Khazaal Ossama, Rothstein Aaron, Husain Muhammad R, Broderick Matthew, Cristancho Daniel, Reyes-Esteves Sahily, Khan Farhan, Favilla Christopher G, Messé Steven R, Mullen Michael T
Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States.
Department of Neurology, Camden Clark Medical Center/WVU Medicine, Parkersburg, WV, United States.
Front Neurol. 2021 Sep 20;12:728111. doi: 10.3389/fneur.2021.728111. eCollection 2021.
Dual antiplatelet therapy (DAPT), compared to single antiplatelet therapy (SAPT), lowers the risk of stroke or death early after TIA and minor ischemic stroke. Prior trials excluded moderate to severe strokes, due to a potential increased risk of bleeding. We aimed to compare in-hospital bleeding rates in SAPT and DAPT patients with moderate or severe stroke (defined by NIHSS ≥4). We performed a retrospective cohort study of ischemic stroke over a 2-year period with admission NIHSS ≥4. The primary outcome was symptomatic intracranial hemorrhage (ICH) with any change in NIHSS. Secondary outcomes included systemic bleeding and major bleeding, a composite of serious systemic bleeding and symptomatic ICH. We performed analyses stratified by stroke severity (NIHSS 4-7 vs. 8+) and by preceding use of tPA and/or thrombectomy. Univariate followed by multivariate logistic regression evaluated whether DAPT was independently associated with bleeding. Of 377 patients who met our inclusion criteria, 148 received DAPT (39%). Symptomatic ICH was less common with DAPT compared to SAPT (0.7 vs. 6.4%, < 0.01), as was the composite of major bleeding (2.1 vs. 7.6%, = 0.03). Symptomatic ICH was numerically less frequent in the DAPT group, but not statistically significant, when stratified by stroke severity (NIHSS 4-7: 0 vs. 5.9%, = 0.06; NIHSS 8+: 1.5 vs. 6.6%, = 0.18) and by treatment with tPA and/or thrombectomy (Yes: 2.6 vs. 9.1%, = 0.30; No: 0 vs. 2.9%, = 0.25). DAPT was not associated with major bleeding in either the univariate or the multivariate regression. In this single center cohort, symptomatic ICH and the composite of serious systemic bleeding and symptomatic ICH was rare in patients on DAPT. Relative to single antiplatelet therapy DAPT was not associated with an increased risk of in-hospital bleeding in patients with moderate and severe ischemic stroke.
与单药抗血小板治疗（SAPT）相比，双联抗血小板治疗（DAPT）可降低短暂性脑缺血发作（TIA）和轻度缺血性卒中后早期发生卒中或死亡的风险。既往试验排除了中重度卒中患者，因为出血风险可能增加。我们旨在比较中度或重度卒中（由美国国立卫生研究院卒中量表[NIHSS]≥4定义）患者中接受SAPT和DAPT治疗的住院期间出血率。我们对入院时NIHSS≥4的缺血性卒中患者进行了一项为期2年的回顾性队列研究。主要结局是伴有NIHSS任何变化的有症状颅内出血（ICH）。次要结局包括全身性出血和大出血，大出血定义为严重全身性出血和有症状ICH的复合情况。我们按卒中严重程度（NIHSS 4 - 7与8+）以及是否先前使用过组织型纤溶酶原激活剂（tPA）和/或血栓切除术进行分层分析。先进行单因素分析，然后进行多因素逻辑回归分析，以评估DAPT是否与出血独立相关。在符合我们纳入标准的377例患者中，148例接受了DAPT（39%）。与SAPT相比，DAPT治疗的有症状ICH较少见（0.7%对6.4%，P<0.01），大出血的复合情况也是如此（2.1%对7.6%，P = 0.03）。按卒中严重程度分层（NIHSS 4 - 7：0对5.9%，P = 0.06；NIHSS 8+：1.5%对6.6%，P = 0.18）以及按是否接受tPA和/或血栓切除术治疗分层（是：2.6%对9.1%，P = 0.30；否：0对2.9%，P = 0.25）时，DAPT组中有症状ICH在数值上较少见，但差异无统计学意义。在单因素或多因素回归分析中，DAPT均与大出血无关。在这个单中心队列中，接受DAPT治疗的患者中，有症状ICH以及严重全身性出血和有症状ICH的复合情况很少见。相对于单药抗血小板治疗，DAPT与中度和重度缺血性卒中患者的住院出血风险增加无关。
