人员分析了缺血性卒中前瞻性登记中心接受血管内治疗的2组患者:接受MT且无溶栓治疗的接受DOA治疗的患者和接受VKA治疗的患者。研究人员使用广义线性混合模型(包括中心为随机效应)根据抗凝亚组比较了血管造影(手术结束时的再灌注率,通过次数>2,手术并发症)和临床(有利和优异的结局,90天全因死亡率和出血并发症)结局。研究人员针对预先设定的混杂因素(年龄、入院NIH卒中量表评分)以及有意义的基线组间差异进行了比较。

在221例患者中,与接受VKA治疗的患者相比,更多的经DOA治疗的患者在手术结束时再灌注成功([mTICI] 2b/3)或接近完全再通(mTICI 2c/3)(n=115,52%),DOA与VKA相比调整后比值比(OR)分别为3.27(95%置信区间[CI]为1.40-7.65)和2.00(95%CI为1.08-3.73)。经DOA治疗的患者90天死亡风险较低,调整后的OR为0.47(95%CI为0.24–0.89),且具有更好的结局,OR为2.40(1.10–5.27)。出血或手术并发症的组间差异无统计学意义。

该研究强调了DOA相比于VKA的优势。在死亡率、优良结局和再通率方面,DOA似乎为AIS患者的MT治疗提供了有利条件。
 
原始出处:

Vincent L'Allinec,et al.MT in anticoagulated patients Direct oral anticoagulants versus vitamin K antagonists.Neurology.2020.https://n.neurology.org/content/early/2020/01/20/WNL.0000000000008873

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