Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Guangdong Province, Guangzhou, China.
Neurosurg Rev. 2023 Jun 3;46(1):134. doi: 10.1007/s10143-023-02043-y.
Nuisance bleeding (NB) without urgent medical attention is rarely characterized despite its frequent occurrence in patients with cerebral aneurysms undergoing flow diversion (FD) who are maintained on dual antiplatelet therapy (DAPT). This study explored the risk factors for NB. Patients with unruptured cerebral aneurysms who underwent intervention using FD (July 2018 to May 2022) and had follow-up data were enrolled. Patient demographics, clinical characteristics, aneurysm features and follow-up data were analysed. Bleeding complications were classified as NB, internal bleeding and alarming bleeding. NB was characterized by easy bruising, bleeding from small cuts and nonfatal petechiae and ecchymosis. Univariate and multivariate logistic regression analyses were performed to determine risk factors for NB. This study assessed 121 patients. Of these, 52 (43.0%) patients had NB. Compared with the non-bleeding group, the NB group had more females (82.7% vs. 56.5%; p = 0.003), lower smoking rate (7.7% vs. 23.2%; p = 0.027) and smaller aneurysms (6.65 mm [4.60-9.60 mm] vs. 8.82 mm [5.65-15.65 mm]; p = 0.007) and had more patients maintained on ticagrelor-containing DAPT regimen (90.4% vs. 66.7%; p = 0.002). Multivariate logistic regression revealed that ticagrelor-containing DAPT regimen (odds ratio, 3.91; 95% confidence interval, 1.29-11.87; p = 0.016) was associated with NB. These results suggest that NB is a common bleeding complaint in patients on DAPT. In patients undergoing FD, DAPT with ticagrelor was the only independent risk factor for NB.
未引起重视的出血（NB）在接受血流导向治疗（FD）且正在服用双联抗血小板治疗（DAPT）的颅内动脉瘤患者中经常发生，但很少有特征描述。本研究旨在探讨 NB 的相关风险因素。
纳入了 2018 年 7 月至 2022 年 5 月期间因未破裂颅内动脉瘤而行 FD 介入治疗且具有随访数据的患者。分析患者的人口统计学、临床特征、动脉瘤特征和随访数据。将出血并发症分为 NB、内出血和警报性出血。NB 的特征是容易瘀伤、小切口出血、非致命性瘀点和瘀斑。进行了单变量和多变量逻辑回归分析以确定 NB 的风险因素。
本研究共评估了 121 例患者，其中 52 例（43.0%）患者发生 NB。与未出血组相比，NB 组女性比例更高（82.7%比 56.5%；p=0.003）、吸烟率更低（7.7%比 23.2%；p=0.027）、动脉瘤更小（6.65mm[4.60-9.60mm]比 8.82mm[5.65-15.65mm]；p=0.007），且 Ticagrelor 联合 DAPT 方案的维持率更高（90.4%比 66.7%；p=0.002）。多变量逻辑回归显示，Ticagrelor 联合 DAPT 方案（比值比，3.91；95%置信区间，1.29-11.87；p=0.016）与 NB 相关。这些结果表明，NB 是 DAPT 患者常见的出血主诉。在接受 FD 的患者中，DAPT 联合 Ticagrelor 是 NB 的唯一独立危险因素。
