抗血小板预处理对急性缺血性脑卒中静脉溶栓后颅内出血风险的影响。
Influence of antiplatelet pre-treatment on the risk of intracranial haemorrhage in acute ischaemic stroke after intravenous thrombolysis.
机构信息
Stroke Unit, Department of Neurosciences, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
出版信息
Eur J Neurol. 2010 Feb;17(2):301-6. doi: 10.1111/j.1468-1331.2009.02843.x. Epub 2009 Nov 12.
BACKGROUND
Pre-treatment with antiplatelet agents (AP) is present amongst 30% of acute stroke patients. Previous studies have shown conflicting results on the effect of these drugs regarding haemorrhagic transformation after thrombolytic therapy. The hypothesis that pre-treatment with AP may increase the risk of cerebral haemorrhage (ICH) after intravenous tissue plasminogen activator (tPA) was assessed.
METHODS
Retrospective study of consecutive prospectively registered patients with acute ischaemic stroke treated with iv tPA (n = 235) in the last 5 years. Baseline characteristics and prior AP therapy were registered on admission. Computed tomography (CT) scan was performed on admission and 24-36 h after tPA. ICH was classified according to the ECASS II criteria into haemorrhagic infarction and parenchymal haematoma (PH). Symptomatic intracerebral haemorrhage (SICH) was defined as a worsening of > or = 4 points in the NIHSS score during the first 36 h in any haemorrhage subtype.
RESULTS
Seventy-two (30.6%) patients were pre-treated with AP (55 aspirin, 14 clopidogrel, 2 aspirin + clopidogrel, 1 triflusal). PH was observed in 33 (14.1%) patients (PH1 13, PH2 12, PHr 8) of whom 16 were symptomatic. Male gender (78.8% vs. 21.2%, P = 0.036), prior AP therapy (54.5% vs. 26.9%, P = 0.001), stroke severity (median NIHSS, 17 vs. 12, P = 0.005) and early CT signs of infarction (12.5% vs. 2.1%, P = 0.004) were associated with PH. The adjusted odds ratios of PH for patients pre-treated with AP therapy was 3.5 (1.5-7.8, P = 0.002) and for SICH 1.9 (0.6-5.9, P = 0.2).
CONCLUSIONS
Pre-treatment with AP is associated with an increased risk of PH after intravenous thrombolysis in patients with acute ischaemic stroke.
背景
30%的急性脑卒中患者在治疗前使用了抗血小板药物（AP）。先前的研究表明，这些药物对溶栓治疗后出血性转化的影响存在矛盾的结果。本研究评估了 AP 预处理可能增加急性缺血性脑卒中患者静脉注射组织型纤溶酶原激活剂（tPA）后发生脑出血（ICH）风险的假设。
方法
回顾性分析了过去 5 年中连续前瞻性登记的 235 例接受 iv tPA 治疗的急性缺血性脑卒中患者。入院时记录基线特征和 AP 治疗情况。入院时和 tPA 后 24-36 小时进行计算机断层扫描（CT）扫描。根据 ECASS II 标准，ICH 分为出血性梗死和脑实质血肿（PH）。症状性颅内出血（SICH）定义为任何出血类型中 NIHSS 评分在 36 小时内增加≥4 分。
结果
72 例（30.6%）患者在治疗前使用了 AP（55 例阿司匹林，14 例氯吡格雷，2 例阿司匹林+氯吡格雷，1 例三氟柳）。33 例（14.1%）患者发生 PH（PH1 13 例，PH2 12 例，PHr 8 例），其中 16 例为症状性。男性（78.8% vs. 21.2%，P=0.036）、AP 治疗史（54.5% vs. 26.9%，P=0.001）、卒中严重程度（中位数 NIHSS，17 分 vs. 12 分，P=0.005）和早期 CT 梗死征象（12.5% vs. 2.1%，P=0.004）与 PH 相关。AP 治疗的患者发生 PH 的调整比值比为 3.5（1.5-7.8，P=0.002），SICH 的比值比为 1.9（0.6-5.9，P=0.2）。
结论
急性缺血性脑卒中患者静脉溶栓前使用 AP 与 PH 风险增加相关。
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