抗血小板治疗史与脑出血结局的关系。
Association Between Previous Use of Antiplatelet Therapy and Intracerebral Hemorrhage Outcomes.
机构信息
From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (N.I.K., F.M.S.); Department of Emergency Medicine (J.N.G.), Department of Neurology (L.H.S.), Massachusetts General Hospital, and Brigham and Women's Hospital Heart and Vascular Center (D.L.B.), Harvard Medical School, Boston; Duke Clinical Research Institute, Durham, NC (M.C., Y.X., R.A.M., E.D.P.); Department of Medicine (E.D.P.), and Department of Neurology (Y.X.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.); Department of Medicine, Stanford University School of Medicine, CA (P.A.H.); Department of Medicine, Ronald-Reagan UCLA Medical Center (G.C.F.); and Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (E.E.S.).
出版信息
Stroke. 2017 Jul;48(7):1810-1817. doi: 10.1161/STROKEAHA.117.016290. Epub 2017 Jun 8.
BACKGROUND AND PURPOSE
Although the use of antiplatelet therapy (APT) is associated with the risk of intracerebral hemorrhage (ICH), there are limited data on prestroke APT and outcomes, particularly among patients on combination APT (CAPT). We hypothesized that the previous use of antiplatelet agents is associated with increased mortality in ICH.
METHODS
We analyzed data of 82 576 patients with ICH who were not on oral anticoagulant therapy from 1574 Get with the Guidelines-Stroke hospitals between October 2012 and March 2016. Patients were categorized as not on APT, on single-APT (SAPT), and CAPT before hospital presentation with ICH. We described baseline characteristics, comorbidities, hospital characteristics and outcomes, overall and stratified by APT use.
RESULTS
Before the diagnosis of ICH, 65.8% patients were not on APT, 29.5% patients were on SAPT, and 4.8% patients were on CAPT. There was an overall modest increased in-hospital mortality in the APT group versus no APT group (24% versus 23%; adjusted odds ratio, 1.05; 95% confidence interval, 1.01-1.10). Although patients on SAPT and CAPT were older and had higher risk profiles in terms of comorbidities, there was no significant difference in the in-hospital mortality among patients on SAPT versus those not on any APT (23% versus 23%; adjusted odds ratio, 1.01; 95% confidence interval, 0.97-1.05). However, in-hospital mortality was higher among those on CAPT versus those not on APT (30% versus 23%; adjusted odds ratio, 1.50; 95% confidence interval, 1.39-1.63).
CONCLUSIONS
Our study suggests that among patients with ICH, previous use of CAPT, but not SAPT, was associated with higher risk for in-hospital mortality.
背景与目的
尽管抗血小板治疗（APT）的使用与颅内出血（ICH）的风险相关，但关于缺血性卒中前 APT 及结果的数据有限，尤其是在联合 APT（CAPT）患者中。我们假设，抗血小板药物的既往使用与 ICH 患者的死亡率增加相关。
方法
我们分析了 2012 年 10 月至 2016 年 3 月期间来自 1574 个 Get with the Guidelines-Stroke 医院的 82576 例未接受口服抗凝治疗的 ICH 患者的数据。患者分为 ICH 入院前未使用 APT、使用单种 APT（SAPT）和 CAPT。我们描述了基线特征、合并症、医院特征和结局，总体上以及按 APT 使用情况进行分层。
结果
在 ICH 诊断之前，65.8%的患者未使用 APT，29.5%的患者使用 SAPT，4.8%的患者使用 CAPT。APT 组与未使用 APT 组的住院死亡率总体上略有增加（24%比 23%；调整后的优势比，1.05；95%置信区间，1.01-1.10）。尽管 SAPT 和 CAPT 组的患者年龄较大且合并症风险较高，但 SAPT 组与未使用任何 APT 组的住院死亡率无显著差异（23%比 23%；调整后的优势比，1.01；95%置信区间，0.97-1.05）。然而，与未使用 APT 的患者相比，使用 CAPT 的患者住院死亡率更高（30%比 23%；调整后的优势比，1.50；95%置信区间，1.39-1.63）。
结论
我们的研究表明，在 ICH 患者中，既往使用 CAPT，而不是 SAPT，与住院死亡率升高相关。
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