乙酰水杨酸预处理、肝素联合治疗与急性缺血性卒中全身溶栓后早期颅内出血风险
Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke.
作者信息
Schmülling Susanne, Rudolf Jobst, Strotmann-Tack Timm, Grond Martin, Schneweis Susanne, Sobesky Jan, Thiel Alexander, Heiss Wolf-Dieter
机构信息
Department of Neurology, University of Cologne, Cologne, Germany.
出版信息
Cerebrovasc Dis. 2003;16(3):183-90. doi: 10.1159/000071114.
BACKGROUND
The risk of intracerebral hemorrhage in systemic thrombolysis for acute ischemic stroke after acetylsalicylic acid (ASA) pretreatment or with subsequent heparin is controversially discussed.
METHODS
300 consecutive stroke patients were treated with recombinant tissue-type plasminogen activator (rt-PA) in a prospective open study (92 pretreated with ASA, 202 ASA nonusers) with 3 months of follow-up. After thrombolysis, 122 patients received low-dose, 153 patients high-dose heparin.
RESULTS
Logistic regression analysis showed no relationship of hemorrhagic complications within the first 48 h to ASA pretreatment (p = 0.15), or heparin application (p = 0.38), but dependency on stroke severity (NIHSS) at baseline (p = 0.01).
CONCLUSION
ASA pretreatment does not increase the risk of symptomatic bleeding after systemic thrombolysis with rt-PA, even if thrombolysis is followed by anticoagulation.
背景
对于急性缺血性卒中患者，在乙酰水杨酸（ASA）预处理后或随后使用肝素进行全身溶栓时发生脑出血的风险存在争议。
方法
在一项前瞻性开放性研究中，对300例连续的卒中患者使用重组组织型纤溶酶原激活剂（rt-PA）进行治疗（92例患者接受过ASA预处理，202例未使用ASA），随访3个月。溶栓后，122例患者接受低剂量肝素治疗，153例患者接受高剂量肝素治疗。
结果
逻辑回归分析显示，在最初48小时内出血并发症与ASA预处理（p = 0.15）或肝素应用（p = 0.38）无关，但与基线时的卒中严重程度（美国国立卫生研究院卒中量表）相关（p = 0.01）。
结论
即使溶栓后进行抗凝治疗，ASA预处理也不会增加rt-PA全身溶栓后发生症状性出血的风险。
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