自发性脑出血后重启抗血小板治疗：功能结局。
Restarting antiplatelet therapy after spontaneous intracerebral hemorrhage: Functional outcomes.
机构信息
From the Departments of Neurological Surgery (C.-J.C., T.J.B.) and Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Neurosurgery (D.D.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (F.D.T.), University of Illinois, Chicago; Department of Neurology (S.K.), University of Miami Miller School of Medicine, FL; and Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati, OH.
出版信息
Neurology. 2018 Jul 3;91(1):e26-e36. doi: 10.1212/WNL.0000000000005742. Epub 2018 May 30.
OBJECTIVE
To compare the functional outcomes and health-related quality of life metrics of restarting vs not restarting antiplatelet therapy (APT) in patients presenting with intracerebral hemorrhage (ICH) in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study.
METHODS
Adult patients aged 18 years and older who were on APT before ICH and were alive at hospital discharge were included. Patients were dichotomized based on whether or not APT was restarted after hospital discharge. The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. Secondary outcomes were excellent outcome (modified Rankin Scale score 0-1), mortality, Barthel Index, and health status (EuroQol-5 dimensions [EQ-5D] and EQ-5D visual analog scale scores) at 90 days.
RESULTS
The APT and no APT cohorts comprised 127 and 732 patients, respectively. Restarting APT was associated with lower rates of good functional outcome (36.5% vs 40.8%; = 0.021) and lower Barthel Index scores at 90 days ( = 0.041). The 2 cohorts were then matched in a 1:1 ratio, and the matched cohorts each comprised 107 patients. No difference in primary outcome was observed between restarting vs not restarting APT (35.5% vs 43.9%; = 0.105). There were also no differences between the secondary outcomes of the 2 cohorts.
CONCLUSION
Restarting APT in patients with ICH of mild to moderate severity after acute hospitalization is not associated with worse functional outcomes or health-related quality of life at 90 days. In patients with significant cardiovascular risk factors who experience an ICH, restarting APT remains the decision of the treating practitioner.
目的
比较 ERICH（颅内出血的种族/民族差异）研究中急诊就诊的颅内出血患者重启与不重启抗血小板治疗（APT）的功能结局和健康相关生活质量指标。
方法
纳入在颅内出血前正在服用 APT 且在出院时存活的年龄在 18 岁及以上的成年患者。根据出院后是否重启 APT，将患者分为两组。主要结局为 90 天时改良 Rankin 量表评分为 0-2。次要结局为 90 天时的优秀结局（改良 Rankin 量表评分 0-1）、死亡率、Barthel 指数和健康状况（欧洲五维健康量表[EQ-5D]和 EQ-5D 视觉模拟量表评分）。
结果
APT 组和非 APT 组分别包括 127 例和 732 例患者。重启 APT 与较低的良好功能结局率相关（36.5% vs. 40.8%；P=0.021）和较低的 90 天 Barthel 指数评分（P=0.041）。然后将这两组以 1:1 的比例进行匹配，每个匹配组包括 107 例患者。在重启与不重启 APT 的主要结局方面，两组之间未观察到差异（35.5% vs. 43.9%；P=0.105）。两组的次要结局也没有差异。
结论
在急性住院后，对于轻至中度严重程度的颅内出血患者，重启 APT 与 90 天时的功能结局或健康相关生活质量无差异。对于有显著心血管危险因素且发生颅内出血的患者，重启 APT 仍然是治疗医生的决定。
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