Gubitz G, Counsell C, Sandercock P, Signorini D
Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU.
Cochrane Database Syst Rev. 2000(2):CD000024. doi: 10.1002/14651858.CD000024.
Most ischaemic strokes are caused by blood clots blocking an artery in the brain. Clot prevention with anticoagulant therapy could have a significant impact on patient survival, disability and recurrence of stroke.
The objective of this review was to assess the effect of anticoagulant therapy in the early treatment of patients with acute ischaemic stroke.
We searched the Cochrane Stroke Group trials register (most recent search: March 1999) and consulted MedStrategy (1995). We also contacted drug companies.
Randomised trials comparing early anticoagulant therapy (started within two weeks of stroke onset) with control in patients with acute presumed or confirmed ischaemic stroke.
Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.
Twenty-one trials involving 23,427 patients were included. The quality of the trials varied considerably. The anticoagulants tested were standard unfractionated heparin, low-molecular-weight heparins, heparinoids, oral anticoagulants, and thrombin inhibitors. Based on eight trials (22,450 patients) there was no evidence that anticoagulant therapy reduced the odds of death from all causes (odds ratio 1.05, 95% confidence intervals 0.98-1.12). Similarly, based on five trials (21, 846 patients), there was no evidence that anticoagulants reduced the odds of being dead or dependent at the end of follow-up (odds ratio 0.99, 95% confidence intervals 0.94-1.05). Although anticoagulant therapy was associated with about 9 fewer recurrent ischaemic strokes per 1000 patients treated, it was also associated with a similar sized 9 per 1000 increase in symptomatic intracranial haemorrhages. Similarly, anticoagulants avoided about 4 pulmonary emboli per 1000, but this benefit was offset by an extra 9 major extracranial haemorrhages per 1000. Sensitivity analyses did not identify a particular type of anticoagulant regimen or patient characteristic associated with net benefit.
REVIEWER'S CONCLUSIONS: Immediate anticoagulant therapy in patients with acute ischaemic stroke is not associated with net short- or long-term benefit. The data from this review do not support the routine use of any type of anticoagulant in acute ischaemic stroke.
大多数缺血性中风是由血凝块阻塞脑部动脉所致。采用抗凝治疗预防血凝块可能对患者的生存率、残疾情况及中风复发产生重大影响。
本综述的目的是评估抗凝治疗在急性缺血性中风患者早期治疗中的效果。
我们检索了Cochrane中风小组试验注册库（最近一次检索时间为1999年3月）并咨询了MedStrategy（1995年）。我们还联系了制药公司。
将急性疑似或确诊缺血性中风患者中早期抗凝治疗（中风发作两周内开始）与对照组进行比较的随机试验。
两名评价员独立选择纳入试验、评估试验质量并提取数据。
纳入了21项试验，涉及23427名患者。试验质量差异很大。所测试的抗凝剂有标准普通肝素、低分子肝素、类肝素、口服抗凝剂和凝血酶抑制剂。基于8项试验（22450名患者），没有证据表明抗凝治疗能降低各种原因导致的死亡几率（优势比1.05，95%置信区间0.98 - 1.12）。同样，基于5项试验（21846名患者），没有证据表明抗凝剂能降低随访结束时死亡或依赖的几率（优势比0.99，95%置信区间0.94 - 1.05）。尽管每1000名接受治疗的患者中，抗凝治疗可使缺血性中风复发减少约9例，但每1000名患者中症状性颅内出血也会增加类似的9例。同样，抗凝剂每1000名患者可避免约4例肺栓塞，但每1000名患者会额外增加9例严重颅外出血，从而抵消了这一益处。敏感性分析未发现与净获益相关的特定类型抗凝方案或患者特征。
急性缺血性中风患者立即进行抗凝治疗并无短期或长期净获益。本综述的数据不支持在急性缺血性中风中常规使用任何类型的抗凝剂。
