Department of Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut, USA.
Department of Medicine, AdventHealth, Orlando, Florida, USA,
Cerebrovasc Dis. 2019;48(3-6):157-164. doi: 10.1159/000504214. Epub 2019 Nov 6.
Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is an effective treatment of acute ischemic stroke (AIS). The safety of intravenous rtPA in patients with thrombocytopenia is unclear. This study sought to evaluate the impact of thrombocytopenia on in-hospital outcomes in patients with AIS who received intravenous thrombolysis.
This was a retrospective study using the 2012-2014 National Inpatient Sample (20% stratified sample of US hospitals). The study identified adult patients admitted with AIS who received intravenous rtPA during hospitalization. The identified admissions were stratified into 2 cohorts based on the presence or absence of thrombocytopenia. Multilevel, multivariate regression analysis and propensity matching were performed to evaluate in-hospital mortality, length of stay, and in-hospital complications.
Of 101,527 patients admitted for AIS and received intravenous rtPA from 2012 to 2014, 3,520 (3.47%) had thrombocytopenia. In-hospital mortality was 10.8 vs. 6.9% in patients with and without thrombocytopenia in original data, p < 0.001. In-hospital length of stay was significantly higher in the thrombocytopenia group (5.9 vs. 8.2 days, p < 0.001). The differences were significant in both the multivariate regression model and the propensity score matching model. Patients with thrombocytopenia also had a statistically higher incidence of intracranial hemorrhage, postprocedural bleeding, blood transfusion, tracheotomy, and mechanical ventilation.
Thrombocytopenia is associated with higher in-hospital mortality, longer length of stay, a higher incidence of intracranial hemorrhage, postprocedural bleeding, and mechanical ventilation in stroke patients who received intravenous rtPA.
静脉注射重组组织型纤溶酶原激活剂（rtPA）治疗急性缺血性脑卒中（AIS）有效。患有血小板减少症的患者静脉内使用 rtPA 的安全性尚不清楚。本研究旨在评估 AIS 患者接受静脉溶栓治疗时血小板减少症对住院期间结局的影响。
这是一项回顾性研究，使用了 2012-2014 年国家住院患者样本（美国医院的 20%分层样本）。本研究纳入了因 AIS 入院并在住院期间接受静脉 rtPA 治疗的成年患者。根据是否存在血小板减少症，将确定的入院患者分为 2 个队列。采用多水平、多变量回归分析和倾向评分匹配来评估住院死亡率、住院时间和住院并发症。
在 2012 年至 2014 年期间，因 AIS 入院并接受静脉 rtPA 治疗的 101527 例患者中，有 3520 例（3.47%）患有血小板减少症。原始数据中，有血小板减少症的患者住院死亡率为 10.8%，无血小板减少症的患者为 6.9%，p<0.001。血小板减少症组的住院时间明显较长（5.9 天 vs. 8.2 天，p<0.001）。多变量回归模型和倾向评分匹配模型的结果均显示差异具有统计学意义。血小板减少症患者还存在颅内出血、术后出血、输血、气管切开术和机械通气的发生率更高的情况。
接受静脉 rtPA 治疗的脑卒中患者中，血小板减少症与更高的住院死亡率、更长的住院时间、更高的颅内出血、术后出血和机械通气发生率相关。
