基底动脉闭塞症溶栓后辅助抗凝治疗引起的症状性颅内出血。

Symptomatic intracranial haemorrhage after thrombolysis with adjuvant anticoagulation in basilar artery occlusion.

机构信息

Department of Neurology, University of Helsinki, Helsinki, Finland.

出版信息

Eur J Neurol. 2015 Mar;22(3):493-9. doi: 10.1111/ene.12597. Epub 2014 Dec 5.

DOI:10.1111/ene.12597

PMID:25482105

Abstract

BACKGROUND AND PURPOSE

Our aim was to determine factors associated with symptomatic intracranial haemorrhage (sICH) in basilar artery occlusion patients treated with intravenous thrombolysis (IVT) and adjuvant anticoagulant therapy.

METHODS

A registry of 176 consecutive patients with angiography-proven basilar artery occlusion who received IVT with alteplase and heparin between 1995 to 2013 was assessed. Post-treatment sICH was evaluated with the European Cooperative Acute Stroke Study II criteria. Unfavourable outcome was defined as a modified Rankin Scale score of 3-6 at 3 months.

RESULTS

Twenty-four patients developed sICH (13.6%, sICH+), all of whom had unfavourable outcome and only two (8.3%) sICH+ patients survived. On admission, sICH+ patients more frequently had extensive ischaemic changes defined as posterior circulation Acute Stroke Prognosis Early CT Score (PC-ASPECTS) < 8 (50% vs. 27% in sICH-, P = 0.031) and lower platelet counts (183 vs. 218 E9/l; P = 0.011). They also had higher systolic blood pressure (SBP) (median 160 vs. 147 mmHg, P = 0.034) immediately after IVT. In multivariable regression analysis, lower platelet values [odds ratio (OR) 0.99, 95% confidence interval (CI) 0.97-0.996; P = 0.006], PC-ASPECTS < 8 on admission (OR 3.6, 95% CI 1.3-10.3; P = 0.017) and higher SBP after treatment (OR 1.03, 95% CI 1.01-1.05; P = 0.017) were independently associated with sICH. Ninety per cent of the sICHs occurred within 48 h from IVT/anticoagulation treatment. No differences in activated partial thrompoplastin times prior to or after the treatment were observed between sICH+ and sICH- patients.

CONCLUSIONS

The risk of sICH was largely determined by extension of ischaemic changes on admission computed tomography. Clinically relevantly, also higher post-thrombolytic SBP as described earlier and lower perithrombolytic platelet counts do increase the risk, a finding requiring confirmation in other patient series.

摘要

背景与目的

本研究旨在确定接受静脉溶栓（IVT）和辅助抗凝治疗的基底动脉闭塞患者发生症状性颅内出血（sICH）的相关因素。

方法

评估了 1995 年至 2013 年间接受 IVT 联合阿替普酶和肝素治疗的 176 例经血管造影证实的基底动脉闭塞患者的登记资料。采用欧洲合作急性卒中研究 II 标准评估治疗后 sICH。3 个月时改良 Rankin 量表评分 3-6 分定义为不良预后。

结果

24 例患者发生 sICH（sICH+，13.6%），均预后不良，仅有 2 例（8.3%）sICH+患者存活。入院时，sICH+患者更常出现广泛的缺血性改变，定义为后循环急性卒中预后早期 CT 评分（PC-ASPECTS）<8（50%比 sICH-患者的 27%，P=0.031）和血小板计数较低（183 比 218×109/L；P=0.011）。sICH+患者的收缩压（SBP）也更高（治疗后即刻中位数 160 比 147mmHg，P=0.034）。多变量回归分析显示，血小板值较低（比值比[OR]0.99，95%置信区间[CI]0.97-0.996；P=0.006）、入院时 PC-ASPECTS<8（OR 3.6，95%CI 1.3-10.3；P=0.017）和治疗后 SBP 较高（OR 1.03，95%CI 1.01-1.05；P=0.017）与 sICH 独立相关。90%的 sICH 发生在 IVT/抗凝治疗后 48 小时内。sICH+和 sICH-患者在治疗前后的活化部分凝血活酶时间无差异。