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中国脑出血后低剂量抗血小板治疗调查:一项回顾性基于医院的研究。

Low-dose antiplatelet therapy survey after intracerebral hemorrhage in China: a retrospective hospital-based study.

机构信息

Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Beijing, 100043, China.

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Beijing, 100043, China.

出版信息

Neurosurg Rev. 2021 Oct;44(5):2923-2931. doi: 10.1007/s10143-021-01483-8. Epub 2021 Jan 27.

Abstract

Restarting of antiplatelet therapy (AT) for patients with a history of intracerebral hemorrhage (ICH) is still a clinical dilemma in China. We aimed to investigate the association between low-dose AT and the long-term clinical outcome in Chinese ICH patients. A total of 312 patients with a history of ICH were retrospectively enrolled and followed. The ischemic vascular events, recurrent ICH, and all-cause death were reviewed retrospectively. We explored the predictors of ischemic vascular events and recurrent ICH from all patients using Cox proportional hazard regression model. One hundred fifty-one (48.4%) patients were treated with low-dose AT, and the median duration of follow-up was 4.0 years (interquartile range, 2.5-5 years). Compared to 30 (19.8%) of 151 participants who restarted low-dose AT had ischemic vascular events, 51 (31.7%) of 161 participants who did not receive AT showed ischemic vascular events (p=0.025). Eighteen (11.9%) of 151 participants treated with low-dose AT had recurrent ICH and 21 (13.0%) of 161 in non-AT participants (p=0.830). Cox regression analysis also showed that diabetes mellitus was an independent risk factor for ischemic vascular events (p=0.029). Uncontrolled blood pressure (BP) was independently associated with the risk for both ischemic vascular events (p=0.025) and recurrent ICH (p=0.001). Atrial fibrillation (AF) was an independent risk factor for recurrent ICH among patients with a history of ICH (p=0.018). In a Chinese population of patients with predominantly deep, mild to moderate severity ICH, restarting of low-dose AT at a median of 6.2 months was associated with a lower risk of ischemic vascular events without increased risk of recurrent ICH.

摘要

在中国,对于有脑出血(ICH)病史的患者,重新开始抗血小板治疗(AT)仍然是一个临床难题。我们旨在研究低剂量 AT 与中国 ICH 患者长期临床结局的关系。共回顾性纳入 312 例 ICH 病史患者并进行随访。回顾性审查缺血性血管事件、ICH 再发和全因死亡情况。我们使用 Cox 比例风险回归模型从所有患者中探索缺血性血管事件和 ICH 再发的预测因素。151 例(48.4%)患者接受低剂量 AT 治疗,中位随访时间为 4.0 年(四分位间距,2.5-5 年)。与未重启低剂量 AT 的 30 例(19.8%)参与者相比,重启低剂量 AT 的 151 例参与者中有 30 例(19.8%)发生缺血性血管事件(p=0.025)。在接受低剂量 AT 治疗的 151 例参与者中,有 18 例(11.9%)发生 ICH 再发,在未接受 AT 治疗的 161 例参与者中,有 21 例(13.0%)发生 ICH 再发(p=0.830)。Cox 回归分析还显示,糖尿病是缺血性血管事件的独立危险因素(p=0.029)。未控制的血压(BP)与缺血性血管事件(p=0.025)和 ICH 再发(p=0.001)的风险均独立相关。AF 是 ICH 病史患者 ICH 再发的独立危险因素(p=0.018)。在以深部、轻度至中度 ICH 为主的中国人群中,在中位时间为 6.2 个月时重启低剂量 AT 与缺血性血管事件风险降低相关,而不会增加 ICH 再发风险。

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