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Resuscitation:抗血小板治疗能否改善院外心脏骤停后患者结局?

2017-12-06 吴星 环球医学

2017年12月,发表在《Resuscitation》的一项由美国科学家进行的研究,考察了抗血小板治疗与院外心脏骤停(OHCA)后患者结局之间的相关性。

2017年12月,发表在《Resuscitation》的一项由美国科学家进行的研究,考察了抗血小板治疗与院外心脏骤停(OHCA)后患者结局之间的相关性。

背景:OHCA期间血流中断导致微血管血栓形成、自主循环恢复后长时间灌注不足和重要器官受损。研究者检测了以下假设:心脏骤停前抗血小板和抗凝药物使用与心脏骤停后更少的器官功能障碍和更好的结局相关。

方法:研究者纳入一家教学医疗中心2005年1月至2014年10月治疗的OHCA患者。研究者将临床和人口统计学数据的前瞻性OHCA注册与结构化图表回顾相联合,以提取家庭抗血小板和抗凝药物。研究者建立非校正和校正回归模型,考察抗血小板和抗凝药物使用与心脏骤停后疾病严重程度、生存和功能良好恢复之间的相关性。

结果:1054例受试者中,心脏骤停前,295例(28%)患者被处方一种抗血小板药物,147例(14%)患者被处方一种抗凝药物。在校正模型中,抗血小板药物与较低的心脏骤停后疾病严重程度(校正OR 0.50 95% CI 0.33~0.77)、较大的出院生存几率(校正OR 1.74 95% CI 1.08~2.80)和较大的功能良好结局几率(校正OR 2.11 95% CI 1.17~3.79)相关。相比之下,通过任何药物的抗凝与疾病严重程度、出院生存或有利结局不相关。

结论:通过抗血小板药物预防骤停时和骤停后微血管血栓形成可以代表改善OHCA后结局的新的治疗目标。

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2017年11月,发表在《Hepatology》上的一项回顾性分析,考察了抗血小板治疗是否会降低慢性乙型肝炎患者的肝细胞癌(HCC)风险。分析结果表明:抗血小板治疗会降低乙型肝炎病毒被有效抑制的慢性乙型肝炎患者HCC风险。但包含氯吡格雷的抗血小板治疗会增加出血风险。

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