Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina; Department of Psychology, University of South Carolina.
Department of Neurology and Allegheny General Hospital Comprehensive Stroke Center, University of South Carolina.
Thromb Res. 2015 Feb;135(2):249-54. doi: 10.1016/j.thromres.2014.11.041. Epub 2014 Dec 13.
Unfractionated heparin (UFH), low molecular weight heparin or fondaparinux are recommended for venous thromboembolism (VTE) prophylaxis in acutely ill medical patients. There are limited data on the safety of fondaparinux for VTE prophylaxis in ischemic stroke. We examined adverse event frequency in hospitalized patients with ischemic stroke who received VTE prophylaxis with fondaparinux versus UFH.
We performed a propensity score matched analysis on a retrospective cohort of 644 consecutive patients with acute ischemic stroke receiving fondaparinux (n=322) or UFH (n=322) for VTE prophylaxis. Patients who received intravenous tPA and continuous intravenous infusions of UFH were excluded. The primary outcome was major hemorrhage (intracranial or extracranial) and the secondary outcome was total hemorrhage (major and minor hemorrhage) during hospitalization. We also examined the rate of symptomatic VTE.
Mean age of the matched cohort was 71.3±14.1 years, median NIHSS score was 4 (IQR 1-11), median duration of anticoagulant exposure was 5 (IQR 3-8) days, and 98.1% received antiplatelet medications. In the matched cohort, there were less observed major hemorrhages in the fondaparinux group 1.2% (4/322) compared to UFH 3.7% (12/322), but this difference was not significant (OR=0.33, 95% CI 0.08-1.10, p=0.08). There were also no significant differences in total hemorrhage (p=0.15), intracranial hemorrhage (p=0.48), major extracranial hemorrhage (p=0.18) and symptomatic VTE (p=1.00) between the groups.
Fondaparinux is not associated with increased hemorrhagic complications compared with UFH in patients with ischemic stroke. There were low rates of symptomatic VTE in both groups.
在急性重病患者中，推荐使用未分级肝素（UFH）、低分子肝素或磺达肝素钠进行静脉血栓栓塞症（VTE）预防。磺达肝素钠用于缺血性脑卒中患者 VTE 预防的安全性数据有限。我们研究了接受磺达肝素钠或 UFH 进行 VTE 预防的缺血性脑卒中住院患者的不良事件发生频率。
我们对连续 644 例接受磺达肝素钠（n=322）或 UFH（n=322）进行 VTE 预防的急性缺血性脑卒中患者的回顾性队列进行了倾向评分匹配分析。排除接受静脉内 tPA 和 UFH 连续静脉输注的患者。主要结局为主要出血（颅内或颅外），次要结局为住院期间总出血（主要和次要出血）。我们还检查了症状性 VTE 的发生率。
匹配队列的平均年龄为 71.3±14.1 岁，中位 NIHSS 评分为 4（IQR 1-11），抗凝暴露中位数为 5（IQR 3-8）天，98.1%接受抗血小板药物治疗。在匹配队列中，磺达肝素钠组的观察到的主要出血事件较少，为 1.2%（4/322），而 UFH 组为 3.7%（12/322），但差异无统计学意义（OR=0.33，95%CI 0.08-1.10，p=0.08）。两组间总出血（p=0.15）、颅内出血（p=0.48）、主要外出血（p=0.18）和症状性 VTE（p=1.00）无显著差异。
与 UFH 相比，磺达肝素钠在缺血性脑卒中患者中不会增加出血并发症。两组的症状性 VTE 发生率均较低。
