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Stroke:近期脑梗不应作为静脉溶栓禁忌症

2017-09-25 杨中华 脑血管病及重症文献导读

尽管FDA更新了药品说明书,不再把近期卒中作为静脉tPA溶栓的禁忌症,但是AHA/ASA一直不推荐近期3个月内卒中病史的急性缺血性卒中采取静脉tPA治疗。缺血性卒中复发风险为20%,其中3个月内复发者的比例高达20%。


尽管FDA更新了药品说明书,不再把近期卒中作为静脉tPA溶栓的禁忌症,但是AHA/ASA一直不推荐近期3个月内卒中病史的急性缺血性卒中采取静脉tPA治疗。缺血性卒中复发风险为20%,其中3个月内复发者的比例高达20%。

2017年8月来自美国的Alexander E. Merkler等在Stroke上公布了他们的研究结果,目的在于探讨3个月内缺血性卒中病史者采用静脉溶栓是否增加颅内出血和不良预后的风险。

该研究复习了36599例采用静脉tPA溶栓治疗的急性缺血性卒中患者,其中568例(1.6%)在过去的3个月内发生过缺血性卒中。接受静脉溶栓治疗的患者颅内出血率为4.9%(95% CI,4.7 - 5.1%),死亡率为10.7%(95% CI,10.4 - 11%)。调整各种因素后发现3个月内缺血性卒中与脑内出血风险升高无关(OR,0.9;95% CI,0.6 - 1.4;P = 0.62),但是与死亡和出院时不良预后升高有关。

最终作者认为对于静脉tPA溶栓的急性缺血性卒中患者,近期缺血性卒中与脑内出血风险增加无关,但是与死亡和出院时不良预后升高有关。

原文出处:

Merkler AE, Salehi Omran S, Gialdini G,et al.Safety Outcomes After Thrombolysis for Acute Ischemic Stroke in Patients With Recent Stroke.Stroke. 2017 Aug;48(8):2282-2284. 

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    2018-08-19 fusion
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    2017-09-27 karmond
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