急性基底动脉闭塞患者的溶栓和辅助抗凝治疗。

Thrombolysis and adjunct anticoagulation in patients with acute basilar artery occlusion.

机构信息

Molecular Neurology, Research Program Unit, Biomedicum Helsinki, Department of Clinical Neurosciences, University of Helsinki, Helsinki.

Department of Neurology, Helsinki University Hospital, Helsinki.

出版信息

Eur J Neurol. 2019 Jan;26(1):128-135. doi: 10.1111/ene.13781. Epub 2018 Sep 12.

DOI:10.1111/ene.13781

PMID:30134080

Abstract

BACKGROUND AND PURPOSE

Patients suffering from basilar artery occlusion (BAO) and treated with intravenous thrombolysis are, in some centers, started on adjunct anticoagulation in hyperacute settings. We aimed to assess the outcome of such patients and to compare low-molecular weight heparin (LMWH) and unfractionated heparin (UFH) in this context.

METHODS

We examined 211 patients with angiography-proven BAO treated with intravenous thrombolysis and either adjunct UFH or LMWH. Main outcome variables were rate of symptomatic intracranial hemorrhage (sICH) according to European Cooperative Acute Stroke Study II criteria and modified Rankin Scale (mRS) at 3 months.

RESULTS

The overall rate of sICH was 11.4% and driven by the UFH group (13.3%). None of the LMWH group developed sICH. Recanalization rate did not significantly differ between the LMWH and UFH groups. An additional propensity analysis was made to balance anticoagulation groups regarding baseline characteristics. Propensity analysis showed a significant difference in sICH rate (0.0% vs. 14.8%, P = 0.044) in favor of LMWH. Independent outcome (mRS score 0-2) was achieved in a total of 31.0% and in 44.8% and 29.1% in the LMWH and UFH group, respectively (P = 0.09). Propensity analysis showed a significant difference in the risk of ending up bedridden or dead (mRS score 5-6; 34.5% vs. 63.0%, P = 0.033) in favor of LMWH.

CONCLUSIONS

Our study showed a lower rate of sICH and a shift towards improved outcome in thrombolysed patients with BAO treated with LMWH as compared with UFH.

摘要

背景与目的

一些中心对接受静脉溶栓治疗的基底动脉闭塞（BAO）患者在超急性期开始使用辅助抗凝治疗。我们旨在评估此类患者的结局，并比较低分子肝素（LMWH）和未分级肝素（UFH）在这种情况下的效果。

方法

我们检查了 211 例经血管造影证实的 BAO 患者，这些患者接受了静脉溶栓治疗，并接受了辅助 UFH 或 LMWH 治疗。主要结局变量是根据欧洲合作急性卒中研究 II 标准和改良 Rankin 量表（mRS）评估的症状性颅内出血（sICH）发生率和 3 个月时的 mRS 评分。

结果

总的 sICH 发生率为 11.4%，主要由 UFH 组引起（13.3%）。LMWH 组无一例发生 sICH。LMWH 和 UFH 组的再通率无显著差异。为了平衡抗凝组的基线特征，我们进行了一项倾向分析。倾向分析显示，sICH 发生率（0.0% vs. 14.8%，P=0.044）在 LMWH 组中显著降低。总的独立结局（mRS 评分 0-2）为 31.0%，LMWH 和 UFH 组分别为 44.8%和 29.1%（P=0.09）。倾向分析显示，在 LMWH 组中，最终卧床或死亡（mRS 评分 5-6）的风险显著降低（34.5% vs. 63.0%，P=0.033）。