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Neurology:低剂量阿司匹林不增加颅内出血风险,反而降低SAH风险

2017-12-10 杨中华 脑血管病及重症文献导读

低剂量阿司匹林广泛应用于缺血性血管事件的二级预防,甚至用于一级预防。随机对照试验或随机对照试验联合队列研究的meta分析把阿司匹林和颅内出血风险增加联系起来,发现二者未达到统计学意义或处于边缘状态。观察性研究的结果更是模棱两可,甚至有研究认为长期服用阿司匹林能够降低蛛网膜出血的风险。


低剂量阿司匹林广泛应用于缺血性血管事件的二级预防,甚至用于一级预防。随机对照试验或随机对照试验联合队列研究的meta分析把阿司匹林和颅内出血风险增加联系起来,发现二者未达到统计学意义或处于边缘状态。观察性研究的结果更是模棱两可,甚至有研究认为长期服用阿司匹林能够降低蛛网膜出血的风险。

2017年11月来自西班牙的Lucía Cea Soriano等在Neurology上公布了他们的研究结果,目的在于评价新使用小剂量阿司匹林与颅内出血风险之间的关系。

研究者利用英国初级卫生保健数据库(primary care database)(THIN数据库,包含了英国6%人口)(译者注:我的理解纳入对象为一级预防者),基线年龄40-84岁新服用低剂量阿司匹林(75-300 mg,n = 199079例)队列按照1:1的比例匹配基线未服用低剂量阿司匹林队列,并进行平均5.4年随访,以探讨颅内出血发生率。采用1000次匹配对照(Using 10,000 frequency-matched controls),计算当前使用低剂量阿司匹林者的调整RR(95% CI)(Index日期前0-7天[颅内出血日期,对照为任意日期])。

共1611例发生了颅内出血,其中脑出血743例,硬膜下血肿483例,SAH 385例。全部颅内出血、脑出血、硬膜下血肿和SAH的RRs(95% CI)分别为0.98 (0.84–1.13) , 0.98 (0.80–1.20) , 1.23 (0.95–1.59) , 0.77 (0.58–1.01)。与药物使用持续时间或剂量无关。低剂量阿司匹林使用>=1年的RRs(95% CI):脑出血未0.90 (0.72–1.13),硬膜下血肿为1.20 (0.91–1.57),SAH为0.69 (0.50–0.94)。

最终作者认为低剂量阿司匹林与任何类型颅内出血风险增加都没有关系,如果使用>=1年低剂量阿司匹林显著降低SAH风险。

原始出处:

Cea Soriano L1, Gaist D2, Soriano-Gabarró M,et al.Low-dose aspirin and risk of intracranial bleeds: An observational study in UK general practice.Neurology. 2017 Nov 28;89(22):2280-2287. doi: 10.1212/WNL.0000000000004694. Epub 2017 Nov 1.

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    2018-08-06 yinhl1978
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    2018-02-03 lovetcm

    研究有偏倚还是真实?

    0

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    2017-12-12 zexyw03
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