Department of Neurology Dongyang Affiliated Hospital of Wenzhou Medical University Dongyang China.
Department of Neurology The Second Affiliated Hospital of Zhejiang University School of Medicine Hangzhou China.
J Am Heart Assoc. 2024 Aug 20;13(16):e032327. doi: 10.1161/JAHA.123.032327. Epub 2024 Aug 9.
There is scant evidence regarding the safety of antiplatelet therapy in acute ischemic stroke (AIS) patients with thrombocytopenia. Our study aims to address this concern by examining AIS patients with thrombocytopenia from a large database in real-world settings.
We included patients with AIS with a platelet count <100×10/L who had complete records of antiplatelet drug use. Those requiring anticoagulation or having contraindications to antiplatelet therapy were excluded. Short-term safety outcomes were in-hospital bleeding events, while the long-term safety outcome was 1-year all-cause mortality. A good clinical outcome was defined as functional independence, indicated by a modified Rankin Scale score of 0 to 2 at discharge. Propensity score matched analyses were used. We screened 169 423 patients with AIS from 90 stroke centers in the CASE II register, ultimately enrolling 2808 noncardioembolic patients with thrombocytopenia. In the propensity score matched analyses, no significant difference was observed between the antiplatelet and nonantiplatelet groups in terms of intracranial hemorrhage (odds ratio=0.855 [95% CI, 0.284-5.478]; =0.160) or gastrointestinal bleeding (odds ratio=2.034 [95% CI, 0.755-5.478]; =0.160). Antiplatelet therapy was associated with improved functional outcomes at discharge (odds ratio=1.405 [95% CI, 1.028-1.920]; =0.033), and showed a trend towards reducing 1-year mortality (odds ratio=0.395 [95% CI, 0.152-1.031]; =0.058).
The use of antiplatelet therapy lessened as platelet count decreased in patients with AIS with thrombocytopenia. However, our findings suggest that antiplatelet medications remain safe and effective for this population.
血小板减少症的急性缺血性脑卒中（AIS）患者抗血小板治疗的安全性证据甚少。我们的研究旨在通过检查真实环境中来自大型数据库的 AIS 伴血小板减少症患者来解决这一问题。
我们纳入了血小板计数<100×10/L 且有完整抗血小板药物使用记录的 AIS 患者。排除需要抗凝或有抗血小板治疗禁忌证的患者。短期安全性结局为住院期间出血事件，长期安全性结局为 1 年全因死亡率。良好的临床结局定义为功能独立性，出院时改良 Rankin 量表评分为 0 至 2 分。采用倾向评分匹配分析。我们从 CASE II 登记处的 90 个卒中中心筛选了 169423 例 AIS 患者，最终纳入了 2808 例非心源性栓塞性血小板减少症患者。在倾向评分匹配分析中，抗血小板组和非抗血小板组的颅内出血（比值比=0.855 [95%CI，0.284-5.478]；=0.160）或胃肠道出血（比值比=2.034 [95%CI，0.755-5.478]；=0.160）发生率无显著差异。抗血小板治疗与出院时功能结局改善相关（比值比=1.405 [95%CI，1.028-1.920]；=0.033），并显示出降低 1 年死亡率的趋势（比值比=0.395 [95%CI，0.152-1.031]；=0.058）。
随着 AIS 伴血小板减少症患者血小板计数的降低，抗血小板治疗的应用减少。然而，我们的研究结果表明，抗血小板药物对这一人群仍然是安全有效的。
