直接口服抗凝剂浓度与急性脑卒中及脑卒中结局的关系。
The association between direct oral anticoagulant concentration upon acute stroke and stroke outcome.
机构信息
Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, ZhongShan South Road, Taipei 100, Taipei, Taiwan.
出版信息
Eur J Intern Med. 2023 Jul;113:31-37. doi: 10.1016/j.ejim.2023.03.023. Epub 2023 Mar 27.
BACKGROUND
This study aimed to investigate the association between direct oral anticoagulant (DOAC) concentration upon acute ischemic stroke (IS) or intracranial hemorrhage (ICH) and stroke outcomes.
METHODS
Patients aged ≥20 years treated with DOACs, including dabigatran, rivaroxaban, apixaban, or edoxaban, and developed acute IS or ICH were enrolled to measure DOAC concentration at the time of hospital presentation by using ultrahigh-performance liquid chromatography with tandem mass spectrometry. Ischemic stroke patients was categorized into low (<50 ng/mL) and effective (≥50 ng/mL) groups. The primary outcome was poor functional outcomes at 3 months (modified Rankin Scale scores of 4-6).
RESULTS
A total of 138 patients were enrolled, including 105 IS (76.1%) and 33 ICH patients. In the IS cohort, the average DOAC concentration was 85.7 ± 88.6 ng/mL (low DOAC concentration: 42.9%). Low level group had numerically higher NIHSS (14 versus 9, p = 0.37), significantly poorer functional outcomes at 3 months (odds ratio [OR], 5.08 [1.32, 19.63]), and higher chance of stroke-in-evolution (OR, 6.83 [1.64, 28.41]). In the ICH cohort, the average DOAC concentration was 128.9 ± 111.9 ng/mL. Reversal therapy was administered in 60.6% of patients. Hematoma growth occurred in 35.7% patients. The DOAC concentration was similar across patients with or without reversal therapy, and with or without hematoma growth.
CONCLUSION
Among DOAC users who developed IS, low drug concentrations at hospital presentation predicted poor outcomes.
背景
本研究旨在探讨直接口服抗凝剂（DOAC）在急性缺血性卒中（IS）或颅内出血（ICH）时的浓度与卒中结局之间的关系。
方法
纳入年龄≥20 岁、使用 DOAC（包括达比加群、利伐沙班、阿哌沙班或依度沙班）治疗且发生急性 IS 或 ICH 的患者，通过超高效液相色谱-串联质谱法测定入院时 DOAC 浓度。将缺血性卒中患者分为低浓度（<50ng/mL）和有效浓度（≥50ng/mL）组。主要结局为 3 个月时的不良功能结局（改良 Rankin 量表评分 4-6 分）。
结果
共纳入 138 例患者，其中 105 例为 IS（76.1%），33 例为 ICH 患者。在 IS 队列中，DOAC 平均浓度为 85.7±88.6ng/mL（低浓度组：42.9%）。低浓度组 NIHSS 评分较高（14 分比 9 分，p=0.37），3 个月时功能结局较差（比值比 [OR]，5.08[1.32，19.63]），进展性卒中发生率较高（OR，6.83[1.64，28.41]）。ICH 队列中，DOAC 平均浓度为 128.9±111.9ng/mL。60.6%的患者接受了逆转治疗。35.7%的患者发生血肿扩大。接受或未接受逆转治疗以及发生或未发生血肿扩大的患者 DOAC 浓度相似。
结论
在发生 IS 的 DOAC 使用者中，入院时药物浓度较低预示着预后不良。
Zotero 插件