Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Neurol Neurosurg Psychiatry. 2012 May;83(5):537-40. doi: 10.1136/jnnp-2011-301794. Epub 2012 Feb 29.
It is uncertain whether thrombolytic therapy is safe in patients with acute ischaemic stroke who are treated with warfarin and have a subtherapeutic international normalised ratio (INR) at stroke onset.
The authors performed a systematic review of the literature and included studies that assessed the relation between prior warfarin use with subtherapeutic INR and outcome after intravenous or intra-arterial thrombolytic therapy in acute ischaemic stroke. Outcome measures were symptomatic intracranial haemorrhage (SICH), modified Rankin scale score 0-2 and mortality. Second, the authors performed a meta-analysis of the included studies.
Seven studies with 3631 patients were included. 240 (6.6%) patients used warfarin before stroke onset. The risk of SICH was increased in the warfarin group (OR 2.6; 95% CI 1.1 to 5.9. p=0.02). There was no significant difference, however, in functional outcome (OR 0.9; 95% CI 0.6 to 1.2, p=0.32) or death from all causes (OR 1.2; 95% CI 0.9 to 1.8).
The risk of SICH after thrombolytic therapy is increased in patients using warfarin with subtherapeutic INR levels. The authors found no evidence of an increase in death from all causes or worsening of functional outcome in warfarin treated patients.
对于在卒中发作时正在接受华法林治疗且国际标准化比值（INR）处于亚治疗范围的急性缺血性卒中患者，溶栓治疗是否安全尚不确定。
作者系统地检索了文献，并纳入了评估卒中前使用华法林与 INR 亚治疗水平与急性缺血性卒中患者静脉或动脉内溶栓治疗后结局之间关系的研究。结局指标为症状性颅内出血（SICH）、改良 Rankin 量表评分 0-2 分和死亡率。其次，作者对纳入的研究进行了荟萃分析。
共纳入 7 项包含 3631 例患者的研究。240（6.6%）例患者在卒中发作前使用华法林。华法林组 SICH 的风险增加（OR 2.6；95% CI 1.1 至 5.9；p=0.02）。然而，两组在功能结局（OR 0.9；95% CI 0.6 至 1.2；p=0.32）或全因死亡率（OR 1.2；95% CI 0.9 至 1.8）方面无显著差异。
在 INR 水平处于亚治疗范围的使用华法林的患者中，溶栓治疗后 SICH 的风险增加。作者未发现华法林治疗患者的全因死亡率增加或功能结局恶化的证据。
