Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
BMJ Open. 2022 Apr 19;12(4):e055469. doi: 10.1136/bmjopen-2021-055469.
Aspirin combined with edaravone is more effective than aspirin or edaravone alone in the treatment of ischaemic stroke. Aspirin is defined as a nephrotoxic drug while the renal safety of edaravone is controversial. We aimed to evaluate whether edaravone will increase the nephrotoxicity of aspirin in patients with ischaemic stroke.
A propensity score-matched retrospective cohort study.
A tertiary hospital in China.
Patients with ischaemic stroke were treated with aspirin from February 2007 to May 2018.
Acute kidney injury (AKI, diagnosed by the Acute Kidney Injury Network), decreased estimated glomerular filtration rate (eGFR,>10%), gastrointestinal bleeding and in-hospital adverse outcomes (defined as dying or giving up treatment in our hospital).
We included 3061 patients, and 986 pairs were successfully matched. Of the 986 pairs of patients included, the incidence of AKI between the aspirin group and the combination group showed no significant difference (7.71% vs 6.29%, p=0.217). While the incidence of eGFR decline (24.75% vs 16.94%, p<0.001) was significantly lower in the combination group. The protective effect was significant in patients with baseline eGFR >30 mL/min/1.73 m, especially in eGFR 60-90 mL/min/1.73 m. In patients with different complications, the incidence of AKI showed no significant differences in patients with chronic kidney injury, hypertension, anaemia, age above 75 years, except in patients with cardiovascular disease (OR, 2.82; 95% CI 1.50 to 5.29; p<0.001). However, the incidence of gastrointestinal bleeding (1.22% vs 2.84%, p=0.011) and in-hospital adverse outcomes (3.25% vs 7.00%, p<0.001) were significantly higher in the combination group.
Our study indicated that edaravone in patients with ischaemic stroke didn't increase the nephrotoxicity of aspirin, and even had a protective effect on mild renal deterioration. Nevertheless, there is a need to be cautious when patients are in bad pathophysiological conditions and at high risk of bleeding.
阿司匹林联合依达拉奉治疗缺血性脑卒中比阿司匹林或依达拉奉单独治疗更有效。阿司匹林被定义为肾毒性药物，而依达拉奉的肾脏安全性存在争议。我们旨在评估依达拉奉是否会增加缺血性脑卒中患者的阿司匹林肾毒性。
倾向评分匹配回顾性队列研究。
中国的一家三级医院。
2007 年 2 月至 2018 年 5 月期间，接受阿司匹林治疗的缺血性脑卒中患者。
急性肾损伤（AKI，通过急性肾损伤网络诊断）、估算肾小球滤过率（eGFR）下降（>10%）、胃肠道出血和住院不良结局（在我院死亡或放弃治疗）。
我们纳入了 3061 名患者，成功匹配了 986 对。在纳入的 986 对患者中，阿司匹林组和联合组的 AKI 发生率无显著差异（7.71% vs 6.29%，p=0.217）。然而，联合组的 eGFR 下降发生率（24.75% vs 16.94%，p<0.001）显著降低。在基线 eGFR>30 ml/min/1.73 m 的患者中，这种保护作用更为显著，特别是在 eGFR 为 60-90 ml/min/1.73 m 的患者中。在有不同并发症的患者中，慢性肾脏病、高血压、贫血、年龄>75 岁的患者 AKI 发生率无显著差异，除心血管疾病患者外（OR，2.82；95%CI，1.50 至 5.29；p<0.001）。然而，联合组胃肠道出血（1.22% vs 2.84%，p=0.011）和住院不良结局（3.25% vs 7.00%，p<0.001）的发生率显著升高。
我们的研究表明，依达拉奉在缺血性脑卒中患者中不会增加阿司匹林的肾毒性，甚至对轻度肾功能恶化有保护作用。然而，当患者处于不良病理生理状态和高出血风险时，需要谨慎。
