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N Engl J Med:合并PFO的隐源性卒中:PFO封堵术+抗血小板治疗vs抗血小板治疗

2017-10-16 吴星 环球医学

2017年9月,发表在《N Engl J Med》的一项调查了合并卵圆孔未闭(PFO)的隐源性卒中患者中,PFO封堵术联合抗血小板治疗与抗血小板单独治疗相比对卒中再发和新发脑梗风险的影响。

2017年9月,发表在《N Engl J Med》的一项调查了合并卵圆孔未闭(PFO)的隐源性卒中患者中,PFO封堵术联合抗血小板治疗与抗血小板单独治疗相比对卒中再发和新发脑梗风险的影响。

背景:隐源性卒中后,PFO封堵术预防卒中再发的疗效不确定。研究者考察了PFO封堵术联合抗血小板治疗与抗血小板单独治疗相比对卒中再发和新发脑梗风险的影响。

方法:在这项纳入合并PFO的隐源性卒中患者的多国试验中,研究者按照2:1的比率,将患者随机分配至PFO封堵术联合抗血小板治疗(PFO封堵术组)或单独抗血小板治疗(单独抗血小板治疗组)。在基线和24个月进行脑成像筛查。共同主要终点指标为随机化后24个月无缺血性卒中的临床证据(按照卒中再发患者的比例报告),以及24个月新发脑梗的发病率,是成像筛查的临床缺血性卒中或无症状脑梗的复合。

结果:研究者纳入664例患者(平均年龄,45.2岁),其中81%的患者行中型或大型心房分流术。在中位随访3.2年的时间里,PFO封堵术组441例患者中有6例(1.4%)患者,单独抗血小板治疗组223例患者中有12例(5.4%)患者发生缺血性卒中(风险比,0.23;95%置信区间[CI],0.09~0.62;P=0.002)。与单独抗血小板治疗组相比,PFO封堵术组的新发脑梗发病率较低(22例患者[5.7%] vs 20例患者[11.3%];相对风险,0.51;95% CI,0.29~0.91;P=0.04),但两组之间无症状脑梗的发病率没有显着差异。PFO封堵术组的严重不良事件率为23.1%,单独抗血小板治疗组的严重不良事件率为27.8%(P=0.22)。PFO封堵术组6例(1.4%)患者出现严重医疗设备相关不良事件,PFO封堵术后29例(6.6%)患者出现房颤

结论:在合并PFO的隐源性卒中患者中,PFO封堵术联合抗血小板治疗后的缺血性卒中风险低于单独抗血小板治疗;然而,PFO封堵术与较高的医疗设备并发症和房颤发生率相关。

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    2017-12-10 ycmayy
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    2018-04-02 Boyinsh
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    2018-08-18 haouestc
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    2018-01-09 spoonycyy
  6. [GetPortalCommentsPageByObjectIdResponse(id=1635290, encodeId=887616352903d, content=<a href='/topic/show?id=42ce985294b' target=_blank style='color:#2F92EE;'>#隐源性卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98529, encryptionId=42ce985294b, topicName=隐源性卒中)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=33a222440448, createdName=新生儿张玉军, createdTime=Sun Oct 29 09:05:00 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2060981, encodeId=17f3206098131, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Sun Dec 10 15:05:00 CST 2017, time=2017-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924750, encodeId=612c1924e5081, content=<a href='/topic/show?id=f9dc1412453' target=_blank style='color:#2F92EE;'>#PFO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14124, encryptionId=f9dc1412453, topicName=PFO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=726030, createdName=Boyinsh, createdTime=Mon Apr 02 02:05:00 CST 2018, time=2018-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1785493, encodeId=71171e85493bf, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Sat Aug 18 11:05:00 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081410, encodeId=01de2081410e1, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Tue Jan 09 07:05:00 CST 2018, time=2018-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1608116, encodeId=dd9c16081165c, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Wed Oct 18 05:05:00 CST 2017, time=2017-10-18, status=1, ipAttribution=)]
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