Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain.
Intensive Care Unit, Hospital Universitario Reina Sofia, Córdoba, Spain.
J Neurointerv Surg. 2019 Feb;11(2):147-152. doi: 10.1136/neurintsurg-2018-014163. Epub 2018 Aug 28.
A stent is often necessary for the treatment of stroke. In such cases,it is essential for the patient to have antiplatelet therapy. There are several methods of antiaggregation, such as oral loading doses of aspirin and clopidogrel, intravenous aspirin, or intravenous glycoprotein IIb/IIIa receptor antagonists, such as abciximab. The aim of this study was to evaluate the incidence of symptomatic intracerebral hematoma (sICH) associated with our antiplatelet protocol: intravenous abciximab bolus at half the dose (0125 mg/kg) at the time of the stenting procedure; oral aspirin (150 mg) and clopidogrel (75 mg) daily added the next day after CT shows no significant hematoma.
Retrospective review of our database of endovascular management of large acute vessel occlusion treated with intravenous abciximab between January 2015 and March 2018. Demographics data, material, drugs, and complications were registered. Fisher tests were used to compare the incidence of sICH in the literature where abciximab 0.25 mg/kg plus maintenance doses are often administrated.
Intravenous abciximab was administered to 99 patients. No sICH was observed. According to the European Cooperative Acute Stroke Study Scale, there were 8 cases of hemorrhagic infarction 1, 5 cases of hemorrhagic infarction 2, 4 cases of parenchymal hemorrhage 1, and no cases of parenchymal hemorrhage 2. A comparison between sICH with conventional antiplatelet doses based on the literature showed a statistically significant difference favoring our protocol.
In the endovascular treatment of acute ischemic stroke, a bolus dose of 0125 mg/kg of abciximab with no maintenance doses, followed by 150 mg of aspirin and 75 mg of clopidogrel orally the next day, is safe and effective.
支架常用于治疗中风。在这种情况下，患者需要进行抗血小板治疗。抗血小板聚集的方法有几种，如口服负荷剂量的阿司匹林和氯吡格雷、静脉内给予阿司匹林或静脉内给予糖蛋白 IIb/IIIa 受体拮抗剂，如阿昔单抗。本研究旨在评估我们的抗血小板方案相关的症状性颅内血肿（sICH）发生率：支架置入术时静脉内给予半剂量（0.125mg/kg）的阿昔单抗推注；CT 显示无明显血肿后第二天给予口服阿司匹林（150mg）和氯吡格雷（75mg）。
回顾性分析 2015 年 1 月至 2018 年 3 月期间采用静脉内阿昔单抗治疗的大急性血管闭塞的血管内治疗数据库。记录人口统计学数据、材料、药物和并发症。Fisher 检验用于比较文献中阿昔单抗 0.25mg/kg 加维持剂量的 sICH 发生率。
99 例患者接受了静脉内阿昔单抗治疗。未观察到 sICH。根据欧洲合作急性卒中研究量表，有 8 例出血性梗死 1 型，5 例出血性梗死 2 型，4 例脑实质出血 1 型，无脑实质出血 2 型。与文献中常规抗血小板剂量的 sICH 比较显示，我们的方案具有统计学显著差异。
在急性缺血性卒中的血管内治疗中，给予 0.125mg/kg 的阿昔单抗推注，无维持剂量，随后第二天给予 150mg 阿司匹林和 75mg 氯吡格雷口服，是安全有效的。
