Muscari Antonio, Bartoli Elena, Faccioli Luca, Franchi Elena, Pastore Trossello Marco, Puddu Giovanni M, Spinardi Luca, Zoli Marco
Stroke Unit - Medical Department of Continuity of Care and Disability, S.Orsola-Malpighi Hospital, Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Neurol Sci. 2020 Sep;41(9):2485-2494. doi: 10.1007/s10072-020-04354-0. Epub 2020 Mar 24.
Subcutaneous heparin at a prophylactic dose (SHPD) is a rather common treatment in ischemic stroke, but whether it confers an increased risk of hemorrhagic transformation of cerebral infarct (HT) and whether its reduction or discontinuation favors HT regression are presently poorly understood.
Two samples of ischemic stroke patients with a cerebral lesion diameter ≥ 3 cm on brain CT scan, admitted over 7 years to our stroke unit, were retrospectively examined: (1) patients treated or not treated with SHPD (enoxaparin 4000 U/day), with subsequent assessment of possible HT appearance (N = 267, mean age 75.9 ± 12.8 years) and (2) patients treated with SHPD, with HT and subsequent reduction/discontinuation or maintenance of the initial dose, and subsequent assessment of HT evolution (N = 116, mean age 75.7 ± 11.1 years). HT severity was quantified according to the ECASS study (HT score).
In the first sample, after adjustment for age, sex, stroke severity, cerebral lesion diameter, and other possible confounders, SHPD was inversely associated with HT appearance (hazard ratio 0.62, 95% CI 0.39-0.98, P = 0.04). In the second sample, after adjustment for age, sex, stroke severity, cerebral lesion diameter, and initial HT severity, SHPD reduction/discontinuation had an inverse effect on both HT score improvement (odds ratio 0.42, 95% CI 0.18-0.99, P = 0.049) and HT improvement according to neuroradiological reports (odds ratio 0.34, 95% CI 0.14-0.82, P = 0.015).
This retrospective study suggests that SHPD may play a protective role in HT appearance and evolution, which requires verification by a randomized clinical trial.
预防性剂量的皮下肝素（SHPD）是缺血性卒中相当常见的一种治疗方法，但目前对于其是否会增加脑梗死出血性转化（HT）的风险，以及减少或停用SHPD是否有利于HT消退，人们了解甚少。
回顾性研究了7年期间入住我们卒中单元的脑CT扫描显示脑损伤直径≥3 cm的缺血性卒中患者的两个样本：（1）接受或未接受SHPD（依诺肝素4000 U/天）治疗的患者，随后评估可能出现的HT情况（N = 267，平均年龄75.9±12.8岁），以及（2）接受SHPD治疗、出现HT且随后减少/停用或维持初始剂量的患者，随后评估HT的演变情况（N = 116，平均年龄7岁）。5.7±11.1岁）。根据ECASS研究（HT评分）对HT严重程度进行量化。
在第一个样本中，在对年龄、性别、卒中严重程度、脑损伤直径和其他可能的混杂因素进行调整后，SHPD与HT出现呈负相关（风险比0.62，95% CI 0.39 - 0.98，P = 0.04）。在第二个样本中，在对年龄、性别、卒中严重程度、脑损伤直径和初始HT严重程度进行调整后，SHPD减少/停用对HT评分改善（优势比0.42，95% CI 0.18 - 0.99，P = 0.049）和根据神经放射学报告的HT改善（优势比0.34，95% CI 0.14 - 0.82，P = 0.015）均有反向影响。
这项回顾性研究表明，SHPD可能在HT的出现和演变中起保护作用，这需要通过随机临床试验进行验证。
